Medication Policy. Supporting Service Users to Manage their Medication SH TQ 47. Version: 6. Summary:

Transcription

1 SH TQ 47 Medication Policy Supporting Service Users to Manage their Medication Version: 6 Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: The purpose of this policy is to protect and support service users and the staff in TQ21 and TQ At Home, to manage medication with increasing confidence and understanding, supported and evidenced by appropriate training and demonstration of good practice. Medication, medicines, advice, medication policy, TQ47. All staff that administer medication in TQ21 and TQ At Home. Next Review Date: September 2018 Approved and Ratified by: Medicines Management Committee Date of meeting: 4 th November 2015 Date issued: December 2015 Authors: Sponsor: Carol Cleary, Interim Head of Service, TQ21 Stephen Bleakley, Trust Deputy Chief Pharmacist Dr Lesley Stevens, Medical Director (Quality) December

2 Version Control Change Record Amend. No. Issued Page Subject February 2011 Version 3 All October 2011 Version 4 All Minor changes throughout the document, staff encouraged to re-read the whole policy. Appendix 10 added re Social Re-enablement Team July 2013 Version 5 All Full review with additions and amendments Appendix 6b Competency Assessment Tool added. Nov 2014 Version Addition of appendices 16, 17, 18 Oct 2015 All Full Review with additions and amendments 12/12/17 Review date extended from Dec 17 to Jan 18 1/2/18 Review date extended to March 2018, new policy being developed 4/4/18 Review date extended to May /5/18 Review date extended to June /7/18 Review date extended to July /8/18 Review date extended to August /9/18 Review date extended to September 2018 Reviewers/contributors Name Position Version Reviewed & Date Directorate Management Board v5, June 2013 Medicines Management Committee v5, June 2013 TQ21 Medicines Management Focus Group v5, June 2013 Sarah Baines Head of Nursing & Quality Mental Health & v5, June 2013 Learning Disability Services Paula Hull Head of Nursing and Quality Integrated v5, June 2013 Community Services David Jones Chief Pharmacist v5, June 2013 Louise Hartland Quality and Compliance Manager (LEaD) V6 October 2015 Mental Health Drugs and Trust wide representation V6, October 2015 Therapeutics Forum Medicines Management Trust wide representation V6, November 2015 Committee Sue Mills Interim Chief Pharmacist V6, November 2015 December

3 Contents Page 1. Introduction 4 2. Underpinning Values 4 3. Staff Role in Supporting Service Users 5 4. Determining the Level of Support Required 6 5. Receiving of, Storage, Security, and Disposal of Medication Staff Management of Medicines and Support to Service Users Medication Errors Crushing or cutting medication Supporting service users to manage medicines whilst away from 18 home 10. Training and Competency Conclusion Index of Appendices December

4 Medication Policy Supporting Service Users to Manage their Medication 1 Introduction 1.1 The purpose of this policy is to protect and support service users and the staff in TQ21 and TQ At Home, to manage medication with increasing confidence and understanding, supported and evidenced by appropriate training and demonstration of good practice. 1.2 By following the policy, guidance and procedures within it, and in conjunction with the training and competency assessment, staff in TQ21 and TQ At Home will be able to: Assess how much support a person requires to manage their medication Provide the required support in a competent manner Support service users to store, record and dispose of all medication appropriately Support service users who wish to and are capable of self-administering their medicines to do so safely Administer medicines to service users in a safe way Store, record and dispose of medicines including controlled drugs in line with best practice and the law. 1.3 Adherence to the policy will ensure that support to service users, to manage their medication, is provided in line with best practice, including The Care Quality Commission - Essential Standards of Quality and Safety and the NMC Standards for Medicines Management. 2 Underpinning Values 2.1 Every service user will be supported to determine their ability to manage their medication, with a resulting support plan outlining an agreed level of support to do so Each service user will be offered the choice of managing their medication from a secure facility of their own, for example, a locked drawer/cabinet in their own room. Storage will be risk assessed in accordance with individual need There may be individuals who do not wish to manage their medication. The appropriate level of support they may require will be identified in their support plan Each service user will be supported to manage their medication safely, by staff having received appropriate training and achieved the relevant competencies Each service user will have a medication folder containing a mental capacity assessment pertaining to medication, risk assessments and support plans, medication chart, photograph of themselves, medication record sheet, and an outline of common side effects It is important that we approach the subject of supporting service users to manage their medication, from the point of view that we give them as much control over the process as possible, promoting dignity and respect as part of the process. December

