Assistance and Administration of Medication for Domiciliary Care Staff

This is an official Northern Trust policy and should not be edited in any way Assistance and Administration of Medication for Domiciliary Care Staff Reference Number: NHSCT/12/543 Target audience: Domiciliary Home Care staff and those teams commissioning a medicine service in the community Sources of advice in relation to this document: Sandra Ewing, Head of Domiciliary Care Patrick Graham, Assistant Director, Primary & Community Care Replaces (if appropriate): N/A Type of Document: Trust Wide Approved by: Policy, Standards and Guidelines Committee Date Approved: 31 May 2012 Date Issued by Policy Unit: 6 June 2012 NHSCT Mission Statement To provide for all the quality of services we would expect for our families and ourselves

Assistance and Administration of Medication for Domiciliary Care Staff in the Northern Health and Social Care Trust June 2011 This guidance will be subject to further review based on outcomes from the Regional Medication Compliance Support Working Group.

Index Page 1 Introduction 1 2 Trust Responsibilities 1 3 Alternative Formats 2 4 Sources of Advice in relation to this document 2 5 Legislative Compliance 2 6 Aims and Objectives of guidelines 3 7 General guidance for good practice 3 8 General Information 3 9 Assistance Required 4 10 Definition of terms used 4 11 Home Care Worker responsibilities 5 12 Categories of Medication 5 13 Guidelines on the administration of medication by Home Care Workers 6 14 Procedures to be followed by Home Care staff when assisting service users with medication 8 15 Disposal of Expired Medication 9 16 Order and/or collection of medication 10 17 Consent form 11 18 Glossary of terms 12

Assistance and Administration of Medication for Domiciliary Care Staff in the Northern Health and Social Care Trust (1) Introduction Current health and social care policy has resulted in more people with higher dependency being cared for at home. Some service users could require assistance (prompting/supervision) with their medication. Others may require administration of their medication. It is incumbent on the Northern Health and Social Care Trust to provide guidelines for its Home Care staff which comply with the current policies and standards developed by DHSSPS (Department of Health &Social Services and Public Safety), RQIA (Regulation and Quality Improvement Authority) and NISCC (Northern Ireland Social Care Council) and for it to be consistent with Human Rights legislation. Trust Audience These guidelines are directed to address the assistance and administration of medicines and provide guidelines for domiciliary Home Care staff and those teams commissioning a medicine service in the community. While every effort has been made to ensure the accuracy and reliability of the information in these pages, it should not be relied upon as an authoritative statement of the law. Consequently, the guidance should not be used as a substitute for legal advice, which should be taken on the particular aspects of any individual case where there is any doubt. The Northern Health and Social Care Trust will not accept responsibility for medication administered to clients in their own homes by any person not employed or contracted by them. These guidelines have been drawn up with the advice and guidance of colleagues from nursing, pharmacy and social work services within the Trust, Northern Board and pharmacy representatives. They take cognisance of the Evaluation of the Management of Medicines in Domiciliary Care Agencies RQIA Report, September 2010. Equality, Human Rights & DDA The policy is purely clinical/technical in nature and will have no bearing in terms of its likely impact on equality of opportunity or good relations for people within the equality and good relations categories. (2) Northern Trust responsibilities Ensure that guidelines exist for the Trust and that all staff are aware of the guidelines and adhere to them. Provide appropriate awareness training in the management of medicines to all Home Care Workers, ensuring that they know when, 1

