Protocol for the Self Administration of Medication within the Locked Rehabilitation and Recovery Inpatient Unit DOCUMENT CONTROL: Version: 1 Ratified by: Clinical Assurance Sub Group Date ratified: 28 September 2011 Name of originator/author: Wendy Joseph on behalf of the Trust Medicines Management Committee Name of responsible Clinical Assurance Sub Group committee/individual: Date issued: 02 November 2011 Review date: September 2014 Target Audience Clinical Staff working within the locked Rehabilitation and Recovery Inpatient Unit.
CONTENTS SECTION PAGE NO 1. INTRODUCTION 3 2. PURPOSE 3 3. SCOPE 3 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4 4.1 Modern Matron/ Manager in Charge 4 4.2 Clinical Staff working in the locked rehabilitation and recovery 4 inpatient unit 4.3 Care Co-ordinator 4 5. PROCEDURE/IMPLEMENTATION 4 5.1 The environment 4 5.2 Supplying/storage of the medicines 4 5.3 Assessing a patient s ability to self medicate 5 5.4 Supporting patients to self administer medication 5 5.5 Patients who are working towards self administration 6 5.6 Medication supplied in liquid form 6 5.7 Information to patients 7 5.8 Reporting errors and incidents 7 6. TRAINING IMPLICATIONS 7 7. MONITORING ARRANGEMENTS 8 8. EQUALITY IMPACT ASSESSMENT SCREENING 8 8.1 Privacy, Dignity and Respect 8 9. LINKS TO OTHER PROCEDURAL DOCUMENTS 9 10. APPENDICES 9 Appendix 1 Record of administration of medication 10 Page 2 of 10
1 INTRODUCTION This protocol recognizes that individual s with enduring mental health problems require opportunities to acquire greater levels of autonomy and independence within which the selfadministration of prescribed medicine is an important aspect of the care process. The expectation is that any patient who is receiving care and treatment as an inpatient on the locked rehabilitation and recovery unit will be able to administer their own medication prior to discharge. The preferred method of medication administration is a monitored dosage system [MDS] filled by a pharmacist, and if possible this system of medication administration should be introduced to the service user at the earliest opportunity. It is essential that wherever the patient is encouraged to self-administer medicines the management of such an approach will be in keeping with the following principles: The environment is to have secure individualised storage facilities in place for each patient. An emphasis on support, facilitation and concordance should be the primary feature of self-medication approaches. Whilst the patient may accept a personal challenge for growth and skills development these can neither be expected nor demanded. Independence requires education; the pathway to self-administration requires knowledge and understanding of mental illness and the medicines used in treatment. In order to acquire a safe and competent attitude towards medicines the patient will have to understand and value their use from a personal perspective. Competence in self-administration will be measurable by the patient s capacity to demonstrate knowledge and understanding of, and commitment to, the need to safely manage medicines whilst also carrying out the requirements of the prescription. Individualised care must be recognised for all patients. Not all patients will be successful in self-medicating and this fact may well determine the level of support that continues to be necessary following discharge form the service. This support, which may become necessary, can be bought in as part of their package of care at the point of discharge for the patient if necessary. 2. PURPOSE The purpose of this protocol is to provide clear guidance on matters related to the management of the individual patient s self-administration of medication within the locked rehabilitation and recovery inpatient unit, and is to be read in conjunction with the Trusts safe medicines management policy. 3. SCOPE The contents of this protocol are only applicable to clinical staff and patient s within the locked rehabilitation and recovery inpatient unit, and only covers the self administration of prescribed medication. Page 3 of 10
4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Modern Matron/Manager in Charge of the locked rehabilitation and recovery inpatient unit. The Modern Matron and Manager in Charge are responsible for:- Clinical staff being aware of the contents of this policy. The inclusion of this policy in the local induction of any new staff. Monitoring compliance with the standards set out in this policy. The provision of safe medication storage facilities. 4.2 Clinical staff working within the locked rehabilitation and recovery inpatient unit. It is the responsibility of clinical staff working within the unit to: Be familiar with the contents of this policy. Have a knowledge and understanding of the role of medicines in mental health care and the typical observations that would trigger concern related to the efficient and effective use of medicines (e.g. evidence of over use or under use of medicines in comparison with the expectation of the prescription). Ensure that there is a continuous supply of the patient s medication (including any PRN medication). Report any non-compliance with the contents of this policy. 4.3.1 Care Co-ordinator The Care co-ordinator is responsible for the following: Pre admission: providing the staff with information about any support the patient may require enabling them to safely self administer their prescribed medication. To review the level of support required at each CPA review or earlier if indicated. 5. PROCEDURE/IMPLEMENTATION 5.1 The Environment Safe and secure individualised storage facilities for medication are made available for those patients who are deemed to be capable of self-medicating. In the event that a patient is not fully self medicating there are individual medication cabinets located in the treatment room for staff to utilise. 5.2 Supplying/storage of the medication Where possible the medication will be supplied in Monitored Dosage System [MDS] format and stored by the patient in the secure facility which is provided within their room. This facility is a lockable cabinet and patients are provided with a key which enables them to access their medication as prescribed. The staff also hold a master key to all the individual cabinets. Page 4 of 10