5 3 Staff Role in Supporting Service Users 3.1 The staff role will be to support service users to manage their own medication safely and effectively, promoting dignity and respect at all times. 3.2 The registered manager or support manager will be responsible for ensuring that the guidelines in this policy are adhered to, including: The ordering of medicines The storage of medicines The level of support required for individuals to take their medicine Recording and monitoring of medication received, administered and disposed of The procedure for supporting service users to take their medicines Training, assessing and updating of staff competencies Ensuring that only staff who have received medication training and have been assessed as competent will support service users to manage their medication 3.3 The registered manager or support manager will ensure that the staff team follow the guidelines and procedures in this policy Staff take responsibility for their own actions relating to their role in storage, administration, recording and disposal of medication Staff will be responsible whilst supporting service users, to observe for benefits and side effects of medication, reporting to the relevant prescriber, healthcare professional and manager. 3.4 Support staff will follow the guidelines outlined in each service user s own medication file which will include the following: A photograph of the service user, signed and dated as a true likeness by the registered manager or support manager A completed service user mental capacity assessment, medication management documentation and outcome of the service user s medication A completed support plan to outline the level of support required by the service user Other support plans in relation to all prescribed medication A risk assessment, if required, in relation to medication management A risk assessment detailing management of keys for service users who manage their own medication cabinets The current medicine chart and record sheet A copy of the up to date medication information leaflet provided from the pharmacy or easy read documents (found at A support plan for as required or PRN medication A support plan for homely remedies (see appendix 12A) Details of non-prescribed medication which the service user chooses to take should be included on a risk assessment and support plan. 3.5 At all times, staff will support service users in a manner promoting choice, understanding, dignity and respect. 3.6 Trained Nurses (See Appendix 10) Trained nurses working in TQ21 and TQ At Home services will operate to the guidance and procedures as outlined in this policy. They will undertake the required training and complete the portfolio of competence in line with Trust requirements. They must also operate to the standards set by their own professional body s code of December

6 conduct, performance and ethics. 4 Determining the Level of Support Required 4.1 To ensure that the service user receives the appropriate level of support to manage their medication, an assessment of their understanding of the process is vital and will form the basis of their medication support plan (Appendix 1). The person s mental capacity will also be considered as part of this process. 4.2 Using Appendix 1, the registered manager, support manager, support co-ordinator, will use the assessment and their knowledge and experience to complete a medication support plan, outlining the support a service user requires to manage their medication. This must also involve any cultural or religious considerations that may need to be taken. 4.3 The assessment is to be completed within the first week of the person moving in to their home and will be reassessed annually unless there is evidence of changing health or it is indicated otherwise on their assessment documentation. The assessment and support plan will form part of the service user s medication support file. 4.4 The service user assessment, Appendix 1 will be completed as a direct observation assessment, making the service user aware of the process and noting responses or actions in relation to the key tasks of the assessment. 4.5 Following assessment, the registered manager/ support manager or the support coordinator will complete the Outcome of the Service User Medication Assessment document - also found in Appendix 1. The registered manager/ support manager or support co-ordinator will conclude the service user s level of ability and the key factors that resulted in that decision. 4.6 The manager or support co-ordinator will then complete a support plan to outline the support required to assist the service user to manage their medication. The manager will discuss with the service user the level of support they will receive. Clarity regarding the outcome of the mental capacity assessment will also be included in their support planning documentation. The manager will ensure that the assessments and support plan are detailed in the service user s medication file. The manager will ensure that all staff are aware of the service user s ability to manage their medication, and the support required, if any. If capacity allows, the service user has to agree with the level of support outlined in the support plan. If there is no agreement, then best interest processes must be followed 4.7 The assessment may identify that the person is unable or unwilling to take responsibility for their medicines. This may be due to their learning disability, but can also be due to a physical disability or choice. There are situations where a service user is willing or able to look after some medicines and not others. An example is when a service user keeps an inhaler for immediate use, but prefers the support staff to look after other medication. 4.8 At any point during the assessment, the service user may indicate that they do not want to take responsibility for their medication. They may indicate that they wish to manage some medication, e.g. creams, but not others. This must be carefully detailed in the support plan. 4.9 When the assessments are completed, the support plan is in place, and any risk assessments required are in place, trained support staff can support the service user December

