Medicines Policy. Drugs and Therapeutics Committee Date Ratified: 19 th September 2011

Transcription

1 Authorising Officer: Signature Of Authorising Officer: Dr. Geraldine O'Sullivan, Executive Director Quality & Medical Leadership Version: V6 Ratified By: Drugs and Therapeutics Committee Date Ratified: 19 th September 2011 Name of originator/author: Head Of Medicines Management Name of responsible committee HPFT Drugs and Therapeutic Committee Date Issued: September 2011 Review date: September 2013 Subject Of Document: The core standards and procedures to be followed with regard to the prescribing, dispensing, storage and administration of drugs. PRINCIPAL TARGET AUDIENCE: All staff involved with the prescribing, dispensing, storage and administration of drugs. Hertfordshire Partnership NHS Foundation Trust is committed to providing an environment where all staff, service users and carers enjoy equality of opportunity. The Trust works to eliminate all forms of discrimination and recognise that this requires, not only a commitment to remove discrimination, but also action through positive policies to redress inequalities. Providing equality of opportunity means understanding and appreciating the diversity of our staff, service users & carers and ensuring a supportive environment free from harassment. Because of this Hertfordshire Partnership NHS Foundation Trust actively encourages its staff to challenge discrimination and promote equality of opportunity for all. Page 1 of 80 September

2 Version Control Version Date Author Status Comment V1 April 2004 Head of Medicines Management Superseded Archived V2 V3 V4 November 2005 January 2008 September 2008 Head of Medicines Management Head of Medicines Management Head of Medicines Management V5 March 2010 Head of Medicines Management V5.1 March 2011 Head of Medicines Management V6 September 2011 Head of Medicines Management Superseded Superseded Superseded Superseded Superseded Current Archived Archived Agreed DTC on 19 th May 2008 Agreed Trust Executive Agreed DTC on 16 th Nov 2009 Trust Executive on Checked and addition of Section Monitoring of prescriptions and strengthening of section 5.2 with regard to identifying service users. Agreed DTC Agreed DTC 19 th September 2011 National Health Litigation Authority Risk Management Standards Standard 2 Competent and Capable Workforce Criterion 10 Medicines Management Training The organisation has an approved documented process for ensuring the delivery of effective medicines management training to all permanent staff groups that is implemented and monitored. The organisation can demonstrate compliance with the objectives set out within the approved documentation described at Level 1 in relation to the: Process for checking that all permanent staff groups as identified in the training needs analysis complete relevant medicines management training Process for following up those who fail to attend relevant medicines management training National Health Litigation Authority Risk Management Standards Standard 4 Clinical Care Criterion 5 Medicines Management The organisation has an approved documented process for managing the risks associated with medicines in all care environments that is implemented and monitored. The organisation can demonstrate the monitoring of compliance with the objectives set out within the approved documentation described at Level 1, in relation to the: process for ensuring the accuracy of all prescription charts. Page 2 of 80 September 2011

3 CONTENTS Section Page No: 1. Introduction 5 2. Purpose 5 3. Duties 5 4. Training 6 5. Prescribing, Dispensing and Administration of Medicines 5.1 Prescribing Prescription Guidelines Prescribing Responsibilities Prescription Standards Abbreviations Used When Prescribing Prescribing medication without a current UK Licence Service User Perspective Transcribing Prescriptions 13 a) Verbal Orders 12 b) Telephone Orders 13 c) The transcribing of medication information by a registered nurse onto the electronic patient record (care notes) 14 d) The transcribing of medication information by a registered nurse onto a medicines administration record Transfer of service users between wards/units Prescription Review Discharge Prescriptions, Weekend Leave and Visits 15 (TTOs/TTAs) Out-Patient Prescriptions FP10(HP) prescriptions Private Prescriptions Service User Information Process for the monitoring of side effects of medication 19 prescribed Monitoring of Prescriptions Administration of Medication and Recording Responsibility for the Administration of Medicines Who can administer medicines Principles for the Administration of Medicines Procedure for the Administration of Medication Clinical observations Rapid Tranquillisation Short Acting Insulin PRN Administration of Immunisations Administration of Medication in clinical departments Archiving of Records Authorisation for Nurses to Administer Discretionary Medicines Inpatient Units Patient Group Directions Cytotoxic Therapies (Chemotherapy) 5.3 Dispensing Dispensing Prescriptions Outpatient and Discharge Medication Access to Medication when the Pharmacy is closed 5.4 Ordering and Supply of Drugs Transport & Receipt 33 Page 3 of 80 September

