Medication Management Policy and Procedures

POLICY STATEMENT This policy establishes guidelines for ensuring safe and correct management of client medications in accordance with legislative and regulatory requirements and professional practice competency obligations. The Carer Provisions of the Health (Drugs and Poisons) Regulation 1996 under the Queensland Health Act allow a carer as defined in this policy to help another person with the taking of medication, provided the person receiving the medication (or his/her authorised Attorney or Guardian) requests the carer s help. Consistent with the carer provisions and within prescribed limits, registered nurses employed by Beata Homecare may delegate assistance with medications to unregistered staff whom they have assessed as skilled and competent care workers, and for whom clinical advice and practical support is made available. When a registered nurse appropriately delegates medication assistance tasks, he or she has a professional obligation to provide clinically focused supervision. Staff members accepting such delegation from a registered nurse or from an Attorney or Guardian are responsible for carrying out the tasks safely and correctly, and in accordance with the documented procedures in this policy. SCOPE This policy applies for all programs or services of Beata which have a registered client who has been prescribed medication but does not have the capacity to self-medicate without assistance, and who has requested assistance to be provided by our staff. ACRONYMS Medication Management Policy and Procedures Policy number 02.09 Approved by :CEO Version 1 Scheduled review date 28/3/2018 Created on 28/3/2017 EPOA ISO PRN QIC Enduring Power of Attorney International Standards Organisation Pro Re Nata (when necessary) Quality Improvement Council DEFINITIONS Prescription of medication refers to a written order provided by a registered medical practitioner. Dispensing of medication refers to the preparation of a prescribed drug by a registered pharmacist. Administering of medication refers to the physical delivery of a medication through the prescribed route. Administration of a medication may be required for clients with no cognitive impairment, but who need physical assistance, e.g. people with a physical disability that prevents them from removing tablets from a Webster or blister pack and transferring it to their mouth. Assistance with medication means helping the client by prompting or reminding them when medication is due, and/or handing the medication to the client. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 1 12

Supervision of medication means observing a self-medicating client to ensure the prescribed medication has actually been swallowed. Supervision is a form of Assistance with medication. Pro Re Nata (PRN) Order refers to a medication that is to be administered when necessary (i.e. not at fixed intervals or times). Carer in relation to the Carer Provisions of the Health (Drugs and Poisons) Regulation 1996 refers to a paid or unpaid carer who may include, but not be limited to, direct care staff, lifestyle support workers, diversional therapists or allied health workers. Care Worker is the inclusive term adopted for the purpose of this policy, to define all staff members who have been delegated responsibility for a client s medication management by an authorised Attorney or Guardian or a registered nurse. PHILOSOPHY Consistent with our philosophy of upholding clients rights, it is the belief of Beata that whilst in our care, clients of our programs and services have the right to request assistance to take a controlled or restricted drug that has been medically prescribed, providing an Enduring Power of Attorney (EPOA), Health Attorney or Statutory Health Attorney, or Guardian, has requested that assistance. Factors such as confusion, memory impairment, arthritis and visual impairment, all have an impact on the aging person s ability to self-medicate safely. RESPONSIBILTIES All Direct Care Workers (competent and qualified with medication assistance), Enrolled Nurses and Registered Nurses, practice within their scope of training and is personally liable for his/her actions. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 2 12

PROCEDURES 1 QUALIFICATION, TRAINING AND SUPERVISION 1.1 Direct Care Workers with competency in providing physical assistance with medication assistance. Program Managers or registered nurses who have delegated medication assistance tasks to care workers are responsible for ensuring that the care workers they supervise are competent to perform the task. It is expected that delegated authorities will only be given to care workers who have successfully completed the recommended nationally accredited unit of competence for care workers, Provide Physical Assistance with Medications (CHCCS303A). All care workers providing medication assistance for clients must also successfully complete a mandatory annual Medication Competency Assessment. The assessor must be a Registered Nurse or certified level IV workplace trainer. Direct Care Workers who is competent in providing physical assistance with medication management, will work under the supervision of the Program Manager (who is a Registered Nurse). 1.2 Direct Care Workers Restrictions and Limitations Care workers are not permitted to assist a client with the following: drugs that are to be nebulised but have not been dispensed into unit doses medicines given via feeding tubes that have not been dispensed into unit doses enemas, pessaries and suppositories all medicines that are administered by the nasogastric route, intrathecal medications (into the spinal cord area), intraperitoneal medications (into the peritoneum or abdominal cavity), intraventricular medications (into ventricles of the brain), epidural or intravenous medications, or intramuscular or subcutaneous medications. 1.2 Endorsed Enrolled Nurses and Registered Nurses EENs and RNs : Must have the relevant qualification to administer medications and work within their scope of professional practice. Must to report to the Program Manager (who is a Registered Nurse) for all medication management matters. Complete the annual medication calculation competency and assistance with medication training. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 3 12