7 to manage their medication following directions in the person s medication file The person s ability to manage their medication may change at any time. Support staff must make their manager aware as soon as possible, to adjust the level of support required for each individual, and to safeguard the service user and others. 5 Receiving of, Storage, Security and Disposal of Service User Medication 5.1 All service users medication must be prescribed by a prescriber (i.e. Registered Medical Practitioner), dispensed by pharmacy and used only for the person named on the prescription or label. 5.2 The registered manager or support manager is responsible for ensuring that a complete record is maintained of all medicines received and disposed of. The details will include: Date of receipt and return to pharmacy Name of service user Name of medication Strength of the medication, if applicable Quantity Signature of person receiving or disposing and signature of the pharmacist or pharmacy representative. 5.3 The registered manager or support manager is also responsible for developing a local procedure for receiving (acquisition) and disposing, including: Contact details of GP Contact details of community pharmacy Checking process for incoming and outgoing medication including guidance on how to deal with any discrepancies Expiry date checks Safe receipt of deliveries Ensuring medication is not left unattended on delivery to the service user. When required (PRN) medication checks Controlled drugs medication checks 5.4 All medication received on behalf of the service user must: a) be in the original pharmacy or doctor dispensed container b) have a label that is printed by the issuing pharmacy or doctor s surgery c) have a label that displays the name, form and strength of the drug d) have a label that shows the full name of the person who it is prescribed for e) have full directions about how the medication should be taken, e.g. one tablet to be taken every morning and not as directed. f) include any changes on the medication labels e.g. dose changes, or change of time that the medication is to be given. This must be checked with the responsible GP and then signed as checked and confirmed correct by an appropriately trained member of support staff. g) include visual checks of compliance aid (i.e. MDS Monitored Dosage System) managed medication. A visual check of all medication must be undertaken to ensure all medication dispensed is correct. In order to complete this, a description of all usual medication received from pharmacy should be available so that the counter checks may be undertaken. December

8 h) ensure that visual checks for compliance aids include counting the number of tablets in each strip and confirming it is as expected. N.B. It is acknowledged that medication received from pharmacy that has already been dispensed into pre dispensed containers where more than one medication has been placed i.e. NOMAD system, staff will not be able to always clearly determine and check that each individual tablet is the correct prescribed medication. In these circumstances, individual risk assessments must be in place to determine the level of risk and if necessary, appropriate action taken. This will be agreed with the relevant manager and dispensing pharmacist. 5.5 Where labels have become defaced, detached or otherwise illegible, the container must be returned to the pharmacy and another supply obtained from the GP or pharmacy. If pharmacies are unwilling to do this, this must be reported to the manager and an incident form completed along with the pharmacy s reason for not undertaking this request. This may then be formally reviewed with the manager and if necessary, an alternative pharmacy found. 5.6 If a service user is living in their own home, and requires support to manage their medication, the medication assessment will indicate what type of storage is required for the medication. 5.7 Service users may be prescribed medication to be stored in a fridge at temperatures between 2 o C to 8 o C. This can be stored in a domestic fridge, using a locked cash box in a plastic container. The fridge temperature must be monitored and recorded daily using a minimum and maximum thermometer. In all registered and supported living houses, Safer Food Better Business is in use and this will have the daily domestic fridge temperature records Advice about the storage of medication in fridges can be sought from the community pharmacist For medicines stable at room temperature, they must be stored away from radiators, hot water pipes, out of direct sunlight and in a room which does not regularly exceed 25 o C. 5.8 Staff must support service users to check expiry dates on their medication. Where this is not possible, i.e. with MDS systems, staff will not be accountable for this part of the process. 5.9 Service users must be encouraged as far as possible, to keep their medication safe and secure, dependent on their circumstances Each service user s assessment and support plan will include storage requirement, access to medicine, and the type of facility used to store medicine, for example, locked facilities, drawers, or locked bedside cabinets The support plan will maximise accessibility for the service user, and include clear procedures about the safety of medication keys ensuring only appropriately trained support staff have access The keys to centralised medication cabinets must be accessible only to staff who have received training in medication administration. If keys are lost or mislaid, it should be reported immediately to the support manager, registered manager or manager on call. A decision will then be made as to whether to formally report this to the police. December

