Self-Administration Guidelines

SH CP 168 Self-Administration Guidelines Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: Procedure for when a patient takes responsibility for taking own medicines as prescribed by a doctor and dispensed by a pharmacist in line with NICE guidelines. Self-medication; patient medicines; own medicines. Nurses, MHPs, Pharmacists, Medical Staff. Next Review Date: January 2021 Approved & Ratified by: Medicines Management Committee Date of meeting: 17 th Date issued: Author: Sponsor: Nicola Bennett - Associate Director of Nursing/AHPs Sarah Constantine Medical Director 1

Version Control Change Record Date Author Version Page Reason for Change Sept Anne Leitch 1 Transfer to SHFT format 2014 Tim Coupland Nov 17 Nicola Bennett 2 3 4 5 6 7 8 New contents list Change to title of section 3. Point 3.1 removed from version 1. Numbering changed in section 3 3.3 in version 1 moved to 5.1 in version 2. New section 4 added. Change of name and number for section 4 in version 1 to section 5 in version 2 Additional wording added to section 5. Change of section number 5 in version 1 now section number 6 in version 2 Change of section number 6 in version 1 now section number 7 in version 2. Additional wording added to section 7. Change of section number 7 in version 1 now section number 8 in version 2 Change of section number 8 in version 1 now section number 9 in version 2. Change of section number 9 in version 1 now section number 10 in version 2. Change of section number 10 in version 1 now section number 11 in version 2. Change of section number 11 in version 1 now section number 12 in version 2 Reviewers/contributors Name Position Version Reviewed & Date Nicola Bennett Associate Director of Nursing Version 1 September 2017 Kathryn Lacey Clinical Pharmacist Nov 2017 2

Contents 1. Definition 4 2. Introduction 4 3. Philosophy/Aims 4 4. Risks 5 5. Implementation 5 6. Starting Someone on Self Administration 6 7. Monitoring/Evaluation 7 8. Safety and Accountability 7 9. Nicotine Replacement Therapy 8 10. Compliance Aids 8 11. Monitoring Compliance 8 12. Related Policies 8 13. References 8 Page Appendices A1 Patient Agreement Consent Form 9 A2 Self-Administration/Medication Assessment/Competency Form 10 A3 Medication reminder card 11 A4 Compliance Aid Request Form 12 A5 Sample Monitoring 13 A6 Sample Self Administration Monitoring Phase 14 3

Self-Administration Practice Guidelines (See Social Care Website for Social Care Policy) 1. Definition 1.1 Self administration occurs when a patient takes responsibility for taking/using a medication as prescribed by a doctor and dispensed by a pharmacist. There may be different degrees of self-medication and therefore different levels of responsibility with health care workers working in partnership with the patient. At all times the relative responsibilities must be clearly documented. 2. Introduction 2.1 Self-medication programmes ensure patient participation, highlights the importance of concordance, encourages independence, promotes individualised care and promotes a systematic format for giving education to patients on medication matters. 2.2 A patient who has assumed the responsibility for taking his/her own medication, increases their self-esteem, confidence and awareness about medication and the reasons for taking it. 3. Aims 3.1 The policy supports the principles that: The person using services has at their disposal a wide range of abilities, strengths, personal qualities and experience which are the foundations of living a life beyond illness. It is essential that the emergence of illness, and the use of services, does not lead to the loss of these resources, as they represent hope and aspiration for the future. The person using services will be supported to take control of the way in which services are used, exercising choice through personalisation of their own care. The level of support needed to manage these choices will vary over time and according to need To establish a standardised approach for determining the ability of patients to take their own medication reliably To increase patient understanding of their medication and thereby improve concordance in medication regimes and hence reduce hospital admissions due to poor concordance To establish any support systems which will be required by the patient after discharge 4

4 Risks Self-administration Not Allowing Self-administration Overdose (intentional or accidental) Under dose (including omitted doses) Theft of drugs from a patient who is selfadministering Loss of confidence in patient s ability to manage their own medication during extended hospital stays; Poor concordance with medication on discharge; Poor outcomes with the potential for hospital re-admission. 5. Implementation 5.1 Self-administration systems will not be appropriate for all patients. Participation must therefore be based upon criteria of assessment of suitability, safe systems of practice and informed choice and consent of the patient. 5.2 Self-administration by patients requires commitment by medical, clinical pharmacy, nursing staff and other members of the multi-disciplinary team and must be based upon an informed choice by the patient. 5.3 Each local care facility must look at the feasibility of implementing self-administration and clear monitoring procedures from their different care perspectives. Each care environment must have safety measures in place in which to allow safe practice of selfadministration to be carried out. 5.4 Patients who self-administer must have their own individually dispensed supply of medication, therefore staff must not supply drugs for self-administration from existing ward stocks. Individual patient lockers for the safe, secure storage of medication must be available. 5.5 Excluded medications Controlled drugs Injections (unless the patient is / will be self-administering their medications at home e.g. insulin) Once only doses Variable regimens may not be appropriate (may cause confusion - assess individually) e.g. Loading doses of warfarin, Reducing courses, Sliding scale insulin or clozapine titration Medication which requires refrigeration 5.6 Principles of Self Administration Patients considered for self-administration schemes must have been assessed as competent and have capacity to take responsibility at each level of selfadministration safely For Patients who are detained under the Mental Health Act issues associated with part 4 of the Act continue to apply if self-administering. 5