Clozapine prescriptions are also made up by the pharmacy supplier and included in the Monitored Dosage System. The pharmacy supplier requires 24 hour notice to make additions or changes to the Monitored Dosage Systems. The only time that medication may not be supplied in Monitored Dosage format by the pharmacy supplier is when a medication is known to react with other medications if not kept separate in its foil wrapper. If necessary dosettes can also be split into individual doses. For those patients who are working towards self medication their medication is to be kept in the centralised storage facility. The staff will support, supervise and educate the individual patient to administer their own medication from this central storage facility The storage and administration arrangements for the following items of prescription medications will be decided on an individual basis following consultation with the service user and documented in the individual care plan. Topical preparations Eye/nose/ear preparations Pessaries and suppositories Inhalers Other such preparations Any medication which is not to be kept by the individual patient will be held in the central storage facility until it is required for use. It is the responsibility of clinical staff to ensure that there is a continuous supply of the service user s medication (including any PRN medication). 5.3 Assessing Patients ability to self medicate safely For any patient to self medicate safely it is important that staff undertake the following: An assessment of the patients capacity to self medicate safely (this is to be recorded on the MCA1). It is important that they understand the treatment, likely effects, benefits, and side effects. (staff are to refer to the Trust Mental Capacity Act Policy) Completion of the medicines reconciliation document. Completion of the self medication assessment tool. 5.4 Supporting Patients to self administer medication For safety reasons all patients who are to self administer their medication will be observed and supported by a member of the nursing team for at least the first week Following this the level of support required by individual patients will be routinely reviewed at each CPA review. However it can be revisited if the clinical team feel this is required and any review will where ever possible take place in conjunction with the CPA co-ordinator. Page 5 of 10
The level of support provided will be based on a full needs and risk assessment of the patient, and completion of the medication assessment tool. A plan of care will be formulated to ensure the appropriate amount of support is in place. Each member of the clinical team is to be made aware of the level of support and/or amount of prompting each individual patient requires with regards to the self administration of medication as recorded in their care plan. To ensure the safe self administration of medication as a minimum the following details must be included in the care plan The nature and extent of any assistance that is required; Patient s capacity/consent if they require support in the administration of their medication. List of all current prescribed medication including o o o Name of medication Dose Arrangements for the administration of any medication to be taken as required (PRN) Each patient will be issued with a key to their individual locked cabinet. The staff will check that the individual has taken their prescribed medication, and sign the master log to evidence that this check has been carried out and by whom. [Appendix 1] 5.5 Patients who are working towards self medication For those patients who are working towards self-medication staff should still refer to sections 5.3 and 5.4, and the medication will still be stored in the locked cabinet in the patient s room, however they will not be issued with a key. A trained member of staff will attend the patient s room, open the cabinet with the master key, and prompt the patient to take their medication from the MDS System. This will take place as per the prescription and medication management tool instructions. The member of staff will then sign the prescription card to evidence they have prompted the individual to take their medication and that they have witnessed the individual take their prescribed medication from their MDS system/ dosette. The member of staff will relock the cabinet once the procedure has been carried out. 5.6 Medication supplied in Liquid form. For those patients taking medication in a liquid preparation, the process and storage is still the same, but they will be supplied with disposable measure cups to pour the liquid medication into. NB: Medicines in liquid form that are intended for oral use must be measured and administrated using an appropriate device, such as a 5ml medicine spoon, a calibrated medicine measure (medicine pot) or an oral syringe. Medicines intended for oral use must not be drawn up into syringes that are designed for parental use. Page 6 of 10
5.7 Information to Patients Prior to any patient being prescribed medication whether they are self medicating or not it is important that both they and if appropriate their carers have a full discussion with the prescribing clinician about the risks and benefits of the proposed treatment. This discussion should also cover: Expected benefits of the treatment. Common side effects. Available alternative treatments. Patients will also be given the above information in writing. For patients whose first language is not English arrangements will be made for the presence of an interpreter during any clinic appointments. Staff should refer to the Trust policy for the provision and access to interpreters. 5.8 Reporting Errors and Incidents Any medication errors, including medication being wrongly administered, omitted, or misplaced is to be reported on the Trust electronic incident reporting system, and a record made in the service users clinical records. With regard to any misplaced medication, as well as the loss being reported on the electronic reporting system, arrangements will also need to be made for the service user to be provided with another prescription. 6. TRAINING IMPLICATIONS Whilst there are no specific, identified training needs identified in respect of this protocol, clinical staff working within the locked rehabilitation and recovery inpatient unit be made aware of its contents in the following ways: At local induction for new staff when the unit opens. At local induction for new starters thereafter. Copy of the protocol to be publicised in the Trust Weekly News Bulletin. Copy of the protocol will be available on the Trust website Page 7 of 10
7. MONITORING ARRANGEMENTS Area for Monitoring How Who by Reported to Frequency Compliance with the standards set out in this procedure Monitoring of any IR1s submitted in respect of any medication errors/losses on the locked rehabilitation and recovery inpatient unit. Modern Matron Adult Business Division patient safety group. As and when incident occurs. Investigation of any complaints which relate to noncompliance with the contents of this procedure. Modern matron Adult Business Divisions Leadership and Quality Group. As and when a complaint is received. That the requirements of this procedure are covered at local induction for new staff. Audit Modern matron Human Resources and the Adult Business Divisions Leadership and Quality Group. Yearly 8. EQUALITY IMPACT ASSESMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. Indicate how this will be met No additional issues have been identified in respect of the privacy, dignity and respect of service users. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). Page 8 of 10
9. LINKS TO OTHER PROCEDURAL DOCUMENTS Policy for the Safe and Secure Handling of Medicines Clinical Policies, Section 10. Clinical Risk Assessment and Management Policy Clinical Policies,Section 6 Incident Reporting Policy Health and Safety Policies 10. APPENDICES Appendix 1- Record of medication Page 9 of 10
RECORD OF MEDICATION Appendix 1 Medication Dose Frequency... Times. Date Time Amount Recd. Amount held in drug cupboard Total Quantities returned, destroyed, alterations, remarks etc. Page 10 of 10