9 Medication for external use, such as creams or lotions should be stored separately from medication to be taken internally, and may be kept in a drawer in the person s bedroom. Appropriate locked facilities will need to be considered if the cream or lotion is for restricted use Diagnostic test kits must be stored safely and separately from medication to be taken internally Throughout the process, service users must be involved as much as they choose to and are able to do Controlled Drugs In registered care homes, if controlled drugs are prescribed for the service user, they must be stored in a metal cupboard fixed to a permanent wall. These must comply with the controlled drug legislation and advice can be obtained from the Trust s chief pharmacist. If a service user can manage their own controlled drugs, this can be managed from their own lockable cabinet In supported living and home care services, a controlled drug cabinet is not required. If a service user is prescribed controlled drugs, they must be managed safely and securely, with a risk assessment outlining how this will be managed and monitored If a service user is to access the community and needs to take controlled drugs with them, this should be undertaken through: Ensuring this is clearly addressed on the relevant support plan Ensuring that the medication is signed for being taken out of the house and returned. This will need to be recorded in a specific book for this purpose. The amount of medication being taken and returned will be recorded and where possible, two staff signatures will be required. If this is not possible, the member of staff who is next on duty must ensure they check the amounts taken out and returned and then countersign to confirm what has been recorded. When out, the controlled drug will be in a secure box (usually a lockable tin) within an unobtrusive bag. The staff will ensure they are familiar and competent in the administration of this medicine when out. This will have been assessed at the time of their medication assessment. If medication is lost when out, staff MUST complete an incident report and inform others accordingly, including the police Disposal of Medication Medication no longer required must be returned to the supplying pharmacy for disposal. Staff are required to keep a record of this returned medicine and where possible, a signature from the pharmacy obtained. It is however understood that not all pharmacies will agree to this In Summary: It is important that we keep full records to show when medication is received from the pharmacy, given to the service user and disposed of. Weekly checks as agreed in this policy and locally must be undertaken to ensure all medication is accounted for. December

10 6 Staff Support to Service Users 6.1 Medication Administration and Recording Using the person s medication file, check the support plan to provide the correct level of support Encourage the service user to wash their hands. Staff must wash their hands before and after administering medication to each service user Staff will either support the service user to undertake the following procedure, or will themselves select the medicine. Deal with one medication and one person at a time and consider how distractions will be avoided during the medication administration process. The RIGHT person Check the name of the person on the medication sheet and medicine label. Check the person against their picture or confirm with a regular member of staff you have the right person. Ask the person their name and date of birth (if possible). Ensure they are not allergic to the medication you are about to give. Before administration, check if they are physically well or have any side effects from pervious medication. If concerned contact the GP for advice before administration. The RIGHT drug - Read the medication sheet fully and check you are administering the correct medication. Check the medication label and each individual blisters in the pack to ensure it is the right medication. Ensure the medication is within the expiry date (include drops and bottles which may have a shorter expiry once opened). The RIGHT time - Check the time of the last medication taken on the medication sheet and medicine label. Are you administering at the correct time? If the administration time has elapsed, do you have a support plan which supports how long after the prescribed time the medication can be safely administered (this will need to be done in conjunction with the GP or pharmacist). Staff are permitted to administer medication up to 1 hour either side of the prescribed time. If the administration is outside 1 hour advice must be sought from the GP or pharmacy to ensure the administration is safe to proceed. Records and a support plan should then be made to confirm the outcome of any advice sought and given. The RIGHT dose - Check the name and strength of the medication against the medication sheet, medicine label and each individual blister strip in the medication pack. The RIGHT route Check the route for administration. Consider additional instructions, e.g. swallow whole, or take with food. Is your training in medicine administration up to date? Has your manager confirmed you are competent to administer via this route? The RIGHT procedure - Select the drug required as prescribed on the medication sheet and administer as per support plan and requirements. And Ensuring The RIGHT documentation ensuring the medication record has been signed. If the medication record is unsigned from the last administration then you will need to December

11 confirm with the previous member of staff if the medication was administered. If not, seek advice from the GP Ensure service users swallow their oral medication and have taken all prescribed medication before signing that they have received their medication When supporting service users with liquid medication, support the service user to: Shake the bottle (if appropriate) Read label to understand dose and directions Place bottle with label facing into hand (to protect label) Loosen the cap Pour away from the label to keep it clean and legible Wipe the bottle before returning to the cupboard Ensure the cap is tight when finished Support the person to return medication to the cupboard and make secure Support the service user to sit or stand to take medication with a glass of water, if they wish. Check the support plan guideline to ensure the service user receives the support required to swallow the medication Prior to administration of the medication, if you have any concerns about the persons' state of health, contact the GP for advice Support the service user to take the medication at the time it is made available. Under no circumstances must medication be left for later When the service user has swallowed the medicine, record the administration of the medication before beginning to support the next service user If a variable dose is written, e.g. one to two tablets, consult the person s support plan; record the exact amount of tablets taken At all times through the process, support the person to take as much responsibility as they can for the administration of their own medication Staff must not amend the information on the medication recording sheet, other than to sign for medication unless in the circumstances outlined below. In Exceptional Circumstances: There may be a need for a person to receive medication that has not been entered onto the prescription / MAR sheet. This may relate to a changed dose of warfarin, insulin or urgently prescribed antibiotics or analgesia. This may also relate to people who access Short Stay Services. If this is required, the following should be undertaken in all circumstances: The information received must be from a GP or qualified nurse practitioner from the General Practice or from a hospital / clinic. All information and instruction received must be fedback to the person instructing the prescription to ensure that accuracy and clarity has been established. Where possible, this verbal instruction must be received by two staff. If this is not possible, then support and instruction must be sought from the immediate manager or Locality on-call manager. December

