MMPR009 LOCAL PROCEDURE FOR PRESCRIBING, DISPENSING AND ADMINISTERING MEDICATIONS IN LEARNING DISABILITY RESPITE CARE

Transcription

1 MMPR009 LOCAL PROCEDURE FOR PRESCRIBING, DISPENSING AND ADMINISTERING MEDICATIONS IN LEARNING DISABILITY RESPITE CARE MMPR009 review May 20 Page 1 of 25

2 Table of Contents Why we need this Policy... 4 What the Policy is trying to do... 4 Which stakeholders have been involved in the creation of this Policy... 4 Any required definitions/explanations... 4 Key duties... 4 Chief Pharmacist... 4 Medical Director... 4 The Medicines Management Committee... 4 Nursing staff... 4 Staff at 82 Northampton Road... 4 All other staff... 5 Procedure for management of medicines within short term break services... 5 Prescription Medication... 5 Medication Profile/ Authorisation of Over the Counter Medicines... 5 Medication Admission Form... 6 Medication Change Form... 7 Discrepancies... 7 Booking medication in and out... 8 Stock control... 8 Disposal of medicines... 8 Changing and obtaining medication during admission... 8 Writing the Medication Administration Record... 9 Administering Medication Checking of administration Recording administration Errors / near misses Training requirements associated with this Policy Mandatory Training Specific Training not covered by Mandatory Training How this Policy will be monitored for compliance and effectiveness Equality considerations Document control details Appendix 1 Authorisation to administer over the counter medication to adults only MMPR009 review May 20 Page 2 of 25

3 Appendix 2 - Medication profile Appendix 3 - Short Breaks Service Medication Admission Form Appendix 4 - Short Breaks Service Medication Discrepancy Form Appendix 5 - Medication Change Recording Sheet Appendix 6 - Short Breaks Service Medication Booking Out Form Appendix 7 Medication Booking in Form (Children s Services) Appendix 8 Client Medication Stock Check Form Appendix 9 Medication Administration Form MMPR009 review May 20 Page 3 of 25

4 Why we need this Policy A safe system of work for administering medications within the short-term care services within the Learning Disability Directorate was introduced in This system was recently reviewed by Short Breaks service and it was agreed that an overarching procedure is required which would include prescribing, dispensing and administrating medication, including the safe systems guidance. What the Policy is trying to do This document sets out the procedures to be followed when prescribing, dispensing and administering medicines within the short breaks service and will be implemented in the directorate s short-term services countywide. Which stakeholders have been involved in the creation of this Policy Medicines Management Committee Any required definitions/explanations NHFT - Northamptonshire Healthcare NHS Foundation Trust Key duties Chief Pharmacist Has overall accountability for the safe and secure handling of medicines Medical Director Is the Board member with responsibility for the safe and secure handling of medicines. The medical Director is responsible for the dissemination of this protocol to their Clinical Director's and Clinical Tutor's for onward dissemination to all medical staff. The Medicines Management Committee Will approve and review this procedure. Nursing staff Are responsible for undertaking medicines reconciliation and dealing with any discrepancies identified on admission dealing with issues relating to medication not being brought in by patients on admission ensuring there is a completed medication profile for each patient writing up and updating the medication administration record Staff at 82 Northampton Road This home does not employ any Qualified Nurses, however in order to meet the aims of this policy, the Home has senior staff that have received additional training to enable them to complete the tasks detailed within. So where the policy states a qualified nurse, it is assumed that at 82 Northampton Road this will relate to a person trained in medication administration or reconciliation. MMPR009 review May 20 Page 4 of 25