4 5.6 Security, Storage and Control Security of Medicines Community Health Clinics and Teams Storage of Medicines Keys Temporary Ward/Unit Closure Expiry Dates, Losses and Discrepancies 5.7 Prescribing, Dispensing and Administration of Controlled Drugs Service User's Own Drugs Self Administration of Medicines Aids to Support Concordance (Compliance Aids) Disposal/destruction of medicines Disposal of unwanted or expired medication Disposal of illegal substances 6. Consent to Treatment 6.1 Informed Consent 6.2 Capacity to Consent to Treatment 6.3 Refusal of Treatment 6.4 Covert Administration of Medication 7. Risk Management 7.1 Adverse Reactions/Side Effects 7.2 Alert Notices 7.3 Medication Errors 7.4 Medical Representatives, Samples and Promotional Literature 7.5 Gifts and Benefits 7.6 Staff Medication Policy 8. Standards, Research, Audit and Monitoring 8.1 Standards, Audit and Monitoring 8.2 Clinical Trials Consultation, Approval and Ratification Process Dissemination, Implementation and Access to this document Process for monitoring compliance with and implementation of 68 this document 12 Process for reviewing, approving and archiving this document Associated Documentation 70 Supporting Guidance, Policies and Legislation 14 Definitions, Sources of further information and References Definition of Terms used in this document 73 Appendix l Form for Reconciliation of Medication on Admission 74 Appendix II Receipt of Medication Form 76 Appendix III Agreement for the removal of service user's own medicines 77 Appendix IIV Self Administration Information Leaflet 78 Equality Impact Assessment Stage One Page 4 of 80 September 2011

5 1. Introduction This policy and guidance provides the core standards and procedures to be followed by staff employed by Hertfordshire Partnership NHS Foundation Trust (HPFT) or seconded to the Trust from Partnership organisations, with regard to the prescribing, dispensing, storage and administration of drugs and related topics. The policy applies to all service users of Hertfordshire Partnership NHS Foundation Trust. Where a service is expected to follow the policies of Partnership organisations, this must be included in the service level agreement. Audit of this policy is through the audit of Standards for the Safe and Secure Handling of Medicines in the Trust carried out by the Medicines Management Team and specific audits as agreed by the Trust Drugs and Therapeutic Committee. 2. Purpose The purpose of this policy is to ensure that the prescribing, dispensing, storage and administration of drugs within the Trust follows national and legislative requirements. If there is a medicine related activity which is not covered by this core document, a written standard operational procedure (SOP) may need to be produced for the service. This will be agreed jointly by the appropriate Lead Nurse and the Medicines Management team. SOPs are monitored and archived as set out in section 11 and 12 of this document. 3. Duties The Chief Executive has the overall statutory responsibility for the safe and secure handling of medicines. Corporate responsibility for safe and efficient practices in the use of medicines leads from the Trust Board, through the Integrated Governance Committee to Trust Senior Managers. The Executive Director Quality & Medical Leadership is the lead director on medicines management for the Trust and is the link to the Trust Executive and the Trust Drugs and Therapeutics Committee. The policy and procedures are agreed by the Trust Drugs and Therapeutics Committee and the Trust Risk Management and Patient Safety Committee. All staff involved with medicines have a duty to ensure safe and secure handling of medicines through compliance with relevant legislation, Department of Health guidance, Trust policies and guidance produced by their professional bodies. Staff must be aware of and apply these requirements at all times. The Trust's Senior Managers are responsible for ensuring access and awareness of this policy and all team members are responsible for its implementation. A copy of this policy to be held in all clinical areas. Page 5 of 80 September 2011