12 Any changes or new instruction must be noted on the appropriate support plan and amendments made to risk assessments if necessary. Clear reference must be written in the staff communication book (if available) instructing staff to read the service users relevant notes that changes have been made to a person s prescribed medication All amendments then made to the prescription or MARS sheet should be made in clear, capital writing using black ink. Where possible this should be countersigned by a second member of staff Where amendments of this nature have been made, all efforts must be made to receive an updated MAR sheet, prescription card or label from the dispensing pharmacy within the next 72 hours (It is however recognised that this may not be possible in short stay services and in such cases, a detailed support plan will be drawn up to highlight the support needed when a last minute change in medication occurs) 6.2 Medication Used on an As Required Basis (PRN) Should someone require medication on an as required basis or as a variable dose (such as one or two tablets to be taken), this should be clearly detailed on the person s medication chart A support plan should accompany the medication chart, and should list the exact circumstances under which the medication may be administered, and if there is a variable dose what are the factors which would affect the choice of dose. The support plan should identify the signs, symptoms or triggers for the individual and the minimum and maximum doses of medication over a specific period of time When administered, the medication must be recorded on the recording sheet. Staff trained in the administration of medication can give as required medication following the guidelines in a support plan, in the service user s medication file The outcome of all PRN medication given must be recorded on the PRN efficacy monitoring sheet (Appendix 9B) and full evaluation completed in line with the frequency of support plan reviews (maximum interval of three monthly) The registered manager or support manager must ensure that all as required (PRN) support plans and prescriptions are up to date, and reviewed every three months PRN medication that is classified as a benzodiazepine or a controlled drug must be checked as a minimum of weekly intervals as a stock control measure. See Appendix 9A. 6.3 Rectal or Vaginal Preparations, Injections (including insulin), oxygen and medicine administration via PEG, PEJ or NG tube In circumstances where any of the above are prescribed and it in the person s best interest to receive them, the member of staff supporting the service user MUST have received appropriate training and assessment by an appropriately qualified professional. WITHOUT ADDITIONAL TRAINING STAFF MUST NOT ADMINISTER MEDICATION OR PREPARATIONS VIA THESE ROUTES In all cases, a support plan will be developed. Relevant competency documents will need to be completed in all cases and can be accessed if required December

13 6.4 Buccal midazolam and rectal diazepam Please refer to the Southern Health NHS Foundation Trust s Policy Guidelines for the management and training of buccal midazolam (SH CP 4) Management of Seizures (SH CP 3) These must be referred to when supporting people to receive buccal midazolam or rectal diazepam. The completion of these should be undertaken with the GP / Consultant Psychiatrist / or neurologist to ensure the guidance and instruction is clear, accurate and appropriate. All staff must have completed the necessary training provided before supporting people to receive this medication. A record of their training must be available in their records. 6.5 Topical Applications, Inhalers and Drugs administered to the eye, nose and ear Topical applications include creams, ointments, gels and transdermal patches. Drugs administered to the eye, nose and ear are usually prepared as drops. N.B. Transdermal patches which contain controlled drugs must be managed under the principles of best practice and local procedures must be put in place. Specific detail may be included on the individual s risk and support plan Should a service user be prescribed one of the above preparations and following assessment, able to administer the preparation without support, they should be encouraged to take responsibility for self-administration. The registered manager or support manager will put clear guidelines in place to inform and direct staff in supporting this Should a service user be prescribed one of the above preparations, and be assessed as unable to self-administer, following the completion of the MCA, clear guidelines on how to support them to administer the preparation must be drawn up for staff to consistently follow The guidelines will follow the prescriber s and manufacturer s guidelines, reflecting the appropriate use of gloves and aprons where relevant. Advice should be obtained from the local pharmacist For emollient creams or lotions, prescribed toothpastes, thickening agents or food supplements (e.g. Fortisip or Ensure) where the person is receiving this throughout the day as part of their general healthcare package, staff do not have to be medicines trained to support people to receive these but do need to demonstrate an understanding of their use. A robust support plan must be in place to explain this. All other prescribed medicines must only be administered by a member of staff trained and deemed competent in the safe administration of medicines 6.6 Homely Remedies (medicines which can be bought for the individual) Staff trained in the safe administration of medicines may administer and buy on behalf of the service user some homely remedies (for adults only), from the list detailed in appendix 12. Only medicines on this list including sun protection creams and lotions may be purchased on behalf of the individual. All other medicines must be prescribed by the GP. The list describes the indication of the medication, the dose that can be safely taken by adults, the frequency it may be taken, the maximum daily dose and December