5 All other staff Are responsible for following this procedure and only undertaking the tasks detailed if they have been trained to do so and have completed the appropriate medicine related competency. Procedure for management of medicines within short term break services This procedure must be carried out in conjunction with NHFT s Control of Medicines Policy Number MMP001 and Medicines Reconciliation on admission to hospital Policy Number MMpr034. Any confusion or concerns regards the procedure should be notified to the line manager. Staff must also adhere to the principles set out in the Nursing and Midwifery Council's Code of Professional Practice. Prescription Medication Clients medication will be brought in from home on admission. It is an agreed expectation between the unit and informal carers that the medication will arrive with a current pharmacy label and are within the expiry date. If the medication has no dispensing label, it must not be used. Informal carers are also told to inform the unit of any medication changes before admission and to complete a medication change form and provide the unit with a copy of this and the repeat medication list from the GP/doctor. If the medication does not get brought in with the client or is not fit to administer (e.g. medication not clearly identifiable) the registered nurse will carry out the following steps: Contact the parent/carer and ask them to deliver the appropriate form of medication and/or packaging as soon as possible, ideally before the next due dose. If unable to deliver, request unit driver, member of staff, community nurse, on-call nurse or other unit staff to assist in medication being delivered to the unit. AND/OR Contact the service users own GP, explain the situation and ask for an immediate prescription to be available for collection. As a last resort the out of hours surgery can be contacted the situations explained and advice sought. Medication Profile/ Authorisation of Over the Counter Medicines Prior to the first admission a medication profile will be sent to the clients GP, if this is not possible request that a fax is sent from the GP to the unit, detailing a current medication list. List on the medication profile each medication that the client is prescribed, the GP will then sign to state that this is a true account. The profile will be reviewed on a 12 monthly basis or sooner, if the medication is changed. The medication profile should be kept up to date at all times, and all medication changes recorded on it. MMPR009 review May 20 Page 5 of 25

6 The GP will also be asked to complete and sign an over the counter medicines form, this is for adults only. Medication Admission Form A member of staff trained in the administration of medication will book all medication in and out of the unit, using the medication admission form. This is to be done immediately to ensure that any discrepancies are identified as soon as possible. Two staff should always check and sign for medications on admission as an extra safeguard, for example to ensure against mis-counting of tablets. Band 2 staff who are trained in the checking of medication can act as the second checker. N.B. At 1 Willow Close (Adult short breaks) Band 2 staff have no contact with medication and do not act as second checker for medication booking in or administration. The members of staff will count/measure and make a record of the medication on the medication admission form. The following information will be recorded on the medication admission form: Service users name Service users date of birth Name of medication Form Strength Quantity Source of information Check against medication card Check against medication profile Check against pharmacy label Check medication change forms Expiry date Date supply finished Quantity returned Discarded or disposed of. Medication reconciliation must be performed within 24 hours of client admission by a qualified nurse (or staff trained in reconciliation at 82 Northampton Road). If the staff member completing the medication admission form is not a qualified nurse or reconciliation-trained person, and there is a discrepancy, a nurse or similar will need to be contacted as soon as possible. Medication reconciliation should ensure that the medicines prescribed on admission into Short Breaks correspond with the medication that the client was taking prior to admission (at home). If the medication admission form has not been completed by a qualified nurse (or reconciliationtrained staff at 82 N pton Rd), the nurse will need to check all entries and sign in the designated MMPR009 review May 20 Page 6 of 25

7 place on the medication admission form. If the medication has been booked in by a qualified nurse, medications reconciliation has been performed and the form will require signing. It is the responsibility of the person in charge of the shift to check medication is returned with the service user, ensuring that the medication is booked out on the admissions form. NB Medication must never be transferred into any container, other than the one it was dispensed into by the community pharmacist. Medication Change Form Any medication changes occurring since the last discharge whilst the service user is at home will be communicated and a medication change form detailing changes is written and signed by informal carers and accompanies the medication brought in on admission. On occasions some carers may not submit a change form but provide a written signed letter stating changes. On these occasions the qualified staff member or shift leader will complete a medication change form. Discrepancies If there are discrepancies regarding medication the following steps will be taken by a qualified nurse: If the medication s pharmacy label does not match the prescription/administration card. Check the service users file for up to date change in medication profile form, care plan, correspondence or other information e.g. from carers Contact the GP and/or Consultant in the first instance if not available contact the community nurse and ask them to confirm the correct medication, dosage and times to be given, ask for this to be faxed. Always ask for a letter of confirmation. Staff can also check for medications on SystmOne, if used by the GP. NB If no professional contact can be gained Follow the most recent communication regarding medication. For example the dispense date on the pharmacy label, the date the prescription/administration card. It may be necessary to refer to the British National Formula (BNF) or contact the GP surgery out of hours surgery or NHS Direct to clarify a therapeutic dose. When the discrepancy has been resolved Change the prescription/administration card and update the medication profile if required. Complete and place a medication change recording sheet at the back of the prescription /administration card. Communicate to all staff through communication book (this is especially important if the pharmacy labels do not match the prescription / administration card) Record the event and the information in the service users daily notes/systmone notes. MMPR009 review May 20 Page 7 of 25