2 ON ADMISSION 2.1 Admission Process The client s care plan will document the client s need with medication management or assistance. Where the client requires medication management, a medication management care plan will be created on admission and the client s medical practitioner and pharmacist is to be notified. The following information will be gathered: - The client s pharmacist - Current medications - Allergies to food, medications. Tapes and detergents/soaps - Preference to the medication (tablet or liquid) 2.2 Authorisation for Medication Assistance All requests for assistance with a client s medication are to be made in writing, using the Medication Authority form or authorisation can also be obtained through the client s power of attorney signing the care plan, which reflects the client s needs for medication assistance. Where a client has impaired capacity and cannot make an informed request for assistance with their medication, the substitute decision-making framework provided through the Guardianship and Administration Act 2000 and the Powers of Attorney Act 1998 will apply. This framework provides the mechanism for decisions to be made on behalf of individuals who do not have the capacity to make decisions for themselves. The Medication Authority form is to have the signed authorisation of the Enduring Power of Attorney (EPOA), Health Attorney or Statutory Health Attorney, or Guardian who is acting for the client in this matter. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 4 12

3 MEDICATION ORDER AND RECORDS 3.1 Medication Orders 3.1.1 Medication Written Orders Written Medication Orders to the person authorising medication assistance for the client are to be provided by the relevant general practitioner or dispensing pharmacist, and attached to the Medication Authority form. Medication Orders are to include the following: The name of the medication The date of the order The dose of the medication The route The time The duration for administration Any cautionary or advisory instructions (such as to be taken with food, requires refrigeration ). Name of the Medical Practitioner The signature of the Medical Practitioner who prescribed the order The order must be legible. If it is not legible, do not give the medication until you clarify with the prescribing medical practitioner. The prescribing medical practitioner must be contacted 14 days prior to the renew and review of the client s medication orders. 3.1.2 Making changes to the medication orders Where a change to the order is required, the medical practitioner must cancel the old order by placing a line through the order and re-write a new order. The new order must be scanned to the pharmacist with a follow-up phone call. If the change requires repackaging of the webster pack, this must be returned to the pharmacist. Any changes to the client s medication management must be reported to the Case Manager. 3.1.3 Medication Verbal Orders Where the medication order is not legible or during emergency situations, the nurse can take verbal order from the prescribing medical practitioner. While taking the verbal order, ensure that you: Write down the order exactly as given (in the verbal order section) Repeat the order back to the medical practitioner Resolve any discrepancy prior to ending the phone conversation Document in the progress note of the requirement of the phone order Ensure that the medical practioner signs the order within 24 hrs P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 5 12

3.1.4 Medication Supply It is preferable for all medications to be dispensed by the pharmacist in a Webster blister pack. Dispensed medications are to be clearly labelled. Medications that are not supplied in a Webster pack, must be clearly labelled with the client s name and instruction for use. The nurse is responsible for checking the supplied medications to ensure that they are the right medications for the clients. 3.2 Medication Records The client s medication drug chart will have the clients: Photograph of the client The client s full name, Date of Birth Allergies (if known) Information of the Pharmacist and GP How the client is to be assisted with the medication The following documents are to be attached to the client s medication record: Clinical Care Records: DOC 06.08 Medication Authority Medication Chart Clinical Care Records: DOC 10.08 Signature Logsheet (records of staff s name and signature) 3.2 Self Medication If the client wish to self-medicate, the Program Manager will be required to conduct an assessment using the Australian Pharmaceutical s Advisory Council Assessment Tool, paged 75, of the NATFRAME assessment tools. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 6 12