6 Due to the geographical spread of the Trust, services are supplied by different pharmacies throughout the County. The Trust expects staff to follow the policies and instructions specifically relating to pharmacy arrangements provided by the Trusts which host those pharmacies. Line Managers must ensure that all direct care staff have clear instructions on the service operational procedure when prescribing, dispensing, storing or administering drugs in the area in which they are based. Individual health and social care professionals have the duty, within their area of responsibility, to implement the requirements set out in this document with regard to medicines management. This duty extends to the supervision of support staff when duties are delegated. 4. Training Lead health care professionals (and Ward Managers as appropriate) must ensure that new medical staff, registered nurses and other health/social care professionals are provided with a formal induction, which must include the provision of guidelines and protocols covering prescribing practice, medicines administration and error reporting arrangements. New members of staff should sign to acknowledge receipt and understanding of the guidelines as per the Trust Induction Procedure. The Trust Induction Checklist must also introduce new staff to contact points in the hospital s pharmacy service The HPFT Preceptorship Guidelines & Workbook sets out the specific requirements with regard to medicines management for newly qualified nurses/nurses returning to practice The requirements for the safe and secure handling of medicines may change over time. It is essential that all health professionals keep up to date with current practice through continuing professional development. It is the personal responsibility of all health care professionals to ensure that they keep their practice up to date. The Medicines Management Team provide a rolling programme of medicines management training for Trust staff. As part of the need for continuous professional development, the Trust will endeavour to support training initiatives with regard to medication issues when these are brought to the attention of managers or professional leads Social workers/support workers/health Care Assistants or other unregistered staff required to handle medicines to have training in medication issues as appropriate to their role. The Trust provides an NVQ Level 3 Support use of medication in social care settings Level3 HSC For further information refer to the HPFT document The role of unregistered members of staff in the administration of medicines to service users. Page 6 of 80 September 2011

7 4.2 Training Needs Analysis Hertfordshire Partnership NHS Foundation Trust Level of Training Induction Administration and safe handling of medication HSC3047 to support use of medication in social care settings Level3 Medicines Management Training Service Staff Group Provider Frequency Inpatient and Community Inpatient and community Community Inpatient and Community Medical Staff Registered Nurses Health/Social care Professionals Essential training All Registered Nurses to complete Medicines Management E- Learning and score 100% All other unregistered health support workers, Occupational Therapists and Social Care Professionals who handle medicines to complete HSC 3047 Level 3 Support use of medication in social care settings Medical Staff Registered Nurses Health/Social care Professionals HPFT HPFT HPFT HPFT Annual MMT Education & Training Programme On employment Every 3 years Once As required by the individual for continuous professional development The training schedule applies to indicated staff groups whether temporary or permanent. Section 4 of the Risk Management Training Prospectus , also describes the process for checking that all relevant staff groups complete the training they need, and the process for following up those who fail to attend this, or any such training Line Managers are responsible for ensuring that staff are trained and updated as required, and must keep records of this. Trust staff are responsible for attend the required training at the required intervals. 5. Prescribing, Dispensing and Administration of Medicines in All Care Environments Page 7 of 80 September 2011