8 In situations where the medication has been changed the nurse will, at the earliest opportunity, get a list of the change of medication from the G.P. A copy of this list should be kept in the medication folder. PLEASE COMPLETE MONITORING OF DRUG DISCREPANCY FORMS IF ANY PROBLEMS WITH MEDICATION. Booking medication in and out Medication may leave the unit on a daily basis and travel with the client to school or day centres. All medication MUST be booked in and out of the unit. In the case where the client is not being discharged, staff are to complete a Medication booking out form. It will be the responsibility of the shift leader to ensure that the medication is booked back in, when the client returns. Stock control It is the responsibility of all staff that administer medications, to check supplies of medication and to request repeat prescriptions if necessary during a service users stay. The unit will purchase over the counter medication and keep in date stock in the unit to use as and when required. Health Care Assistants are to inform the registered nurse if more medication is required. It is the responsibility of the registered nurse to purchase and request all medications. Home managers are responsible for monitoring and ensuring stock control systems are in place. The medication cupboard is checked weekly as part of the clinical equipment procedure and recorded on the paperwork provided. The unit manager is responsible for monitoring and ensuring the stock control systems are adhered to. Each client s medication to be stock-checked every 24 hours by night staff who are trained in medication administration or checking, using the children s services booking-in form (appendix 7), and complete the stock check form (appendix 8). Staff should check the amount of tablets remaining against the number that should have been used at that time, and report any discrepancies to the shift leader or registered manager. This does not apply to the John Greenwood Shipman Centre. Disposal of medicines Expiry dates of stock, must be checked regularly. Any out-of-date medicines or medicines which are no longer currently prescribed should be taken to the community pharmacy for destruction. In the case that service users own medication has expired, this will be returned to the parent/carer clearly labelled that it is out of date. This must be documented on the client admission form. Ensure all medicines disposed of are first documented on the medication admission form. For individually prescribed medication state the service user s name, the name of the medicine, dose and quantity on the medication admission form. A registered nurse must authorise this procedure. Changing and obtaining medication during admission In exceptional circumstances there may be occasions where the unit needs to request a medication change and/ or prescription during admission. This usually occurs due to the client becoming ill whilst in short-term care or an unexpected shortage of medication. Where a medication change is MMPR009 review May 20 Page 8 of 25