4 MEDICATION ADMINISTRATION All nurses are responsible in exercising their skills and judgement and is accountable for their action. All nurses should know when not administer the medication and when to refer to the medical practitioner or emergency services. 4.1 8 Rights for Medication Administration All nurses must comply with the 8 Rights for Medication Administration and they are: 1. The right medication: compare the name of medication to the order prescribed. 2. The right dose: double check any drug calculations, to ensure the right dose is given. 3. The right client: check the client s identification by getting the client to verify their name and date of birth and compare this information to the drug chart. 4. The right route: the medication must be given via the right route and check against the drug chart. 5. The right time: medication is given to the time prescribed on the drug chart. 6. The right reason: check that the medication is still required for the right reason. 7. Check the expiry date 8. Proper documentation: document the client s status prior to administrating any medications given and also when the medications was given, the dose and route of the drug. Also document the client s response to the medications given. Staff who has checked, prepared and administered the client s medication must sign the medication chart immediately after administering the medication and to also sign and record his/her full name and position in the Clinical Care Records: DOC 10.08 Signature Logsheet. 4.2 Refusal of Medication If the medication was not given due to refusal or illness of the client, must be documented in the medication drug chart by using the approved abbreviation and documented in the client s progress notes. If the client continues to refuse the medication, this must be reported to the medical practitioner and to the Program Manager. 5 STORAGE OF MEDICATION All medications should be securely stored away in a clean and tidy cupboard, away from easy reach by children/cognitively impaired elderies. Medications should be stored according to the drug manufacture s instruction. 6 DISPOSAL OF MEDICATION Expired medications from the packet, bottle or Webster packs that is no longer required due to the change to the medication order, must be returned to the pharmacy for disposal. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 7 12

7 MEDICATION INCIDENT REPORT 7.1 Medication Incident The following is an example of a medication incident: Error in the supply and packaging of the medication Missing medications or theft Broken ampules Incorrect medication given Medication given at the wrong time The wrong dose of medication given Webster pack found broken for the dose and time to be administered Suspected adverse drug reaction Administer of medication that the client has known sensitivity to Drugs given but not documented The client ingest a medication or chemical substance not prescribed 7.2 Medication Incident Reporting Procedure Any medication errors, observed adverse reactions or side effects are to be immediately reported to the client s designated medical practitioner and/or their legal representative, and where required emergency services should be called if it is life threatening. A Medication Incident Report is to be completed and provided to the Case Manager. If the incident was related to an adverse drug reaction, the following details is required to be documented in the progress notes: - Date and time - Name of drug suspected - Signs and symptoms of reaction and severity - Name of the person observing the reaction - Who was notified and what was the action? If the incident was related to a medication error, the following details is required to be documented in the progress notes: - Date and time - What the error is - Any signs and symptoms developed as a result of the error - Who was notified and when? - What action was taken from the person being notified? A copy of the Clinical Care Records: DOC 20.08 Medication Incident Report is to be filed in the client s record, and a second copy forwarded to the Program Manager for presentation at the Quality Committee Meeting. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 8 12

8 PRN MEDICATIONS If medication assistance has been requested for a client who has been ordered PRN (when necessary) medications to be taken whilst in the care of a Beata s service or program, the Program Manager is responsible for ensuring that clear and exact written directions are obtained from the medical practitioner, covering: - the circumstances under which the medication is to be given - the procedures to be undertaken when giving the medication - circumstances under which a further dose may be given (i.e. a safe interval between doses) - the maximum PRN dose - Circumstances in which the medical practitioner, or a registered nurse or Program Manager must be notified. - The date, time and dose of any PRN medication given to a client are to be recorded on the Medication Record, together with a record of the effectiveness of the medication given. 9 INFECTION CONTROL Hand hygiene practice must be performed when attending to medication administration. Medications should be administered directly from the medication container or cup or spoon to the client. 10 STANDARD PRECAUTIONS It is the responsibility of the relevant Program Manager to: ensure safety protocols for medication management are implemented by those with designated responsibility for providing medication assistance to clients which includes managing and communicating changes in medication orders and treatment regimes; processes for the secure storage and disposal of medications; and ensuring staff comply with required procedures for records maintenance and reporting of medication errors. All care workers or registered nurses providing assistance, supervision or administration of medications are to ensure the following standard precautions are routinely practiced: check the name of the client requiring the medication check the Medication Record to ensure the medication has not already been given check the identity of the client (e.g. photo ID, name tag) check the name of the medication ordered check the dose of the medication ordered check the time for administration of the medication check the route for administration of the medication check if there are any known client medication allergies check cautionary/advisory labels on the medication (e.g. to be taken with food) check expiry dates on the medication container. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 9 12