Care plans must clearly indicate the aims and education required by each patient who is on the self-medication programme Care plans and medication prescription cards should be clearly marked that the patient is self-medicating and the appropriate stage of the programme The patient embarking upon these schemes must be provided with supportive education and information material (Appendix 3) Patients must agree and consent to participation with the scheme (Appendix 1). Such participation, however, does not mean that all responsibility for drug administration has been transferred from the nurse to the patient. All self-administration schemes must be subject to monitoring, supervision and review by the multidisciplinary team (MDT) including the ward pharmacist and recorded in the patient electronic record (EPR). Secure storage must be available to the patient for the safe keeping of medication. There are a minimum of three possible phases of the self-administration process: Units may choose to add additional phases in their local policy, e.g. Differing amounts of supply for different phases. Phase Responsibility Reminders Supplies Storage Compliance check 1 Patient requests at suitable times from the nurse. After suitable time period Ward stock/trolley As ward stock NA 2 Patient requests at suitable times from the nurse 3 Patient takes responsibility No No Limited supply of labelled medication Labelled supply of medication Safe and secure medication locker Safe and secure medication locker Tablet count Tablet count 6. Starting Someone on Self Administration Assessment The Self Administration scheme is fully discussed with the patient and the responsibilities involved are explained. The Multi-Disciplinary Team (MDT) must ensure that the patient has the capacity to be involved in the process. Once MDT agreement has been reached to proceed, the patient having made an informed choice in which to participate completes the consent form (Appendix 1). If a decision is made that the patient should not self-medicate at that time, this should be documented in the notes and a review date recorded. The patients named nurse and/or pharmacist assess their ability to self-administer. Sample assessment form (Appendix 2). 6

The patient s medication should be prescribed on a Trust Prescription Chart. A supply of medicines fully labelled with directions should be requested. The assessment must take into account religious, cultural and spiritual aspects of the person s life, their beliefs and any learning disability, visual/ communication disability or communication issues. 7. Monitoring/Evaluation 7.1 Nursing staff and Mental Health Practitioners (MHPs) should monitor any difficulties in taking medication on the drug monitoring sheet (See Appendix 5). This should be attached to the drug card. Depending on success, a patient can move on to the next phase as appropriate (See Sample Monitoring Form, Appendix 4 and 5). The level of retained knowledge relating to individual patients medicines should regularly be checked and reinforced as necessary by the registered nurse, AMHP or pharmacist. If at any time it is considered by a registered nurse/amhp that it is unsafe for a patient to continue on their present stage they should be reassessed and either changed to a suitable stage or self-medication stopped. An explanation must be given to the patient as to why the action was taken and this is recorded in their EPR and care plan reviewed. Patients can request to go back a stage if they are experiencing difficulties or can miss a stage if it is considered safe for them to do so. In each case, the appropriate medical team involved will record the reason for the decision. Physical health monitoring should continue whilst the patient is on the self-medication programme. 8. Safety and Accountability 8.1 Medication must always be stored in a lockable cupboard. The patient must be made aware of the importance of keeping the cupboard locked and retained the key on their person 8.2 Medication no longer required must be returned to the supplying pharmacy for safe disposal 8.3 Incidents relating to self-medication should be reported to the medical staff and pharmacist, recorded in the progress notes and a trust incident form completed 9. Nicotine Replacement Therapy Following an individual risk assessment, patients may be given up to 24 hours supply of prn NRT as per MCAPP (CP1). It should be labelled with the patient s name and may be kept on the patient for self-administration. The quantity given should be documented below in addition to the date/time/initials 7

10. Compliance Aids 10.1 Compliance aids are often inappropriately used for patients. They are often used when a simpler tool e.g. Reminder cards, would address the problem. All concordance issues should be discussed with the clinical pharmacist or medicines management technician. Staff are also referred to the Trust policy Filling a Compliance Aid. 11. Monitoring Compliance 11.1 Monitoring of this guideline will be undertaken as part of Medicines Control, Administration and Prescribing Policy audit. 12. Related Policies SH CP 1 Medicines Control, Administration and Prescription Policy ( MCAPP) SH CP 43 Filing and Checking Compliance Aids SH CP 149 Physical Health Monitoring Guidelines for Medicines Commonly Prescribed in Mental Health 13. References Audit Commission. A spoonful of sugar medicines management in NHS hospitals. London: Audit Commission; 2001 Department of Health, National Service Framework for Older People. The Stationary Office; 2001 Altman I et al: Self-administration of Medicines in Brighton; Hospital Pharmacist 2002;9:305-307 Policy for Self-administration of Drugs, Renal Unit, Derriford Hospital Care Quality Commission: Essential Standards of Quality and Safety, March 2010: Outcome 9: Management of Medicines: http://www.cqc.org.uk/sites/default/files/media/documents/essential_standards_of_qualit y_and_safety_march_2010_final_0.pdf 8