9 made ask the GP to enter this on SystmOne, including the reason. Wherever possible the prescription will be obtained from the service users own GP. When collecting the prescription, and where the service user cannot sign the back of the prescription it will be the responsibility of the member of staff collecting the medication to tick the appropriate section and sign on the service users behalf. The medication will be taken back to the unit as soon as practical and checked against the repeat prescription form or photocopied prescription. Any discrepancies must be addressed with the pharmacist. NB It is recognised that there may be extreme cases whereby neither a photocopy nor repeat prescription is obtainable. This situation should be the exception rather than the norm. On receipt of the medication within the unit it will be recorded on the medication admission form. The medication will then be locked in the appropriate medicine cupboard. For all changes to medication whilst in short term care a medication change form will be completed and the informal carers informed. The registered nurse will: a) Update the Medication Administration Record. If a medicine is stopped it must be crossed off and the cancellation signed and dated. If a dose is changed the direction must be cancelled and the medicine rewritten on a new line with the new dose. Changes must NOT be made without rewriting the whole line. It is good practice for the GP to sign any changes in dose they ask to be made when or if they visit the home. If this is not done the name of the prescriber who gave the new instructions must be recorded. The entry should be signed and dated including the signature of a witness b) Check the medication container and pharmacy labels match the information on the Medication Administration Record. Record the information in the clinical notes. c) Update the Medication Profile, and the electronic administration chart d) Inform all staff via the communication book and any other home communication routes. e) Medicines that are no longer current should be managed as described in the previous section on the disposal of medicines. Writing the Medication Administration Record The Medication Administration Record has been redesigned as a single-use document for the duration of each separate short break see appendix 9. It is held in electronic form at each Home/Unit, and must be initially completed by the appropriate qualified person (i.e. registered nurse or senior staff trained in medication reconciliation). It must be clearly legible using capital letters. Initially, the label on the pharmacy container will be checked against the repeat prescription form or the prescription photocopy. After the initial check the details will be taken from the MMPR009 review May 20 Page 9 of 25

10 pharmacy label on the medication container and documented on the Medication Administration Record. The entry must clearly state: Client information: The patient s name, date of birth, G.P., allergies (including none known) and include any relevant dietary information. It should include a photograph of the client, embedded into the chart. Medication information: Name of medicine, dose, route, frequency and any other specific information relating to the administration of the medicines. Over The Counter Medicines that have not been approved by the GP for the client must be crossed off the Medicine Administration Record. Each section of the record: Must be signed and dated by the person completing it. Must be checked by a member of staff trained in medicines administration. This may be a Health Care Assistant or a Registered Nurse The medication administration record will be checked for accuracy, against the pharmacy label on the container. The staff member will countersign each entry. If at any stage there are concerns around the accuracy of the medication prescribed the community pharmacist or GP surgery should be contacted for advice. Where the client has PRN (as required) medication the informal carer will provide or support the development of a care plan that will direct the use of PRN. This document will be signed by staff and informal carers. Once the electronic administration record has been completed, it may be printed off for use on subsequent short breaks, as long as the following guidelines are followed once the chart is printed for each new admission; Two staff (competent in medication administration) must check the new chart against the last one this is kept in the client s medication folder. Once this check is completed, the old chart may be scanned into SystmOne On admission, check medication as procedure Record any new medication changes on the chart. This should ideally be done by amending the electronic chart and reprinting it. Staff must ensure the old electronic version is deleted, so that the old version is not subsequently reprinted in error for a future admission. If the change is made by hand in using a pen, the person making the changes must ensure that the changes are subsequently made to the electronic chart - this can be done later, but needs to be completed to ensure the chart printed off for the client s next stay is then accurate On discharge, keep the completed chart in the client s medication file, so it can be used for checking against when they are next admitted MMPR009 review May 20 Page 10 of 25

11 Administering Medication Process for administration of medicine Before administration of a medicine, a practitioner must: Read the prescription/authority to administer carefully and check patient's name age and weight if appropriate any allergies and hypersensitivities recorded date the dose is due and time route of administration name of medicine, dose and frequency time of previous dose, if any signature of prescriber Check authorisation of administration (FormsT2 ort3) if the patient is detained under the Mental Health Act Ensure that where an as required medication care plan is in use this is followed Check that the dose has not already been given Check that the prescription has not been discontinued and is legible. Select the appropriate medicine and check: name of medicine strength form expiry date Prepare the correct dose. The practitioner must then check the identity of the patient using the photograph on the administration chart, or patient wristband if in use and administer the medicine. Extreme care is required to ensure that the patient's identity is confirmed by visual recognition and verbal questioning before proceeding to administer the dose. When verbally questioning a patient, the patient should be asked to state their name and their date of birth not given this information and asked to confirm it Obtain the patients consent to the intended administration taking into account Mental Capacity Act, Mental Health Act and drugs used in the treatment of an Emergency. Provide information to the patient about the medication as appropriate Administer the medicine. Patients must be observed to have taken their medicines by the Designated Practitioner. Prepared medicines must not be left unsupervised with the patient unless the patient/carer self-administration procedure is being followed. MMPR009 review May 20 Page 11 of 25