how and who they should contact within the Northern Trust if they experience any problems. The Named Worker must ensure that a medication record has been drawn up and a copy is kept at the service user s home and forms part of the care plan and is reviewed by the named worker following any additions or changes to the service user s medication. Ensure that other members of the community care team involved in the service users care are kept aware of any changes in circumstances whilst a member of staff is administering medication. Ensure that all records and information relating to a service user s treatment are collected and stored in the service user s file. Maintain the service users rights to independence and dignity at all times. (3) Alternative formats This document can be made available on request on disc, larger font, Brailie, audio-cassette and in other minority languages to meet the needs of those who are not fluent in English. (4) Sources of advice in relation to this document The Policy Author, responsible Assistant Director or Director as detailed on the policy title page should be contacted with regard to any queries on the content of this policy. (5) Legislative Compliance These guidelines should be read in conjunction with RQIA Guidelines for the Control and Administration of Medicines: Domiciliary Care Agencies, and also the DHSSPS Domiciliary Care Agencies; Minimum Standards. Regulation 15(7) of the Domiciliary Care Agencies Regulations (Northern Ireland) 2007 requires the Registered Person to: Make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines used in the course of provision of personal services to Service Users. Standard 7 of the Domiciliary Care Agencies Minimum Standards relates to the Management of Medicines and states that: The agency has arrangements in place to ensure that care workers manage medicines safely and securely. 2

(6) Aims and objectives of these guidelines To provide a baseline set of standards for Northern Trust Home Care staff to adhere to in the assistance or administration of medication within the domiciliary care setting. To set out guidelines for managers and care workers responsibilities. To provide guidelines on use of compliance aids. To promote and maintain the users rights, dignity and independence. To provide information to other members of the community team. To comply with DHSSPS, RQIA and NISSC standards. To promote service users health and well-being. (7) General guidance for good practice on administration of medication Medications must only be administered to the person for whom they are prescribed. It is essential that the written directions on the original pharmacy dispensed containers/monitored dosage system are followed at all times. If the directions on the container are unclear the medication should not be given and advice should be sought. To ensure the safe administration of medicines by care workers the following details must be documented in the service users care plan: The nature and extent of help required A current list of prescription medicines including: - Name of medicine - Dose - Time of administration - Frequency of administration - Method of assistance - Arrangements of the management of monitored dosage cassettes - Arrangements of the management of medicines to be administered on an as required basis e.g. pain relieving Medication (8) General information The majority of service users within the community will be responsible for storing, disposal of and administration of their own medication. It is important that service users are encouraged to maintain this independence. Only in exceptional circumstances where a service user is physically or mentally not capable of self-medication and relatives/carers cannot assist, should Home Care staff be asked to administer medication. 3

Service users requiring Home Care Workers to administer medication, should always have the medication in the original pharmacy dispensed containers or a monitored dosage system which has been supplied by the Community Pharmacy under the Managing Your Medicines Scheme. Clear instructions must be attached for each individual medication in monitored dosage systems. The internal Home Care Service cannot commence assistance/administration of medication unless the guidelines within this document are adhered to by the professional requesting the service. Home Care staff cannot administer medication from dossett boxes/bottles etc filled by family members. (9) Assistance which may be required Service users, under exceptional circumstances, may require assistance/ administration with medication. All medication administered must be in original labelled bottles/sealed dosage system as dispensed by the Community Pharmacist. (10) Definition of Terms Used Assistance* Prompting: Home Care Worker required to remind service user to take their medication. Home Care Worker will not handle medications. Supervision: Home Care Worker required to hand medication in original pharmacy dispensed container or monitored dosage system to service user. Service user will dispense and administer their own medication. Administration Home Care Worker is required to dispense medication from original pharmacy dispensed container or monitored dosage system and place in the service users hand/spoon for those service users who can self administer their medicines. For those unable to self administer their medicines, the Home Care Worker is required to administer the medication into the service users mouth. This may be in exceptional circumstances following a comprehensive review of the service users needs. Full training and competency assessment of Home Care Worker providing this level of administration support will be required.. *When Home Care staff are asked to assist with medication they will not remove the medication from containers or direct the service user as to which medication they should take. 4