8 Section 5.1 to 5.6 covers the prescribing, dispensing and administration of medicines other than controlled drugs which is detailed in Section Prescribing Prescribing Guidelines a) The Trust Drugs and Therapeutic Committee will take the lead in monitoring issues with regard to medication and advising where supplementary policies/protocols to the Trust are required. Service specific Therapy Advisory Committees will take the lead on local issues. b) The Drugs and Therapeutic Committee will provide specific prescribing guidance. c) The Trust will be advised on prescribing by the National Institute for Health and Clinical Excellence (NICE) which produces evidence-based guidance on clinical issues. d) The Trust will work to meet prescribing targets set out in the present or future National Service Frameworks as appropriate to Trust services. e) The treatment is based, whenever possible, on the service user's awareness of the purpose of the treatment and their informed consent. For further information on consent refer to Section 3 of this policy. f) The prescriber will follow the requirements of the HPFT policy for Reconciliation of Medicines on Admission to ensure that accurate and reliable information about the service user s medication is available. Refer to Appendix l for the recording form for the reconciliation of medication Prescribing Responsibilities Persons authorised to prescribe within the Trust: i. A medical practitioner employed by the Trust. All medical staff are required to practice within their competency. There is no specific restriction on the prescribing by medical staff other than those provided by statute and by the policies of the Trust. All medical staff are required prescribe within their capabilities and to seek further advice from appropriate authorities when needed, for example, from senior colleagues, pharmacist, medicines manufacturers and other competent established bodies. Individual clinical teams may have policies regarding prescribing, which medical staff are required to follow. ii. A nurse, pharmacist or allied health professional who has successfully completed a recognised training course as a supplementary prescriber. The supplementary prescriber can prescribe any medicine, including controlled drugs, which has been agreed with the independent medical prescriber and is included in a clinical management plan for the individual service user. All supplementary prescribers are required to practice within their competency. NB: Page 8 of 80 September 2011

9 Independent prescribing is not approved by the Trust unless authorised for an individual For further information refer to the "Supplementary Prescribing by Non-Medical Personnel within Hertfordshire Partnership NHS Foundation Trust". Medication is administered on the authorisation of a prescription written on an: official Trust prescription chart or out-patient prescription form or FP10(HP) or a General Practitioner's prescription A Patient Group Direction 1, which has been agreed by the Trust Drugs and Therapeutics Committee. Registered nurses named on the Patient Group Direction are authorised to administer the medication as instructed by the Patient Group Direction. For further information refer to the Trust document Policy and Guidance for Patient Group Directions Prescription Standards The prescription must be clearly written legibly in black ink, typed or computer generated and be indelible. (See Section 5.7 for writing prescriptions for controlled drugs). The prescription must clearly identify the service user for whom the medication is intended. The prescription must be signed and dated by the authorised prescriber. The prescriber is responsible for ensuring the prescription has the correct service user identification name, address, date of birth and that all information sections are completed. The prescription must clearly specify the medication to be administered, using its generic or brand name where appropriate and its stated form, together with the strength dose, timing, frequency of administration, start and finish dates (if applicable) and route of administration. Record the weight of the service user on the prescription chart where the dose of the medication is related to weight. If a prescription is in any way unclear, ambiguous or illegible, the prescriber must re-write or clarify before administration of the drug. Pharmacists may make minor clarifying amendments to the chart according to service operational protocol enabling procedures but must consult the prescriber first if the original instruction is unclear. Pharmacists employed by, or working on behalf of HPFT, will write on prescription charts in green ink. Purple ink may be used where copies of the 1 A patient group direction is a specific written instruction for the supply and administration of a named medicine in an identified clinical situation. It applies to groups of service users who may not be individually identified before presentation for treatment. Patient Group Directions HSC 2000/026 NHS Executive. Page 9 of 80 September 2011