12 In general only scored tablets should be halved. The remaining half should be discarded and not put back in the foil container. Where liquid medications are prescribed in units other than 5ml spoonfuls (e.g. 2.5ml or 7.5ml) the dose should be administered using an oral syringe and NOT a syringe intended for intravenous use. Where medications are administered to patients via either PEG or naso-gastric tubes this is unlicensed use and careful consideration should be given to the following: Use of liquid preparations where possible Which preparations are suitable for crushing prior to administration- where this is not clear contact the drug information department of your local acute trust or pharmacy advisor. For more information contact pharmacy departments Do NOT crush any medication which is coated or modified or sustained release preparation unless confirmed as correct by drug information Enteral feeding tubes should not contain ports that can be connected to intravenous syringes or that have end connectors that can be connected to IV or parenteral lines. The practitioner who has administered or supervised the administration of the medicine must, at the time of administration of each dose, sign with initials in the appropriate column of the official prescription chart and complete CD register if controlled drug has been administered with witness recorded. Checking of administration Except in extreme emergency, in inpatient areas (including Short Breaks) the following must be checked by 2 practitioners: All medicines given by continuous administration, e.g. IV infusion, syringe drivers. There should be a record of the individual practitioner setting up and replenishing each intravenous infusion. All bolus injections and IV additives All injections taken from multi-dose vials. When a patient has shown competence to self-administer the medicine (e.g. insulin) the checking of administration need only involve one practitioner. All medicines administered to a child under 12 years of age. The second check may be undertaken by non-qualified staff if locally approved. It is accepted that in the community setting preparation and administration will be undertaken by a single practitioner except if children are under 12 in which case the Second Check can be completed by a band 2 or 3 Health Care Assistant that has completed the relevant training and clinical competency. However in order to promote best practice, within Short breaks Homes All client medication should be administered with a second checker present, except in exceptional circumstances. MMPR009 review May 20 Page 12 of 25

13 Pump Feeds When administering prescribed feeds via a pump, practitioners and checkers should ensure both the correct amount of feed is present, and also that the pump is set to administer at the prescribed flow rate. Recording administration All medicines administered must be recorded on the Medication Administration Record. Where a variable dose has been prescribed the actual dose administered must be recorded. If a dose is omitted the appropriate code for non-administration must be written in the appropriate section. Any over the counter medications administered are to be recorded in the Medication to be given once only section of the record. Approved Over The Counter Medicines (OCT) may be administered by Registered Nurses or by a health care assistant under the same conditions as PRN medication (see NHFT Control of Medication policy MMP001, SECTION , ) A record will be maintained of all designated staff trained to administer medicines together with their signatures and initials. This will be kept in the clinic and/ or next to the medicine cupboard Errors / near misses For errors and near misses, staff must follow the CRM002 Incident Policy (covering near misses and serious incidents). Also complete the directorate s Medication Administration Discrepancy Form (Appendix Four). Training requirements associated with this Policy Mandatory Training Training required to fulfil this policy will be provided in accordance with the Trust s Training Needs Analysis. Management of training will be in accordance with the Trust s Statutory and Mandatory Training Policy Specific Training not covered by Mandatory Training Ad hoc training sessions based on an individual s training needs as defined within their annual appraisal or job description. All Health care assistants involved in the administration of medication will undertake the appropriate medicines administration competency. How this Policy will be monitored for compliance and effectiveness The table below outlines the Trusts monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs. MMPR009 review May 20 Page 13 of 25