Appendix 1: Self-Administration PATIENT AGREEMENT CONSENT FORM Part 1 I have discussed the self-administration procedure with.. (Name of clinical pharmacist and or nurse) and I. Wish to be assessed under the requirements of the self-administration scheme. Signature of Patient Name Printed:... NHS No... Signature of Nurse/Pharmacist. Name (Printed) Date. 9

Appendix 2: Self-Administration SAMPLE ASSESSMENT PHASE SELF ADMINISTRATION/MEDICATION ASSESSMENT/COMPETENCY FORM To include: Observation and discussion with the patient to determine awareness, knowledge and physical ability Name Date of Birth NHS No. Ward. Consultant Named Nurse.. Pharmacist Date & type of admission Predicted date of discharge Is the patient aware? What the medicine(s) is/are called ( ) What to do if you miss a dose ( ) What the medicine(s) is/are for ( ) What common side effects may occur ( ) What dose to take ( ) What to do if side effects occur ( ) How to take the medicine(s) ( ) Can alcohol be consumed ( ) How long to take the medicine for ( ) Can other medication be taken ( ) How to find out more information ( ) Ability with Labels Can Read: Computer ( ) Large Print ( ) Understand Instructions ( ) Ability with Containers Can Manage: Non Clic Loc ( ) Blister/Strip pack ( ) Halving Tablets ( ) Clic Loc ( ) Oral Syringes ( ) Syringes for injection ( ) Spoons ( ) Measuring Beaker ( ) Sachets of power ( ) Summary of findings............ Patient is competent to Self Medicate YES ( ) NO ( ) Signature of Nurse/Pharmacist/MHP Date.. Time. 10

Appendix 3 Medication Reminder Card PATIENT S NAME HOSPITAL NUMBER. Completed by Date Patient Learning Programme Personal Medication Information Name of medication Reason for taking Dose Any recommendations/warnings Side effects 11

Appendix 4: Self-Administration Southern Health NHS Foundation Trust Compliance Aid Request Form Patient s name NHS No.... Ward/Unit. Consultant. These are not appropriate for everybody. Some patients find them very difficult to use and some medications are not stable in compliance aids. They should only be tried if the patient has failed to take medication safely from boxes and bottles. The medication will usually be given a TWO WEEK expiry when it is dispensed into a compliance aid. It is important to establish who will fill compliance aids when the patient goes home. Ideally the community pharmacist will fill the compliance aid. The clinical pharmacist will contact the local community pharmacist to discuss this and ascertain which aids are available. Pharmacy can check with the patient s local chemist. Consider whether the patient or carer themselves could fill their own compliance aid. If neither of these options are available, see Filling a Compliance Aid Policy CP43. Reason for Request (more than one reason can be ticked) Confused Difficulty opening containers Previous compliance problems Poor memory Difficulty reading labels incl English not being their first language Future compliance concern Other (please specify) Who will be responsible for administering the medication? Patient Carer Home Care Other (please specify). Are any medications obtained from another source? Y / N Comments: Who will fill compliance aid after discharge? Patient Carer Community Pharmacy Community Team Other (please specify).. Contact community pharmacy to see if willing to fill compliance aid Date contacted.. Details.... Arrange weekly collection from the pharmacy if necessary. 12

Appendix 5: Self-Administration SAMPLE MONITORING FORM WARD. NAME OF PATIENT NHS No. Time taken = time the patient actually took their medicines Intervention = interventions made to prevent the wrong drugs or doses being taken with reasons and any prompting required before the patients asks for medications. Any further comments on the patient s capability please state on the back with date. REGULAR DRUGS Date Time Taken Breakfast Intervention MONITORING PHASE 1 OR PHASE 2 Midday Meal Time Taken Intervention Tea Time Time Taken Intervention Bed Time Time Taken Intervention 13

Appendix 6: Self-Administration SAMPLE SELF ADMINISTRATION MONITORING PHASE Ward Name of Patient NHS No.. Commencing.. Drug/Dose/Frequency Date 1 2 3 4 5 6 7 No of tab remaining: Planned: Actual: Number Dispensed No of tab remaining: Planned: Actual: Number Dispensed No of tab remaining: Planned: Actual: Number Dispensed No of tab remaining: Planned: Actual: Number Dispensed No of tab remaining: Planned: Actual: *Patient is to: (a) Continue to self-administer (b) Go back to Phase 2 Signed Date *Delete as appropriate 14