4.2.9 MEDICATION For the frail elderly and younger people with a disability, the ability to self-manage medications is essential to sustain independent living. CBS provides education and support to clients and/or primary careers to maintain their independence as long as possible including managing their own medicines in a safe and effective manner. Community Based Support host families and support staff are not expected to have knowledge regarding medication and are not permitted to administer medication but may assist with medication as outlined below. Employees with nursing qualifications may be engaged to administer medication. Medication Assistance - is prompting and/or assisting the client with self-medication and involves Reminding and/or prompting the client to take the medication. Support staff must only assist with taking the medication from the pack if the medication is stored as individually packaged medication (such as with the Webster pack prepared by a pharmacist) as per the care plan. Where medication is not suitable for a medication aid (eg liquid, eye drops, eardrops, cream etc) Medication Care Plans should indicate where and how body creams and lotions, eye and ear drops etc are to be applied/administered. Some medications are available in supermarkets and other shops. These medications are not subject to controls under the Poisons Act and Poisons Regulations. However, these substances, which may include vitamins and other complementary medicines, must be written up on a client s Medication Information Form (4.2.9C) by the medical practitioner or other authorised prescriber. The process of assisting with medication is to be under the full control of the consumer, including ensuring the correct medication is taken at the correct dosage at the correct time. If required an assessment of a client s ability to self-administer is undertaken by the medical practitioner in collaboration with the relevant health professional and the person responsible. Where the consumer is not competent to direct and there is no primary carer. (This relates to specifically named consumers under the instruction of the Senior Manager Community Care or CEO only) Any situation in which the consumer is not competent to direct and where there is no primary carer, must be referred to a Senior Manager Community Care. A client Medication Consent form (4.2.9.A) will be completed by the coordinator and signed by the client or their representative. The coordinator will develop a client Medication Support Plan (included in care plan) in conjunction with the Medical Practitioner /Registered Nurse. The
Medication Support Plan should not have specific medication names on it. It is used only to prompt staff to the medication to be given, e.g cream to legs, Webster pack. Only medication that has been ordered by the medical practitioner, nurse practitioner or authorized prescriber/pharmacist on a client s Medication Information Form (4.2.9C) is permitted to be administered by a support worker. Procedure: A qualified nurse may be utilised to administer the medication or in rare cases specific training might be provided to support worker with approval of a qualified medical practitioner (Medication Assistance form 4.2.9B and/or a communication book will be required to record action taken on every occasion). Staff must check the identity of the client on each occasion that medication is administered Administer each dose of the medication to the client directly from the container supplied by the pharmacist, Immediately sign Medication Assistance Form (4.2.9 B) following the administration of medications Clients are to be observed for any changes to their health status, any changes are to be reported to a coordinator/pager. Where a client refuses the administration of medications a coordinator is to be advised and incident report immediately completed. The Senior Manager Community Care is to communicate any concerns about the competence of the support worker to administer medication as per CBS policies and procedures Special Cases (This relates to specifically named consumers under the instruction of the Senior Manager Community Care or CEO only): While the above is in effect a No Medication Policy, there may be special cases where it becomes necessary to administer emergency medication to consumers outside of their Webster Pack routine. In these circumstances, this may be the only alternative to enable the consumer to remain at home and prevent admission to a nursing home or hospital. Procedure: Immediately contact the coordinator (or the out of hours emergencies number) to inform them of the situation and for further advice The coordinator should inform the Senior Manager Community Care/CEO and contact the client s medical practitioner Notify Medical Practitioner stating client s condition prior to administering medication
Explain situation to Medical Practitioner and if necessary he/she will give permission for you to provide medication. You must then verify the dosage and method of provision (with the medicine in your hand) whilst still on the phone with the Doctor After obtaining consent write all details in the Medication Assistance Form (4.2.9B) 1. Time of consent 2. Time of administration and number of tablets left in pak. 3. Thoroughly note the occurrence in the communication book. Doctor will initial or sign off phone order in the drug book when he or she next visits. 4. If there is a problem you can always ring the manager/coordinator or the out of hours emergencies number. Medication Incident Guidelines Actions in the event of a medication incident Support Worker (Refer to 4.2.9E Medication Incident flowchart) A medication incident is any event where the expected course of events in the administration of medications is not followed. It can include the following: Medication given to the incorrect client (eg Respite House) Incorrect medicine being given Incorrect dose being given Incorrect time of medicine Incorrect route of medicine Spilt or dropped medicine Out of date medicine Missing medicine Breaches of the CBS policy and procedures Client refuses medication Incorrect supply of medications from the pharmacy In the event of an incident in the management and or administration of client medication the support worker should: Remain calm and acknowledge that an incident has occurred Call manager/coordinator to seek further advice Call an ambulance if the client is in distress or showing signs of being unwell
Amended 13/11/2012 Record the incident (Hazard/Incident report form 6.1.4A) and provide this report to coordinator/manager Do not leave the client until instructed to do so by manager/coordinator In the event if a client refuses to take medication the support worker must observe the flowing procedure: Explore with the client the reasons why the medication was refused Wait 15 minutes and offer the medication again If the client still refuses, then the support worker must inform the manager/coordinator Actions in the event of a medication incident Manager/Coordinator (Refer to 4.2.9E Medication Incident flowchart) In the event of an incident in the management and or administration of client medication the manager/coordinator should: Identify the nature of the incident (e.g wrong tablet been given, has the dedication been dropped or client has refused their medication) Contact the general practitioner, pharmacist or Poisons Information Centre 131126 (24 hours) Follow advice provided by the GP, pharmacist or Poisons Information Centre (get this advice confirmed in writing as soon as possible after the event and include it as part of the medication incident report) Instruct the support worker to call an ambulance if the client is in distress or showing signs of being unwell Advise the support worker when they can leave the client Assist the support worker to complete hazard report form Advise the client s carer of the medication incident Ring to check on the client later in the day/next day (if appropriate) Inform the Senior Manager Community Care Senior Manager Community Care to carry out an investigation of the specific incident and develop an action plan to prevent re-occurrence of the incident Procedural Guidelines training and support for staff (Refer to 4.2.9D Medication Management Procedures Flowchart) The decision to assign medication administration to a support worker must be based on the GP /registered nurse judgment to ensure safe medication administration. CBS will provide supervision in line with the regulation and as required by CBS policies and procedures.
Prior to administering medication in a community setting, a support worker who has met training requirements (Completed a minimum of certificate III qualification with the following units HLTAP301B recognize healthy body systems in a health care context prerequisite unit for CHCCS305B and CHCC305A assist clients with medication) must: Be orientated to the CBS s medication policies and procedures Have successfully completed the CBS s annual competency assessment A refresher course must be undertaken in accordance with the requirements of the course at least once every three years If concerns arise regarding the support worker s competency to administer medication then re-education and/or competency assessment should be undertaken immediately Relevant legislations: a) Poisons Act 1971 Poisons Regulations 2008 http://www.thelaw.tas.gov.au/index.w3p b) Health Practitioner Regulation National Law (Tasmania) Act 2010 c) Aged Care Act 1997 d) Australian Nursing and Midwifery Council (ANMC), Delegation and Supervision for Nurses and Midwives, 2007 e) Standards for the Scope of Professional Nursing Practice for Nurses and Midwives, 2006 (Nursing Board of Tasmania as adopted by the Nursing and Midwifery Board of Australia) f) Standards of Medication Management for Nurses and Midwives, 2008 (Nursing Board of Tasmania)