14 the caution and contraindications of each medicine listed. No medicine may be given without evidence that staff have taken all the necessary guidance into consideration. This must be clearly documented in the appropriate section of the administration chart and the service user s records Full and comprehensive risk assessments and support plans must be in place to support this. When writing the plan to support a person taking any homely medicines, the following must be considered and appropriate reference made to confirm that these points have been considered: Is a consultation with the person s GP or Pharmacist required? Has the person taken this medication before? If the medication has been taken previously, was there any indication of an adverse reaction? Has the person any known allergies that may react to this medication? Has the medication been sourced from a pharmacy who are aware of the other medication the client is prescribed? The expiry date of the medication along with its disposal date Has a risk assessment been completed? What are the main risks? Reference to BNF, BMA New Guide to Medicines or Patient Information Leaflet for more information if required Ensure a clear record of when the medication is taken is available (See appendix 12B) 6.7 Alternative medicines Alternative medicines such as herbal, homeopathic, oriental and aromatherapy products are not recommended for general use (due to complex drug interactions) and staff should not recommend, use or refer service users to such products. Where service users insist on buying alternative medicines for themselves, staff will alert the GP of the service users intentions to use the medication and if necessary an appropriate risk assessment will be put in place. Where the people we support choose to receive aromatherapy or homeopathic treatments from qualified practitioners, staff must ensure that written confirmation has been received from the practitioner stating that they have checked that no contraindications or adverse effects will be experienced by the service user as a result of the treatment they provide. This will need to include sharing details of all prescribed medication. Clarity of this will need to be included in the person s risk assessment and support plan. 6.8 Controlled Drugs Controlled drugs are prescribed medicines with additional legal and practice requirements for storage, administration recording and prescribing because of their ability to cause dependence and be misused. Their main use within TQ21 and TQ At Home is for severe pain, epilepsy management, drug dependence and to aid sleep Controlled drugs are prescribed and dispensed for individually named people in the same way as other medicines. December

15 6.8.3 There are special requirements for controlled drug prescriptions so allow extra time for these to be written If support staff collect controlled drugs from a pharmacy on behalf of someone else, they may be asked to provide identification Controlled drugs are separated into schedules depending on the harm to society and associated regulations. Controlled drug schedules Schedules Examples Comment 2 Methylphenidate Fentanyl Morphine Sulphate Oxycodone Methadone 3 Midazolam Temazepam Tramadol 4 Diazepam Lorazepam Clonazepam Zopiclone Zolpidem 5 Morphine sulphate (low strength 10mg/5mls) Codeine Dihydrocodeine Full storage and recording requirements for registered care homes and domiciliary care homes Full storage and recording required for registered care homes and domiciliary care homes Store, record and administer as for any prescription medication Store, record and administer as for any prescription medication Administering of Controlled Drugs In order to give a controlled drug, the same administration procedure should be followed as for any other medicine. In registered care homes, it is good practice for a second trained and competent support staff to witness this process if available. In home care settings, no witness is required unless specified but clear processes for double checking must be in place at the earliest convenience Records for Controlled Drugs Registered care homes and domiciliary care services, (where support with medication is part of an agreed support plan) must maintain a separate record of the receipt, administration and disposal of controlled drugs. The record must be in a bound book or register with numbered pages. Administration must be recorded on the medicine record card and the controlled drugs register. Where there is a witness, both people must sign the register having checked the amount in the container and the amount in the register. Where there is no witness, the remaining amount of medicine must be checked and signed by 2 people at shift handover, if available. Where there is no handover, the receiving member of staff should check the quantities of controlled drugs, note any anomalies and contact the manager if concerned. December

