INDEX Prescribing Page 2 Dispensing Page 3 Safe Administration Page 4 Problems & Errors Page 5 Self Administration Page 7 Safe Storage Page 8 Controlled Drugs Best Practice Procedure Page 9 Controlled Drug Register - example Page 10 Standing Orders Page 11 Pain Management Page 12 Analgesic Agents Page 13 Use of Morphine Page 14 Safety with Warfarin Page 15 Review of Medication Page 17 Disposal of Medication Page 17 Administration of Liquids Administration of Insulin Guidelines on Medication for Respite Clients Page 1 of 20
Safe Medicine Management POLICY: Residents / residents will receive medication in a safe and timely manner according to current standards and best practice guidelines. Medications are for best possible health outcomes for residents. Errors / problems with medications will be detected and managed with the focus upon prevention. Medicines must be reconciled [against prescription and counted according to guideline] at all stages of Medicine Management. REFERENCES: NZS 8134: 2004 Part 5.3 & NZS 8134: 2007 Safe Management of Medicines: A Guide for Managers of Old People's Homes and Residential Care Facilities; Douglas Pharmaceuticals resource material; NZNO Organisation Guidelines for Safe Administration Medicines Medicines Act 1981, Medicines Regulations 1984, Misuse of Drugs Act 1975; Misuse of Drugs Regulations 1977, New Ethicals. http://www.medsafe.govt.nz, Medicine Management Standard NZS 8134 DHB STRUCTURE: MOH Benchmarking Stats Program GP Support External Consultant Support Statistics & Data Team Leader Manager or RN Laboratory & Pharmacy Douglas Pharmaceuticals Team Current Health & Safety Representatives Keeping safe Staff Service Users / Residents & their families Visitors Page 2 of 20
RISK MANAGEMENT STRUCTURE Ministry of Health Benchmarking Stats Program Compares with other providers Accesses Best Practice Guidelines District Health Boards Printouts How do we compare? Information for staff Information for residents Surveillance & Data Collection Medication Error / Problem Forms Quality Review Medicine Management by External Consultant /s Manager RN Team Leader H&S Reps Laboratory Reporting Notifiable Diseases Share Information Education Program Inductions ALL EMPLOYEES Manager / RN Training Staff Training Assessing educators Assessing understanding Learning sessions in response to surveys Learning sessions in response to incidents Doctors Share information Agree guidelines Business Risk Management Known Risks Assessed / Rated / Controlled / Minimised Page 3 of 20
RIGHTS & RESPONSIBILITIES: The fundamental principal, according to the NZNO Guidelines for the Safe Administration of Medicines: - Residents /clients should not be treated without their consent - People have the Right to Refuse Refusal needs to be discussed to find out the reason for it. We need to consider if the refusal is likely to affect the person s wellness, or other medicines that are being taken. Refusals need to be reported Document well [use Medication Problem Form] NB: People are sensible to refuse medicines they no longer need NB: RN s need to be able to recognise when a refusal can result in a poorer medical condition. E.g. High blood sugar or blood pressure. - Consent needs to fully inform - Our resident or client needs to be able to understand TYPES OF MEDICINES: 1. Prescription Medicines - Can only be supplied by a doctor, dentist, registered midwife or prescribing endorsed Nurse Practitioner. 2. Pharmacist only or Restricted Medicines - Medicine supplied by a pharmacist 3. Pharmacy only Medicines - Medicine sold at a pharmacy or hospital or isolated shop with special license 4. General Sale Medicines - Medicine supplied from any retail outlet Page 4 of 20
PRESCRIBING: Doctor / Other Prescriber Responsibility [SEE PRESCRIBING POSTER APPENDIX THIS POLICY] Prescriptions must: 1. Be dated 2. Be reviewed within the past month [past three months at doctor discretion] 3. [Doctor Responsibility] Meet Section 41 Medicines Act 1982 for prescribing i.e. a. Signed [with clear signatures] b. Be legibly and indelibly printed [no twink]. No transcribing. c. Contain adequate instructions including the number of times the drug may be given / length of course. d. Clearly indicate: name of the recipient, dosage of the medicine and the route for administration. 4. The doctor signs medications as discontinued and crossed them out on the prescription. [Unused medications are returned to pharmacy]. 5. Allergies are clearly marked in red or by yellow highlighter so that anyone looking at the file is instantly alerted to this potential risk. NB: Residents [according to DHB contract] are to be seen by a GP at least monthly, including a medication review. This may be changed to 3 monthly at doctor discretion. The manager or RN may also determine a greater frequency of visit at any time. DISPENSING: Pharmacy responsibility Shared Manager / Team Leader responsibility: 1. Medicines scripts are signed by the resident s doctor or specialist. 2. The prescription is faxed delivered to the pharmacy. A copy is kept in the Resident Medication Profile. 3. The pharmacy dispenses the prescribed medication, to that individual resident. Medicines are collected by the Service By Medicines are delivered to the Service. By... Page 5 of 20