(11) Home Care Workers responsibilities To adhere to the Northern Trust guidance on administration of medication. To attend appropriate training in the management of medicines, as required. To inform the line manager of any changes in service user s circumstances. To maintain the service user s rights to dignity and independence at all times. To keep all information about a service user s medication and treatment confidential. To never introduce, sell, offer advice or recommend any form of medication, remedy or preparation, including homeopathic and herbal to a service user. With regard to hospital discharges, the following should be observed when a client returns home. When a service user requires assistance with medication and the prescribed medication care plan must be updated. Home Care staff should: - Only administer the medication that has been dispensed to the service user from the hospital pharmacy on discharge and other medication as listed in the medication section of the care plan. - Disregard all other medication in the home until a Community Pharmacist has reviewed it to ensure no duplication has occurred. The responsibility for this review lies with family or the individual s named worker. - Following communication from the Hospital / Named Worker the Home Care Officer will advise Home Care Workers re appropriate medication assistance. - Any concerns should be reported to the Home Care Officer immediately. (12) Categories of Medication Regular Daily Medication Medication which is prescribed by the service users G.P. Home Care 5

staff who administer medication should record all individual medication when given. Such medication should already be in an original container or monitored dosage systems supplied and dispensed by the pharmacist with clear instructions for Home Care staff re administration. Some monitored dosage systems are supplied with an accompanying medication administration record (MAR) sheet which facilitates recording of individual doses of medication administered. As and When Medication (PRN) Such as laxatives, pain relief and non-steroidal creams. Home Care staff should receive specific instruction re administering and duration of treatment. Short Term Medication (Courses of treatment) Such as antibiotic therapy, eye drops and any creams/ointments. Home Care staff should receive specific instruction re administering and duration of treatment. Controlled Drugs/Patches Home Care staff must read instructions for use on individual packaging and have received instruction from the relevant community nurse and be deemed competent, prior to undertaking this task. This is required for each change. Dressings Home Care staff can secure any original dressing that becomes loose or apply a dry dressing. Community nursing services must then be contacted to review the situation. (13) Guidelines for the assistance/administration of medication by Home Care staff Support with medication can only be provided following an assessment by a Social Worker or other authorised person. Support with medication can only be provided when previously agreed with the service user and authorised by the Named Worker who will inform the Home Care team of the appropriate level of input required. The Named Worker must ensure that a medication permission form (attached) is signed by the service user or service users advocate and placed in the service user s file. A copy must be sent to the Home Care Officer. The Home Care Officer/Home Care Manager will give instructions to Home Care worker regarding this task. Home Care Workers can only carry out this task following instruction from the Home Care Officer. 6

Home Care staff delivering domiciliary care will only take responsibility for supporting service user s with medication after the appropriate professional i.e. Social Worker, CPN, Pharmacist, Community Nurse etc, advises at referral, the level of input that is required. Home Care staff will only agree to administer medication under exceptional circumstances, if the service user is assessed as not being physically or mentally capable of administering their own medication and there are NO relatives/friends/informal carers who can administer and where service user/advocate has signed the consent form. In such exceptional circumstances, service users requiring Home Care Workers to administer medication must have medication provided in original pharmacy dispensed containers or appropriate monitored dosage systems. Home Care staff must not give medication to any service users unless instructed to do so by their Home Care Officer. Home Care staff can only administer medication when the pharmacist has clearly labelled the original containers/dosage system to include: (a) Name of service user (a) Name and strength of medicine (b) Directions for use (c) Date of dispensing (d) Amount dispensed (e) Expiry date (where available) Level of assistance must be recorded in the medication comments/recording sheet (held in the service user s home) on all occasions. The date, time of day and signature must be clearly written. In exceptional circumstances it may be necessary for Home Care Workers to administer medication directly into the service user s mouth. This task must be clearly recorded on the care plan. If following encouragement a service user continues to refuse their medication the Home Care Worker must: - Record the episode in the medication comments sheet; - Date and sign; and - Inform the Home Care Officer. The Home Care Officer will inform the service users Named Worker/Relative/Carer. Home Care Workers must leave medication in a safe place at all times with the agreement of the service user, advocate or social worker and this must be clearly recorded on the care plan by the assessor. 7