16 The amount of medicine held in stock should be checked weekly by the registered manager or support manager. Where a service user manages their own controlled drugs, a record of the amount received and returned to pharmacy must be recorded, if the member of staff is responsible for obtaining and disposing of medicines Disposal of Controlled Drugs Controlled drugs must be returned to the pharmacist or dispensing doctor who supplied them at the earliest opportunity. A record of the return must be made in the controlled drugs register and a signature for receipt obtained from the pharmacy or dispensing doctor. 6.9 Dealing With Practicalities and Difficulties If the person taking the medication chews the medication, then you need to contact the pharmacy to check whether the medication can be given in liquid form Service User May Not Want to Take Medication If a service user expresses the wish not to take medication, check their support plan. If no guidance exists: Wait 5 minutes and offer the medication again Ask a colleague to support the service user with the medication Try to remove distractions, or alter the environment, e.g. turn the volume down on the television Contact the GP or NHS Direct for advice Seek advice from the Registered Manager/Support Manager or on-call If the service user continues to decline the medication, record on the medication record sheet, and contact the GP urgently for advice Review the support plan in case this becomes a regular occurrence, using the guidance of the GP in relation to how many doses can be safely missed in a particular period of time. Covert administration of medicines Disguising medication in the absence of informed consent from the client (covert administration) may be regarded as deception and must not occur unless it is thoroughly discussed and agreed with the GP, pharmacist and support manager and clearly documented in a support plan with a review date. Carers and advocates should also be involved. The decision to administer covertly must not be considered routine and only reached after a full assessment of the client s individual needs. A clear distinction must be made between those clients who have the capacity to refuse medication and those whose refusal should be respected and those who lack this capacity. The medication must be considered essential for the service users health and well-being or for the safety of others and the method of administration must be agreed by a pharmacist. At each review of the covert care plan attempts should be made to encourage the client to agree to take their medication. December

17 6.11 Drug calculations Staff will seek advice from the pharmacist around any complex drug calculations; for example strength and quantities of liquids to administer. To prevent medication errors, if staff are unclear regarding the dose to administer advice MUST be sought before administration. Metric quantities 1kg = 1000 grams (g) 1 gram = 1000 millograms (mg) 1 milligram = 1000 micrograms (mcgs) 7 Medication Errors 7.1 For the purpose of this policy, the definition of a medication error includes any error during the medication process which may include during prescribing, dispensing, administering, storage, disposal of and recording of any medicine, or the omission of any of these points. 7.2 If an error or omission of administration occurs, service user wellbeing is paramount and advice should be sought from the GP immediately. In all other cases of error, this should be reported to the manager or in an emergency, the on call manager for advice. 7.3 The Trust employs an open and honest approach to medication errors. All medication errors should be reported on a Trust incident form (electronic forms are available), Registered and Support Managers should give consideration to reporting the incident to the Care Quality Commission and to the local Adult Services team. If the error relates to controlled medication the Chief Pharmacist should be informed. 7.4 The Registered Manager/Support Manager with support from their line manager should investigate the incident, and consider the need to draw up recommendations to deal with the error if needed. A RECORD OF REFLECTION WITH THE INDIVIDUAL WHO MADE THE ERROR WILL BE REQUIRED AND THIS WILL BE RETAINED N THE STAFF S PERSONAL FILE ALONG WITH ANY MEASURES THEY WILL TAKE TO REDUCE THE LIKLIHOOD OF RECURRENCE. This may include further training and assessment or more formal action under the Trust s performance management policy 8 Crushing or Cutting Medication 8.1 Should service users medication require cutting or crushing, this can only be carried out after discussion with the pharmacist, and noted in the support plan. 8.2 Some medicines such as those with an enteric coating (EC) modified release or slow release tablets should not be crushed. 8.3 The required cutter or crusher equipment should be obtained from the local pharmacy and used only for that service user. 8.4 The equipment will require cleaning as recommended by the manufacturers. Should a medication require crushing, this will be documented by the local pharmacist. December