14 Aspect of compliance or effectiveness being monitored Duties Process form management of medicines within Short break service Competency of staff Method of monitoring Individual responsible for the monitoring Monitoring frequency Group or committee who receive the findings or report To be addressed by the monitoring activities below. Audit of Manager in Annual. Medicines records each centre management committee Records of completion of relevant competency assessments and work books Manager in each centre Annual. Medicines management committee Group or committee or individual responsible for completing any actions Medicines management committee Medicines management committee Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed. Equality considerations See MMP001 Control of Medicines Policy. Reference Guide There are no references or bibliography associated with this document MMPR009 review May 20 Page 14 of 25

15 Document control details Author: Approved by and date: Responsible committee: Any other linked Policies: Policy number: MMpr009 Version control: 2 Marie Rendall Home Manager, Short Break Service Medicines Management Committee Medicines Management Committee MMP001 Control of Medicines Policy CRM002 Incident Policy (covering near misses and serious incidents) Version No. Date Ratified/ Amended Date of Implementation Next Review Date Review Reason for Change (eg. full rewrite, amendment to reflect new legislation, updated flowchart, minor amendments, etc.) 2 10/05/ Information updated by Rachael Wye to reflect 1 Willow Close processes with Systmone MMPR009 review May 20 Page 15 of 25

16 Appendix 1 Authorisation to administer over the counter medication to adults only Service user s name DOB.. Drug and Preparation Maalox (Co-magaldrox 195/220) Suspension Glycerin suppositories 4 grams Indication for Administration Dyspepsia Relief or uncomplicated constipation without abdominal pain Dose Contra-Indications Caution Side-effects Advice to Nursing Staff 5-10mls up to 6 times a Avoid debilitated individuals, Occasional diarrhoea or day if required severe abdominal pain, possible constipation in some bowel obstruction or renal One suppository to be inserted into the rectum daily impairment Contra-indications: none known Caution: Diabetics and those at risk of dehydration Dehydration, very rarely, hypoglycaemia, cardiac arrhythmias and hyperosmolar non ketotic coma Moisten with water before use. For rectal use only, do not take by mouth Paracetamol 500mg tablets Mild to moderate pain Adults: Two x 500mg tablets every 4 hours, when required (Max. 4g total in each 24 hours) Hepatic impairment Renal impairment Alcoholism Liver and renal damage only if prolonged use or excess dosing. Rarely side effects at standard dosing Maximum dose 8 tablets in 24 hours. Beware of hidden Paracetamol that patient may have taken in other medicines Simple Linctus GSL Relief of cough 10mls as required Avoid in diabetics. Contains sugar. Will not help a wheezy cough. Senna ( Senokot ) 7.5 mg tablets Relief of uncomplicated constipation without abdominal pain 1 to 4 tablets to be taken at bedtime N.B Any medication on this list will not replace medication routinely prescribed. Authorisation to administer for up to 24 hours? Do not use in intestinal obstruction. Initial dose should be low then gradually increased as required. Prolonged use can cause onset of an atonic non-functioning colon and hypokalaemia Abdominal cramp GP to delete items from this list, if appropriate Acts in 8 to 12 hours therefore usually best given to adults at bedtime to induce an early morning bowel movement. If abdominal pain present CONSULT the doctor G.P signature List agreed (date).. MMPR009 review May 20 Page 16 of 25

17 Appendix 2 - Medication profile NB Include all prescribed and over the counter medicines approved by the service user s G.P. Name DOB. Allergies... Any special requirements e.g. diabetic.. G.P. Signature Date. PHOTOGRAPH Sheet No..of.. Date started Medication: Drug, Strength Timing, Frequency Date stopped/ changed Reason Record completed by (Name) G.P. to complete if possible MMPR009 review May 20 Page 17 of 25

18 Name D.O.B. Sheet No..of.. Date started Medication: Drug, Strength Timing, Frequency Date stopped/ changed Reason Record completed by (Name) G.P. to complete if possible MMPR009 review May 20 Page 18 of 25