11 12 13 14 SHARPS Do no recap the needle. Sharps must be disposed in the client s sharps container immediately. Drug Handbook Resources such as the MIMS or drug handbook should be available and used when needed. EXPIRY OF DRUGS The date of the opening of the following drugs should be documented on the package and discarded: - Anginine ( after 3 months) - Eye drops and insulin ( after 1 month) MONITORING The following medications require monitoring of blood levels to ensure therapeutic levels are maintained: - Digoxin - Warfarin - Tegetrol Blood levels should be monitored, frequency of the blood test and any changes to the medication dosage is to be communicated with the medical practitioner. 15 CRUSHING OF MEDICATIONS Medications cannot be crushed if it is enteric coated. If the client has swallowing difficulties, this must be alerted to the pharmacist. Medications can only be crushed of approved by the pharmacists. Where possible, the Medical Practitioner, should prescribe the medication in a liquid form. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 10 12

EXPECTED OUTCOME Only competent and qualified direct care workers and nursing staff are permitted to assist clients requiring medication assistance/prompting or management. Medications are given safely and accurately documented according to the policy and procedures and professional practice. The direct care worker and nurses is able to recognise the changing condition of the client and knows when to report and seek assistance. The Program Manager will work closely with the GP, Pharmacist and representative when managing the client s medication and incidents. Occupational Health and Safety Risk is minimised through safe handling and disposable of medications. Medication Incidents are reported, managed and accurately documented in the Clinical Care Records: DOC 20.08 Medication Incident Report. Medication incidents are minimised through: - Compliance with the policy and procedures and professional practice; - Consultation with external stakeholders; and - Review and risk management of medication incidents (Quality Committee). Related Documents: Agreement and Disclaimers Records: DOC 1.09 Client Agreement Operation of Client Services Records: DOC 3.07 Client Care Plan Clinical Care Records: DOC 06.08 Medication Authority Clinical Care Records: DOC 07.08 Medication Competency Assessment Clinical Care Records: DOC 20.08 Medication Incident Report Audit Tools and Checklist Records: DOC 08.10 Medication Management Audit Checklist Clinical Care Records: DOC 10.08 Signature Logsheet Clinical Care Records: DOC 03.08 Drug Calculation Australian Pharmaceutical s Advisory Council Assessment Tool, paged 75, of the NATFRAME assessment tools. P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 11 12

Registers: REG 31.13 Staff Training Register REG 5.13 Clinical Incident Report Register References: The Aged Care 1997 Drug, Poisons and Controlled Substances Act 1981 (VIC) Drug, Poisons and Controlled Substances Regulations 2006 Australian Nursing and Midwifery Federation. Nursing Guidelines: Management of Medicines in Aged Care. Melbourne: ANMF, 2013. Nursing and Midwifery Board of Australia Australian Pharmaceutical Advisory Council Guiding Principles The Home Care Standards (2013) (Standard 2 Expected Outcome 2.2, Standard 3 Expected Outcome 3.5) Guardianship and Administration Act (2000) Health (Drugs and Poisons) Regulations 1996 (Carer Provisions: Sections 74, 183, 270) Human Services Quality Standards (2012) (Standard 3) ISO 9001:2008 Quality Management Systems Requirements (Standard Requirements 5.2, 7.2.1, 7.5.4) Powers of Attorney Act (1998) QIC Health and Community Services Standards (Standard 1.3, 1.6, 1.8, 2.1, 2.2) The Aged Care Act (1997) Quality of Care Amendment (Home Care) Principle 2013 Quality Management System Policy POL 06.02 Control of Records Workplace Safety Policy POL 09.06 Client Protection and Harm Prevention Workplace Safety Policy POL 01.06 Duty of Care P O L 0 2. 0 9 M E D I C A T I O N M A N A G E M E N T P a g e 12 12