10 prescription charts require transmission via a fax machine to the supplying pharmacy. Where the new prescription replaces an earlier prescription, the original prescription must have been clearly cancelled and the cancellation signed and dated by an authorised prescriber. Where a prescription is discontinued, the prescription must have been clearly cancelled and the cancellation signed and dated by an authorised prescriber. Any change in dose, route or time of administration must be made by the prescriber by re-writing the prescription completely. The prescription must not be for a substance to which the service user is known to be allergic or otherwise unable to tolerate. Drug sensitivities/allergies must be recorded clearly in the appropriate section of the prescription chart. The alert section of the care record/care notes must be completed and full information must be recorded in the care record. Refer to the HPFT policy for the Management of Care Records for the recording of alerts. Dosage quantities should be written as follows: Less than 1 gram should be written in milligrams, which may be abbreviated to mg, for example, 500 mg and not 0.5G. The dose units should be written in full where there is space to do so. Less than 1 mg should be written in micrograms and this should not be abbreviated, for example, 100 micrograms, not 0.1 mg and not 100 mcg. Where decimals are unavoidable, a zero should appear in front of the decimal point. General guidance on prescribing is available in the British National Formulary (BNF/BNFC). Abbreviations should be restricted to those listed Medicines must be reviewed periodically Prescribers in secondary care should inform the service user's GP of any changes within an agreed time scale. All prescription charts used in the Trust must be approved by the Drugs and Therapeutics Committee or the relevant Therapeutic Advisory Group. Page 10 of 80 September 2011

11 5.1.4 Abbreviations Which May Be Used When Prescribing Cap Capsule po by mouth (orally) ml. millilitres Inj Injection pr Rectally b.d. twice daily Supp Suppository pv Vaginally t.d.s. three times daily Tab Tablet Lt. Left q.d.s. four times daily Stat Immediately Rt. Right o.d. once daily PRN (when required) must be explained by further information, such as, the frequency, maximum daily dose and reason for use. (minimum dosage Neb Nebuliser o.m. or mane in the morning CONC. Concentrate interval) SC Subcutaneous Top Topical o.n. or nocte at night IM Intramuscular S/L Sublingual Inhal Inhalation IV Intravenous mg milligrams g. grammes For further details see the BNF/BNFC Prescribing Medication without a Current United Kingdom Product Licence or Licensed Products used outside the terms of their licence Definition In the United Kingdom, "licensed" medicines are those that have received a Marketing Authorisation (previously called a product licence). Licensing arrangements are determined by the Medicines Act 1968 and are implemented through the Medicines and Healthcare products Regulatory Agency (MHRA). For each medicine, the doses, indications, contraindications and side effects given in the British National Formulary reflect those in the manufacturer's Summary of Product Characteristics. Many medicines that are prescribed to service users are not licensed for the particular indication, age of the service user, or dose and their use in this situation has been termed as either 'off label' prescribing or the use of licensed drugs for an unlicensed application. Information on the use of unlicensed drugs in paediatric and psychiatric practice can be found in the Hertfordshire Partnership NHS Foundation Trust document, "Policy for The Use of Unlicensed Medicinal Products, And Medicinal Products Used outside the Terms of Their Licence" Page 11 of 80 September 2011

12 5.1.6 Service User Perspective (Also refer to section Service User Information) Staff work with service users from diverse communities and some may have specific communication needs. In order to achieve equality of service, staff require their competencies to meet the requirements of service users as expected under equality legislation for example, the Disability Discrimination Act 1996 and the Race Relations Amendment Act The following are some key points to consider when prescribing. a) Communication with the service user The provision of clear instructions and information to the service user regarding medication is essential to ensure compliance with treatment and that informed consent has been received. Information given to service users should be culturally appropriate. It should also be accessible to the service user with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Carers and relatives should have the opportunity to be involved in decisions about the service user s care and treatment, unless the service user specifically excludes them. Carers and relatives should also be provided with the information and support they need. Interpreting services are available within the Trust. The HPFT Policy Communicating with Service Users from Diverse Communities incorporates guidance on the interpreting service and gives full information on the service provided and how to access it. b) Interactions with other medication Effective communication with the service users will help to identify whether complementary medicines or over the counter medication are being taken that may affect their prescription. Prescribers need to ensure that the prescription takes into account any possible interactions. c) Cultural/Religious obligations/beliefs Where there are specific cultural/religious practices which affect compliance with treatment the service users should be given the opportunity to discuss and agree adjustments or alternatives to enable treatment to go ahead. Fasting Fasting is an important part of several religions. Usually people who are ill do not have to fast but they may wish to do so. Service users should be given the opportunity to discuss how the timing of medication can be adjusted during the fast and any other precautions that need to be taken. Page 12 of 80 September 2011

