4. The following medicinal products are excluded from self-administration: Controlled drugs

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1 Procedure for Adult in-patient Self-administration of Medicines (SAM) Definition Self-administration of medicines may be defined as: suitable patients having responsibility for the storage administration of their medicines with the nurse/midwife the pharmacist acting as educators facilitators of the process. Introduction This procedure aims to promote a stardised efficient scheme for patients to self-administer medicines whilst being an in-patient at the RSCH. With the purpose of providing benefits to patients to the Trust the aims are: To help patients maintain /attain independence confidence when administering their own medication in hospital. To allow suitable patients to take their medication in an environment where expert advice, training supervision are available. To improve patient understing of their medication in terms of its purpose, side effects safe administration. To discover work to resolve problems which arise from medication regimes e.g. poly-pharmacy, non-compliance, awkward administration times. To facilitate successful discharge to reduce readmission rates. Patient selection assessment Patients who have expressed a wish to self-administer their medication themselves or who are identified as being potentially suitable for SAM by the relevant healthcare professional have agreed to do so should be assessed using form in appendix 1 as outlined below: 1. In order to commence on the self-administration scheme, agreement must be reached between the sister/charge nurse/midwife pharmacist with medical staff involvement. 2. Before proceeding further with the full self-administration process: all medicines must be assessed for their suitability for use following guidance set out in Procedure for using Patients own Drugs (POD). This can be found on G:\ shared\trustwide\pharmacy. drugs will be removed from the locker if not prescribed or deemed unsuitable for use All regular medicines prescribed on the chart must be present correct in the locker in order for the patient to be considered for SAM 3. The following groups of drugs may be self-administered provided they do not meet the exclusion criteria (point 4) Insulin Parkinson s disease medication Topical preparations Eye, Ear or Nose preparations Inhalers All oral medication Other (specify on form - appendix 1) 4. The following medicinal products are excluded from self-administration: Controlled drugs Self administration of medicines procedure Version: 4 Supersedes: 3 Page 1 of 9

2 Intravenous or intramuscular injections However, a patient receiving one or more of these medicines, could selfadminister the remainder of their treatment if appropriate. 5. The nurse/midwife is the best person to identify assess suitable patients through observation during the day should ideally be the person carrying out the initial assessment using form in appendix The medication regime should be rationalised (simplified) by the doctor pharmacist where possible. 7. Patients considered suitable by the team for self-administration will be given an information sheet (Appendix 2). 8. If the patient agrees to participate in the scheme they will be asked to sign consent Form (Appendix 3). This form should be attached to the drug chart. 9. Before self-administration begins, the pharmacist/medicine Management technician (MMT)/nurse/midwife will educate the patient about their medicines in terms of their purpose, dosage, timing side effects explain the aims of the programme. Additionally, the pharmacist/mmt will obtain any compliance aid that the patient may require, such as plain bottle tops, large print labels or medication compliance chart (Pink Card or equivalent). Levels of Self-Administration 10. The patient will be assessed by a nurse/midwife/doctor/pharmacist using form in appendix 1to establish the patient s understing of their medication to determine specific needs. This assessment form will be used to assign the patient to their starting SAM level. The word SAM level number will be written on the front of the drug chart at the top left h side. 11. The registered nurse/midwife/doctor/pharmacist will document in the medical notes that the patient is willing to participate in a self-administration scheme at what level they are self-administering. It must also be stated in the notes whether the patient is administering all of their medication or not. If not, a list of those medicines they are self-administering must be documented in the notes (categories such as inhalers, insulin, Parkinson s disease medications can be used provided that the patient will be self-administering all of those medicines prescribed to them within that category). Level 1 Not suitable for SAM 12. Medication will be administered recorded by the nurse/midwife as per the Trust s medicines management policy. Level 2 Patient self-administers with nurse/midwife supervision 13. Patients participating at level 2 will be given the key fob/key to their POD locker at each medicine round. If patient unable to open POD locker then the nurse/midwife can assist. 14. Under the supervision of the registered nurse/midwife, the patient will select the correct medication dose. 15. The registered nurse/midwife ensures that the patient is taking the medication in line with the given instructions. 16. The registered nurse/midwife supervising administration will sign the prescription chart for each medication administered in the usual way the letter A (assisted) endorsed. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 2 of 9