18 9 Supporting Service Users to Manage Medicines Whilst Away from Home 9.1 Should a service user have a holiday, supported by regular staff, arrangements can be made to transport all the medication belonging to the service user with them, to be administered as directed Should a service user have a holiday with regular family members, the registered manager or support manager can provide the relatives with the required medication to support the service user, including MDS medication and prescription and recording sheet forms. Recording of the amount of medication given should be signed for by the responsible relative Should a service user require medication whilst away from home on a regular basis, e.g. attending a daytime activity or employment, the GP should be asked to review the medication to assess the continuing need for administration at that time. 9.3 If the medication has to be given at any time when they are regularly away from home e.g. if no arrangements for the person to take the medication with them has been prepared by the pharmacy e.g. TTO or filled compliance aid that has been prepared by the pharmacy, TQ21 staff must prepare a compliance aid with the person's name, date of birth, address, details of medication to be taken, and time for the medication to be taken, clearly outlined on the container (Appendix 2). This must be handed to the service users themselves if they have the capacity to self-manage and administer their medication OR to the appropriate person that will be supporting them with their medication on that day whilst they are away from home. 9.4 TQ21 staff may only prepare medication to be given at a later time by placing in a compliance aid if: They are competent and proficient to administer medicines They have been deemed competent to fill a compliance aid All medicines are either tablets or capsules i.e. not liquids, drops or creams They have checked with a community pharmacist to ensure that the medicines will be stable if placed in a compliance aid 10 Training and Competency 10.1 All staff working in TQ21 and TQ At Home who administer medication need to be appropriately trained in medication administration. TQ21 and TQ At Home provide bespoke training based on this policy to ensure that staff receive the knowledge, support and feel confident when administering medication. All staff that require training are identified on the Training Needs Analysis (Appendix 17). The training process is described in detail in Appendix 13. Available Training includes: Safer Administration of Medicines (SAM) which includes an introduction to the administration of medicines, an overview of this policy and practical advice. An on line test will also need to be completed following attendance at SAM training. This one off training is mandatory for all staff that are expected to administer medicines across TQ21 and TQ At Home. December

19 3 x practical and theoretical assessments undertaken in practice (one of which must be undertaken by an external assessor). This part of the assessment must also be successfully completed before staff will be deemed as competent to administer medication. Medication Theory update for staff except assessors (every 2 years) This is a mandatory session focusing on medicines updates and policy changes for all staff who administer medication (excluding assessors see below). The training is available as an on-line video and e-assessment or as a face to face session. Practical assessment updates annually and more frequently if required Assessor Medicines Training. This 3 hour session is designed for staff who are required to become medicines assessors. A peer assessment in practice will be completed following attendance at this course and the competency assessment document as found in appendix 7 must be completed. All assessors must also attend every 3 years to maintain their competency. Assessors who attend this course are not required to attend the 2 yearly medication theory updates but are required to undertake an annual practical medication competency assessment in the workplace If required for the role Epilepsy awareness training and Buccal Midazolam/Rectal Diazepam Training in the administration of rectal preparations Understanding of PEG / PEJ / NG tube Management in the administration of medicines Diabetes management and the administration of insulin Where staff work additional hours (bank) in houses other than where they have completed the 3 Safer Administration of Medicines practical and theory assessments, they will be required to complete the medication competency statement once only (Appendix 8) in every house they work in. This is to provide evidence that the member of staff has ensured they have read all the relevant information pertaining to supporting the service user(s) to receive their prescribed medication safely 10.2 Consistent Errors in the Administration of Medication Where staff experience difficulties in following the agreed procedure to ensure people receive the correct medication at the right time in a way that is suited to them, a decision will need to be taken by their manager regarding further training and assessment of their competence. In cases where consistent or significant errors occur, action may be taken according to the Organisational Performance and Capability policy. Further detail and guidance may be found in Appendix TERMINOLOGY This policy has made reference to trained, competent and approved levels of staff and assessors. In order to clarify these roles, the following guide has been prepared: Competent Staff Those members of staff who have attended the 1 day Safer Administration of Medicines course and have completed and passed the exam as competent to December

20 administer medication. They should also have passed 3 assessments in the workplace Competent Assessor A manager or support co-ordinator having attended the assessors workshop and been assessed and proven competent to assess others External Assessor A competent assessor from another service/house who can undertake an assessment of a member of staff in another service/house in which they do not work 11. Conclusion Supporting service users to manage their medication involves a difficult balance between a person s level of ability and ensuring their safety and the safety of others. An assessment of the person s ability and willingness to participate are key aspects of the medication process and are essential before comprehensive support plans are put in place. Staff vigilance during the process of supporting the person is vital to promote respect and dignity and to ensure the correct administration of medication. Staff will be provided with a comprehensive training schedule to ensure they are competent and confident in supporting people to receive the correct prescribed medication. Where someone requires medication that involves an invasive technique including oxygen, administration via PEG, NG tube, rectal or buccal preparations, staff must receive additional training from a relevant qualified professional to undertake the procedure and administer the prescribed medication. A clear record of that training must be provided. Without training, staff must not administer or undertake any invasive treatments. Finally, any concerns, re: any aspect of the medication process must be addressed. There are many services available to contact for advice including the Trust pharmacists, local pharmacists, GP s, emergency services, health care colleagues, registered managers, support managers or locality manager. December