Authorisation to Administer Medicines Health Guidance Publication date: March 2016 This information sheet is produced for the guidance of Care Inspectorate staff only. The contents should not be regarded as a statement of Care Inspectorate policy, nor relied upon as a comprehensive statement of best practice, but as common sense guidance on issues of topical interest based upon authoritative statements of best practice in the relevant field, at the time of preparation, and which may be of assistance to Care Inspectorate staff when reviewing practices and policies. Publication code: HCR-0316-098 Page 1 of 6
Introduction and purpose of guidance It is important that the rights and dignity of people in care services is protected, and medicines are given as prescribed and in line with the law. The purpose of this guidance is to clarify legal and best practice issues about how a person is authorised to administer medicines to residents within care homes. Background In the United Kingdom, anyone can legally administer a prescribed medicine to another person. This includes prescription only medication (POM) and controlled drugs (CD). However, the administration must only be in accordance with the prescriber s directions. The Medicines Act 1968 as amended states: no person shall administer (otherwise than to himself) any such medicinal product unless he is an appropriate practitioner or a person acting in accordance with the directions of an appropriate practitioner In care service settings this means that staff should not be expected to administer POM medicines to people unless they can satisfy themselves that there is a current prescription in existence to authorise the administration. Guidance Best practice guidance is that the Care Home should see the NHS prescription forms for repeat medicines before the medicines are dispensed by the Pharmacy; they should not go directly from the GP Surgery to the Pharmacy. This recommendation is made for a number of reasons e.g. to ensure that the prescriptions concur with what the home has ordered, to cut-down on waste. It is also of particular relevance to care staff administering medicines when the GP does not sign a prescription sheet/record held by the home. Page 2 of 6
The NHS prescription form is dual purpose in that it authorises the pharmacist to supply the medicine as well as authorising the care staff to administer the medicines. We recommend that, at minimum, the care home staff see the signed prescription, but advise they keep copies (paper or electronic e.g. scans) of the forms to evidence that at the time of administration there was a current prescription in existence for that person (see below also). The copies of the prescriptions forms should be retained by the home for the same length of time as all other medication records. The care service should have a policy for how long they keep all types of records. Medication Administration Recording (MAR) charts produced by a pharmacy, inhouse recording documents or dispensing labels do not fulfil the criteria of a prescription i.e. they are not the authority to administer medicines. When a verbal instruction is given to amend a dose, discontinue an item etc. best practice is for this authority to be backed up in writing from the prescriber (e.g. fax or email). There should be a system in place to ensure that medicine charts detailing what is prescribed are checked against the original prescription before they are used as the prime document for administration. This is to identify situations such as both the Page 3 of 6
MAR chart and medicine supplied by the pharmacy stating one three times daily but the prescription states one twice daily. Before administering a medicine to a resident staff should: carefully check the identity of the resident observe the medication record, checking the resident s name, medicine dosage instructions, noting any recent changes, and checking whether the medicine has already been given. identify the appropriate medicines, checking that they are still in date the way it has to be administered e.g. via mouth, eye drop etc, and any special instructions e.g. one hour before food ask the person if they want their medicines before it is taken out of the pack - people can refuse medicines for different reasons administer the medicine immediately record administration of the medicine, refusal etc. Medicines should be administered from containers dispensed and labelled by the pharmacy or dispensing GP. Staff should administer medicines from these original dispensed containers and be able to identify and record each individual medicine they administer. If a care services still operates a system whereby medicines are taken from the original dispensed containers and put into pots or compliance aids well in advance of the time of administration, they need to be made aware that this is not best practice and raises safety and legal concerns. This practice is known as secondary dispensing. The resident who is going to receive the re-dispensed medication has the legal right to expect that this re-dispensing will be carried out with the same reasonable skill and care that would be expected of a pharmacist e.g. that the medicines have been labelled in accordance with relevant labelling regulations, and the medicine is suitable for storage in the new container. Staff who are expected to administer medicines which have been secondary dispensed by other staff members or are supplied in unlabelled dosette boxes need to take cognisance of these issues, satisfy that they can identify what they are expected to administer and their liability if they cannot do so. Summary The care home should have evidence that all medicines administered are currently prescribed. Medication administration records should be checked against the original prescriptions before they are put into use. Secondary dispensing is not a recommended practice. Useful Links/Further Reading The Handling of Medicines in Social Care http://www.rpharms.com Page 4 of 6
Standards for Medicines Management http://www.nmc-uk.org The Code for Nurses and Midwives http://www.nmc-uk.org Church C, Smith J. How stable are medicines moved from original packs into compliance aids? The Pharmaceutical Journal 2006; 276:75 http://www.pjonline.com/libres/pdf/articles/pj_20060121_stable.pdf Improving patient outcomes: The better use of multi-compartment compliance aids http://www.rpharms.com Page 5 of 6
Headquarters Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY web: www.careinspectorate.com email: enquiries@careinspectorate.com telephone: 0345 600 9527 @careinspect Other languages and formats Copyright of Care Inspectorate 2016 Page 6 of 6