3 Level 3 Patient self-administers independently 17. As part of this process the pharmacist/nurse/midwife will ensure the patient understs: Which medicines should be taken, at what doses at what times in accordance with the administration sheet (point 21) The purpose of each medicine Any special additional instruction (e.g. swallow whole, with food) The common possible side effects. 18. Patients participating at level 3 will be responsible for the locker key fob/key. 19. The patient is fully responsible for looking after administering his or her own medicines. 20. The patient will be responsible for endorsing the drug administration sheet (appendix 1) after each dose of each medicine administered. 21. At the 10pm drug round the nurse/midwife will confirm doses taken for each medicine with the patient will reconcile this information with the drug administration sheet. The drug chart will then be endorsed self by the nurse/midwife. 22. If insulin is self-administered, the patient is also responsible for regularly monitoring their own blood glucose levels notifying the nurse/midwife immediately of any concerns. In addition, they must be responsible for the safe disposal of sharps. The patient must be provided with their own bedside sharps disposal bin. Insulin is dispensed for individual patients for storage in the bedside locker as with other medicines as it should be stored at room temperature once in use. Continuous Assessment 23. Patients are reviewed daily, if there is a change in the patient s condition that may affect his / her ability to self-administer, or it becomes apparent that patient is not self-administering successfully, the SAM level will be reviewed. The patient may be withdrawn from SAM if necessary. All changes must be clearly documented in the medical notes on the drug chart.the nurse/midwife will inform the pharmacist. 24. If the patient is withdrawn from SAM, cross through the level on the front of the chart initial date. This should also be written in the medical notes appendix 3 form amended. 25. Patient must be re-assessed prior to restarting on SAM documented as outlined in accordance with this procedure. Always refer to form in appendix 1 to identify the patient s level of SAM. 26. Contents of the POD locker should be reviewed regularly by the nurse/midwife/pharmacy team to ensure there are no discrepancies between the medicines prescribed on the chart that the patient is self-administering the locker contents to ensure appropriate sufficient supplies are available. Any discrepancies should be notified to pharmacy staff to rectify. 27. Doctors must inform the patient about changes to their medicines the reasons why should notify the nursing staff or pharmacy staff of any changes. Nursing staff should remove any discontinued medicines notify pharmacy of any addition of new medicines or changes to doses, etc to ensure the medicines in the patient s locker reflect those prescribed on the drug chart. 28. During daily visits to the ward, the pharmacist will continue to monitor the patient s progress ensure any changes to the patient s prescription are explained to the patient. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 3 of 9

4 On discharge 29. The nurse/midwife should ensure that any patient issued with the key/fob to their POD locker returns it before discharge. Security of POD locker medication 30. The patient must only have access to the medication which they have been assessed as competent to self-administer. Medicines not being self-administered, or excess medicines unable to fit in the locker, should be removed from the bedside locker stored in the drugs trolley. 31. For SAM level 3 the patient will be given the fob/key to the medicine locker. 32. Patients must be informed not to leave the POD locker unlocked or the key/fob unattended. 33. The fob/key must be returned to the nurse/midwife in charge before discharge or transfer out of the ward stored securely on the ward. 34. Loss of keys/fobs must be reported immediately to the nurse/midwife who must then notify the pharmacy team complete a Datix web (incident) form. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 4 of 9

5 Appendix 1 SAM ASSESSMENT FORM Patients Name..Date.. To be completed by a trained member of the nursing, pharmacy or medical team Patient information leaflet (App 2) given to the patient: Sign..date... Self administration of: (Please tick relevant medication group) Insulin Parkinson s disease medication Topical preparations Eye, ear or nose preparations Inhalers All oral medication Other(specify) CANNOT BE USED FOR IM/IV INJECTIONS OR CONTROLLED DRUGS Has patient read understood the SAM information leaflet (Appendix 2) PROCEED YES NO - DO NOT Is patient responsible for taking their NO - LEVEL 1 own medication at home? YES Is patient capable enough to self-administer their own medication? NO - LEVEL 1 e.g. not confused or not cognitively impaired YES Is patient capable of complying with the NO LEVEL 1 prescribed medication regime documenting administration as appropriate? YES 3 Is further support or education required NO LEVEL 3 on prescription e.g. new medication, Complete Appendix technique required for use of devices/inhalers? YES LEVEL 2 Complete Appendix 3 Following assessment/supervision NO LEVEL 2 is patient competent to administer the medication? Complete Appendix 3 YES LEVEL 3, Complete Appendix 3 Assessors signature.....date... This must be filed in the patient s medical records in the miscellaneous section Self administration of medicines procedure Version: 4 Supersedes: 3 Page 5 of 9