4. All medicines are checked into the facility. The RN / Team Leader, or their delegate, confirms the medicines against the Residents Medication Prescription as they are unpacked. Any discrepancies must be clarified with the prescribing doctor and pharmacy. All checked medicine is stored securely.... [state where] Deciding who can Administer Medication Nurses Organisation Guide: a) We need to recognise that situations vary widely [high care levels to minimal assistance needed] b) It is vital that there is assessment of response to the medicine [is it working, is it working well enough? Are their any problems? Have an understanding of when medicines should not be given. c) The person who leads the administration needs to fully understand their own accountability. Registered Nurses Regulated by Nursing Council [current practicing certificate] Enrolled Nurses Regulated by the Nursing Council [current practicing certificate] Care Givers Unregulated * Must not give medicines in acute care setting [like A&E] * Must not give to very ill residents [e.g. assessed as Hospital care] * It may help to take medicine from a monitored dosage system [such as Douglas Pharmaceuticals Medico Packs]. 5. Policy on Telephone Instructions: The service does not support telephone orders of medications. It is best for sick people to see a doctor for prescriptions. Prescriptions must be faxed or delivered to the pharmacy. Repeats may be reordered by telephone where part of the prescription is still held by the pharmacy. It is the pharmacy s responsibility to label the medications clearly showing when prescriptions need to be renewed. It is the doctor s responsibility to write the prescription on the appropriate form. NB: Controlled drugs are written on a special prescription form. Page 6 of 20
ADMINISTRATION: Staff Responsibility Safe Administration Step by Step: All medicine administered must follow these established steps [according to guidelines listed on P 2]. 1. Wash your hands well 2. Look at the instructions on the Patient Medication Profile 3. Check the name to ensure it goes to the RIGHT resident. New staff do not give out medication until assessed as competent and part of this competency is to have gotten to know each resident personally. Back up is to have residents self identify. 4. Medication is checked into the facility as correct, according to prescription, by senior staff. Team Leader / RN in charge of the medicine management Program carries responsibility for this. Care staff administer medication directly from blister pack. 5. Explain to the resident that you have their medication. Give the medicines to the resident directly from their container or blister pack. Be careful! A commonly made medication error occurs where a tablet is left behind in a bubble pack. Some residents cannot hold tablets in their hands. Use of a teaspoon is a widely accepted practicable solution, but tablets must be administered directly. 6. Make sure the resident has fluids to take with the medicine, and fill special instructions [e.g. take with milk or take before a meal]. 7. Make sure that our resident actually swallows the medication Medicine must not be left for the resident to take later. 8. Record on the Signing Sheet that the medicine has been taken. Or, make note of withheld doses, refused doses or extra doses given in the event of wastage. Residents have the right to refuse medication. This may or may not be for a sensible reason. Residents can be encouraged [but not coerced or forced] to take Page 7 of 20
medication. Refusals [even those for sensible reason] are recorded on a Medication Problem Form and shown to the manager as soon as possible. Where staff feel concerned that the refusal might compromise care, the prescribing doctor needs to be notified. MEDICATION PROBLEMS OR ERRORS Drug incorrect resident given & takes the wrong kind of medication Dosage Incorrect given the wrong amount [too much or too little] Medication given to wrong resident [takes someone else s meds] Missed medication [forgotten or not returned from leave] Administration error [e.g. tablet dropped on floor]. Resident refused / unable to take medication Adverse reaction to medication diarrhea, ringing in ears, nausea, vomiting, skin rash, allergic reaction where tong may swell / feel strange. Dispensing error (pharmacy) wrong pills or wrong amount packed. Medication not signed for may have been given but not signed for. Medication Problem Guideline: for errors that are more than trivial. 1. STOP 2. Do not give any more meds. 3. CALL FOR SUPPORT! If the team leader is there, tell them straight away. It is the Team Leader responsibility to SUPPORT YOU! 4. If the team leader is not there contact the person on call, or if they cannot be reached, the doctor. They will instruct you from there. 5. Record the error on the Medication Problem Form. These are sorted, as above, for discussion at Service Review Meetings. 6. Recognise errors that require urgent attention: - TOO MUCH INSULIN - TOO MUCH MORPHINE - NOT ENOUGH PAIN KILLERS [MISSED] - REACTIONS WHERE THE RESIDENT IS NOT THEMSELVES [You are concerned] o Confused o Unable to talk properly any more or looks unwell Page 8 of 20
Management Responsibility: Minimising the Risk of Medication Incident: Help Line: Care staff need to have a senior person they can turn to if unsure, or if something goes wrong. Registered Nurse / On Call phone number available in the Office. YES Staff Training: NO - In-house training has a theoretical and practical component - Each is followed by an assessment of knowledge. - Work Based First Aid Training includes action to take in emergency situations and recognising resident distress. - Douglas Pharmaceuticals provide training with their Medico Pack System. Medication Resource Folder: - Actions and side effects of medicines taken by residents / service users. - Up-to-date online resource at www.medsafe.govt.nz (online) - Medication reactions / adverse events should be reported to the NZ Pharmacovigilance Centre [http://carm.otago.ac.nz]. Management Support Following Incident - Supported & monitored - Retrained - Competency reassessed - Given other duties instead if insufficiently confident [or competent]. Staff supporting Management: - By attending training. - By being very familiar with the correct way to administer medications. - Following established steps in medication administration recognising that shortcuts invite risk. - By seeking help when unsure about anything. - Through assessments of knowledge. - Telling Management / H&S Reps about good ideas for improvement. More Page 9 of 20
More. Please print out and laminate the Safe Medication Administration Posters appendixes to this policy Page 10 of 20