19 Appendix 3 - Short Breaks Service Medication Admission Form Client s name Date of Birth Drug Name Form (liquid) Strength Quantity Source of information Expiry date Medication Medication Pharmacy Medication Card Profile Label Change Forms Supply finished Quantity Returned Spilt/expired/ discarded All medication brought in by a patient is their property and must not be taken away or destroyed without their consent. I have identified the medicines and have checked that they are suitable for use on the unit. Booked in by: Name. Signed Designation Date Booked out by Name.... Signed Designation...Date.. MEDICATION RECONCILIATION COMPLTED BY: Name.Signed Designation...Date MMPR009 review May 20 Page 19 of 25

20 Appendix 4 - Short Breaks Service Medication Discrepancy Form Date & Time Client Name How did you deal with the situation? Outcome Datix number Designation & Signature MMPR009 review May 20 Page 20 of 25

21 Appendix 5 - Medication Change Recording Sheet This is to confirm a medication change for: Name: DOB The changes were made by: On Medication Changed from: Medication Dose Time Route Frequency Medication Changed to: Medication Dose Time Route Frequency Special Instructions Have all the medication prescription labels been updated to incorporate the change listed? Yes No How was this information received (by mail, by hand or phone)? Details Parent/Carer Signature Print Staff Name Staff Signature. Print 2 nd Staff Name. +2 nd Staff Signature. MMPR009 review May 20 Page 21 of 25

22 Appendix 6 - Short Breaks Service Medication Booking Out Form Date/Time Client Name Medication Booked Booked in out by by MMPR009 review May 20 Page 22 of 25

23 Appendix 7 Medication Booking in Form (Children s Services) Client s name Date of Birth Drug Name Form (liquid) Strength Quantity Date Source of information Expiry date Medication Card Medication Profile /Systmone Pharmacy Label Medication Change Forms Supply finished Quantity Returned Spilt/ expired/ discarded All medication brought in by a patient is their property and must not be taken away or destroyed without their consent. I have identified the medicines and have checked that they are suitable for use on the unit. Booked in by: Name. Signed Designation Date Booked out by Name.... Signed Designation...Date.. MEDICATION RECONCILIATION COMPLTED BY: Name.Signed Designation...Date MMPR009 review May 20 Page 23 of 25

24 Appendix 8 Client Medication Stock Check Form Please count all medication and check against medication admission form and medication record for any discrepancies. Any discrepancies handover to next shift, complete medication discrepancy form, datix and follow medication policy. Client Name Client DOB Date Comment Sign MMPR009 review May 20 Page 24 of 25

25 Appendix 9 Medication Administration Form Blank Administration Forms are available within each unit. 1Template MASTER blank med chart.xltx Short break Services Adult Learning Disabilities Service Medication Administration Record Patient's Name: Date of Birth: Hospital Number: Sex: Consultant: G.P Unit: Date of Admission: Date Chart Began: Allergies and Special Instructions Special diet (e.g. MAOI, diabetic) Use approved drug names only. Please write all drug names in block capitals. Use 24 hour clock. Write instructions in plain English. Use a fresh line for every new prescription. If prescription is changed, cancel it and re-write it on another line. INSTRUCTIONS Cancellation date: To cancel a prescription, draw a line through the drug namebox, and sign and date the cancellation date. When any part of the chart is full, cancel the whole chart and re-write it. To cancel the chart, draw a line across the whole of this page and enter the date in the cancellation box. Check this card before administering any medication. The prescription might have changed since you last saw it. Ensure you have looked for prescrptions in all sections to avoid omissions. Record each dose as it is given by signing or initialling the appropriate box. If a dose cannot be given as prescribed, enter one of the codes shown inside the box CODES TO BE ENTERED IF DRUG IS NOT GIVEN AS P RESCRIBED 1. Patient is on leave, or off the ward for any othe reason 2. Drug omitted at nurse's discretion (reason should be intered in nursing progress notes) 3. Drug not currently available (e.g. Do not yet have a new prescription, medication out of date) 4. See notes fo rreason why drug could not be given as prescribed. 5. Patient resused to take drug. 6. patient self-medicating. 7. Incomplete or impossible script e.g. Unsigned prescription, or specified dose not available for specified drug). MMPR009 review May 20 Page 25 of 25