If it is not appropriate for the service user to have access to the medication, an arrangement must be made where it is accessible to Home Care Workers and details recorded on the individual care plan by the assessor. If there are any known swallowing difficulties this should be clearly stated on the care plan by the assessor. A risk assessment action plan should also be completed (14) Procedure to be followed by Home Care Worker when administering service users' medication Always wash your hands and thoroughly dry your hands before and after giving medication. Ask the service user and check the record sheet to confirm that they have not already received their medication. The Home Care Worker must read the previous entry on the medication comments sheet before providing any input. The Home Care Worker should explain the procedure to the service user and help the service user into an appropriate position and prepare a cold drink if necessary. When Home Care Workers administer medication it must be from the original pharmacy container or sealed monitored dosage systems dispensed and labelled by the Pharmacist. The Home Care Worker should check the strength and directions of the medication required from the fully labelled medicine container and make sure the name on the medication container and service user s name match. If there is a discrepancy do not administer medication, record and inform your manager. As a safety checklist, the Home Care Worker should check the following: - Right Patient - Right Drug/Medicine - Right Time - Right Dose - Right Route Home Care Workers should avoid handling the medicine, by tipping the appropriate tablets or capsules onto the lid of the container and then into a clean medicine cup, spoon, or plate, or into the service user s hand. If there are any known swallowing difficulties this should be clearly stated on the care plan by the assessor and Home Care Workers must follow the instructions. 8

Do not crush or break tablets/capsules if service user has difficulties swallowing unless instructed to do so by the Home Care Officer. Liquid medication staff should pour medicine with the label on the bottle facing upwards to try and minimise drips down the side of the bottle which may obscure directions. Always regularly wipe the neck of the bottle. NB Please note that Home Care Workers must not force service users to take their medication against their will or disguise it in their food. If a service user refuses to take their medication Home Care Workers should inform and seek advice from their Home Care Officer at all times. A record must be made of the action taken in the medication comments sheet. Any exceptions to the above must be clearly recorded on the care plan by the assessor and agreed with the Home Care Manager. Additional advice/instructions must be provided to the Home Care Worker. If you notice that a service user is having problems with their medication Home Care Workers must inform their Home Care Officer immediately. Home Care staff may be required to administer ear/eye drops, creams, lotions or sprays, inhalers or pain patches. Administration of these should only be undertaken after training in specific techniques has been provided for the Home Care Worker by a qualified healthcare professional. Disposable gloves, available from your (manager) Home Care Officer, must be worn when applying prescribed cream or lotion to the skin or changing pain patches. If a medication error occurs e.g. medication given at the wrong time of the day, or the wrong day of the week, or too many tablets administered, the Home Care Worker must notify the Home Care Officer immediately and record the event in the service users record sheet. The NHSCT incident form must then be completed by the Home Care Manager and forwarded to the Governance Dept as per Trust policy on the management of incidents. Registered Manager must advise RQIA of all medication errors on appropriate form. If the incident occurs out of hours the Homecare staff must inform the Out of Hours service immediately and ask for instruction as to the correct plan of action. The incident must be reported to the line manager the next working day. (15) Disposal of Expired Medication If Home Care staff discovers expired medication in a service users home they must report this to their line manager. The line manager must alert the relevant social worker/named worker. 9

(16) Order/Collection of Medication Home Care staff must not order or collect medication for a service user from the Community Pharmacist except in exceptional circumstances where there is no family or carer involvement. The request to order/collect medication must be clearly recorded on the service user s care plan and arrangements put in place with the local Community Pharmacist by the relevant Named Worker. 10

Permission for help with medication Name of service user Address Level of input required Service user signature Date Name of service user s advocate (if applicable) Relationship to service user Signature Date Special instructions Named worker signature Service users signature Service users advocate Copy to be sent to Home Care Manager prior to commencement of service 11

Glossary of Terms DHSSPS (Department of Health &Social Services and Public Safety) RQIA (Regulation and Quality Improvement Authority) NISCC (Northern Ireland Social Care Council) CPN (Community Psychiatric Nurse) 12