6 Appendix 2 Patient Drug Administration Record Patient Name.Hospital Number Ward.. Sheet of Once you have taken each of your medicines, you must sign/ initial in the box next to the time for each medicine. You must do this each day. Medication details Time to be taken Week No: date date date date date date date Self administration of medicines procedure Version: 4 Supersedes: 3 Page 6 of 9

7 Appendix 3 Patient information about self-medication What is the Self Administration of Medicines scheme? The scheme enables you to take responsibility for taking some or all of your medicines whilst you are in hospital, just as you do, or will do at home. Insulin * Parkinson s disease medication Topical preparations Eye, Ear or Nose preparations Inhalers All oral medication *If you are self-administering insulin, you are also responsible for regularly monitoring your blood glucose levels notifying the nurse/midwife immediately of any concerns. In addition you must comply with the safe disposal of sharps (needles/syringes) in the sharps container provided. Controlled drugs intramuscular or intravenous intravenous injections are excluded from the self-administration scheme. There are two different levels of supervision: Level 2 nurse/midwife will assist you with the administration Level 3 you will be solely responsible for your own administration What is the purpose of self-administration? It allows you to maintain your independence with regard to administration of your medicines It allows you to become familiar with your medicines form a routine so that you are confident of what you need to take, when you need to take them. We will identify any problems that you may have with your medicines, for example your ability to read labels or open bottles. You will receive more information about your medicines build your self confidence to continue your routine at home. What does self-administration involve? You will be asked some questions by the nursing, midwifery, medical or pharmacy team about your medicines. They will explain to you the stages of the self-administration scheme. On completion of the assessments, you will be asked either to take your medicines under the supervision of the nurse/midwife, or if there are no problems you will be given the key to open your bedside medicine locker to access your own medicines. If required, you will be given a medication information sheet (pink card). This will tell you the name of your medicines when to take them. You will be given information to increase your understing of your medication in terms of its purpose, side effects safe administration. Your nurse, midwife, or a member of the medical/pharmacy team will be available to answer any questions that you might have. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 7 of 9

8 With your agreement where possible, we will use the medicines that you have brought into hospital because they are familiar to you. It will also help to reduce medication wastage. Self-administration of medicines is not compulsory you do not have to take part if you do not wish to. Additionally, you can withdraw from the scheme at any time. Please tell the nurse, midwife, pharmacist or pharmacy technician if: You are having problems taking your medicines You misplace your locker key You are worried or unsure about anything You are a carer, relative or a parent are worried or unsure about anything or have any questions Please do not: Take any medicines that you are unsure about Store anything inside your locker other than your medicines Leave your locker unlocked unattended even for a short time Give your cabinet key to a relative(unless you are the parent of a child), visitor or another patient Discuss the details of your medicines with any other patients Share your medicines with any other patients or visitors Please remember to: Keep your locker key out of sight at all times Give your locker key to a nurse or midwife before you leave the ward It is very important that your medicines are checked before you leave the hospital. This ensures you have all the medicines you need that they are labelled correctly for you to continue safely taking them at home. You may need to wait a short time so that this can be done. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 8 of 9

9 Appendix 4 Patient Consent Form (Level 2 & 3) I have read the Patient Information about Self Administration Form am happy to take part in the Self Administration of Medicines Scheme. I underst what the scheme entails agree to keep my medicines in the designated locked medicine cupboard during my hospital stay. I underst that I may withdraw from the self administration programme at any time if I am not happy by informing my named nurse/midwife. I accept responsibility for safe custody of my own Medicines locker key will return it to my named nurse/midwife before I leave. If I am self-administering insulin, I will follow the Trusts safe disposal of sharps guidance. Level 2 (supervised administration) agreed Level 3 (independent administration) agreed Signed.. (Patient) Date.. Print Name.. Witnessed By...Date.. (Staff) Print Name Designation Ward Name. If level is re-assessed changed please amend level above, re-sign date. This form must be attached to the patient s drug chart. Self administration of medicines procedure Version: 4 Supersedes: 3 Page 9 of 9