Appendix 1 Fettle house Procedure for self medication As a rehabilitation unit one of our most important roles is to prepare clients to the best of their ability to manage their medication. Each individual is assessed according to their capacity and understanding as well as according to their move on circumstances. The self- medicating programme starts from admission and all clients on Fettle will be placed on one of the levels 1-3 with a view to assessing and achieving their maximum independence in this area. Each client has their own locked medication drawer assigned to them on the drug trolley in the clinical room. You will find a number on the front of their prescription card corresponding to this drawer. There will also be a coloured sticker indicating the current level the client is working on with staff. Blue- level one Yellow- level 2 Amber- level 3 When signing for medication administered, or observed, a red dot should be marked on the signature column to indicate when the client has needed a prompt. SEE SELF-MEDICATION FLOW CHART for a detailed explanation of each level. Progress through the levels will be continually reviewed at the multi-disciplinary team review. The consultant must discuss this progress with the client and both will sign the contract (appendix 1&2) which is attached to the prescription sheet before commencing Level 3. A care plan must be written with the client so that everyone is clear on the plan. Level 1: Nursing staff will administer medication to the client from the drug trolley. Clients will be encouraged to come to the clinical room without prompting when their medication is due. Nursing staff will record on the prescription sheet when the client has needed to be prompted by placing a red dot at the bottom of the time administered column. Pharmacy will provide each client with their own medication folder. Nursing staff will discuss medication at the point of administration to check for understanding. Level 2: The client self-medicates from their individual medication drawer using labelled medication under direct supervision. The nurse will continue to record on the drug chart at each administration and observe ability to read labels, pop out tablets, use inhalers. Where a preference or need is indicated a medidose /blister pack may be used to improve client motivation and confidence. If a medidose is used the client must fill the containers themselves under supervision of a qualified member of nursing staff. When they take their medication they sign the prescription card and the nurse countersigns self-medicating observed. Level 3: When a client moves on to this level they must agree to keep their medication in a safe place that cannot be accessed by others, - their locked room or safe, and be prepared for staff to check their medication with
them. Pharmacy will make sure they have sufficient medication issued when the client is ready for level 3. We work in collaboration with our clients and are very flexible in our approach to level 3. Some clients feel more comfortable with a day s medication others are happy to have a week s worth which they keep securely in their rooms. Pharmacy supply medication to the named client with clear administration instructions on the box. We are also happy to utilise concordance aids such as medidos boxes and blister packs if the client chooses. When issued with medication to take away from the trolley the client must sign the prescription continuation sheet to show how much has been taken away and at what time they collected it. This should be countersigned by the nurse also. The frequency of checks will be as follows: (i) Daily checks for at least one week. (ii) Then alternate days for at least another week. (iii)then moving on to checks carried out once a week. Spot checks should be allocated in advance on the prescription sheet and signed by the nurse once the check is carried out. There is an accompanying form for the nurse to sign which should be kept with the prescription sheet. (appendix 4) Any changes to the frequency of checks need to be agreed at a team review (e.g. Morning Business Meeting), and documented. The information box on the front of the prescription card will be used to record this information and in addition the days within the card can be signposted for checking. Any changes to the prescription must be communicated to the nursing and pharmacy team. PRN medication is not to be dispensed into a medidose pack. Clients need to request this and be assessed by nursing staff as the need arises. Planned leave should be written in the pharmacists diary to allow for sufficient stock to be in place. If a client is at Level 3 they need to have a current leave prescription sheet with their medicine card to allow them to take hospital medication away from the ward. Incident reports to be completed if errors become apparent.
Appendix 2 PATIENT RISK ASSESSMENT FORM for SELF ADMINISTRATION (a basis for discussion at multidisciplinary meeting) 1. Is the patient currently mentally well enough to self-administer? 2. Is the medication regime suitable for self-administration? 3. Is the person likely to be discharged to an environment where he/she will need to take some responsibility for their medication? 4. Does the person have a history of overdose, accidental or intentional? 5. Does the person have a history of poor concordance with medication, leading to relapse or risk of relapse? 6. Is the person motivated to commence self-administration? 7. Can the person open medication containers? 8. Can the person read the labels?. 9. Does the person need a compliance aid, and if so why? Assessment by:... (Name & signed).. Discussed at multidisciplinary meeting...(date) Suitable / Not suitable for self-administration...(cons.)...
Appendix 3 Consent to self-administration I understand the self administration scheme and I am willing to take part. Patient signature:......... Withdrawal of consent I do not wish to remain involved in the self administration system because:...... I therefore withdraw my consent Patient signature:......
Appendix 4 SELF MEDICATION RECORD FOR.. NHS No:...
Appendix 5 Spot check audit for Self Medication Date NHS No. Is there evidence that meds are dispensed by patient e.g. patient has signed on card. Y/N How days many medication are dispensed at a time? Are Meds correct to date and time? Y/N Is there a photocopy of Px chart in Dosset Box? Y/N Name of Spot checking Nurse Signature