13 Ingredients of medication Hertfordshire Partnership NHS Foundation Trust The service user or family may ask a question relating to their medication e.g. is there gelatine in this medication? This request should be passed on to the relevant pharmacist, who would make the necessary checks and provide the information. In some cases they may be able to suggest an alternative suitable product. This request and the outcome should be noted in the care record Transcribing Prescriptions The Nursing and Midwifery Council states 2 As a registrant you may transcribe medication from one direction to supply or administer to another form of "direction to supply or administer". The nurse is responsible for their actions and omissions and is accountable for what s/he has transcribed. All prescriptions given by telephone, fax, text message or must be confirmed by the doctor who must provide a written prescription at the earliest opportunity, normally within 24 hours. The transcribing of prescriptions must not include Controlled Drugs (including temazepam The procedure for the transcribing of prescriptions is set out below: a) Verbal Orders Verbal orders are given to a registered nurse by a doctor when they are in the same room but are unable to write up a prescription. They should only be given in extreme circumstances. Verbal orders must be restricted to medicines commonly prescribed on the ward/unit and the prescription written up by the doctor following the procedure, as soon as possible, but no later than within 24 hours. b) Telephone Orders Telephone orders are not normally permitted in the Trust and telephone orders for controlled drugs (including temazepam) are NOT permitted. In circumstances where the doctor is not immediately available to see a service user, and there is an immediate need to administer a drug: - Wherever possible an electronic transmission (fax, or text via a blackberry) should be provided by the prescriber. The nurse must ensure that service user confidentiality is maintained. If the device used is not encrypted, identifiable information must not be used e.g. the NHS number used rather than a full name. In the case of a text, the text is deleted from the receiving handset after documentation of the content has been made (that is the complete text message, details of sender, telephone number (it was sent from), the time sent, any response given, and the signature and date when received by the registrant. and a second signature obtained that the documentation agrees with the text message. 2 Nursing and Midwifery Council, (2007) Standards for Medicines Management, Transcribing Standard 3 Page 13 of 80 September 2011

14 - At the initial assessment consideration should be given to a PRN prescription if it is thought that a drug may be required e.g. antimuscarinic drugs. - The fax or or transcription of the text must be attached to the prescription chart/medicine administration record and entered on the prescription chart by the nurse and administration recorded in the usual way. Where there is no prescription chart, the fax must be attached to the care record and an entry made on the record. - In an EXCEPTIONAL SITUATION when it is impossible to obtain a written prescription to prevent deterioration in a service user's condition, an instruction may be given over the telephone to a registered nurse (with a minimum of three years post registration experience) to change a dose or give an additional dose of an existing prescription. - The nurse retains the right to refuse to take a telephone message to administer a medicine. All such orders must follow the procedure below: - The prescribing doctor must either be employed by the Trust or be a General Practitioner. - The instructions must only be taken by a registered nurse (with a minimum of three years post registration experience) over the telephone from the prescribing doctor. - The nurse must record the instructions in black ink in the appropriate place on the prescription chart with the date and time, noting the fact that it was a telephone order from a named doctor. The doctor's name must be recorded with the date and time of the message. Where there is no prescription chart, an entry must be made in the care record. - Telephone instructions must then be read back to the prescribing doctor for verification. - Whenever possible, a second registered nurse should witness this procedure and countersign the entry. - The nurse should request confirmation of the prescription in writing as soon as possible. This request should be recorded. - Administration should be recorded in the usual way. c) The transcribing of medication information by a registered nurse onto the electronic patient record (care notes) Information on the electronic patient record (care notes) is for information only and must not be used for the administration of medication. The information can only be inputted by a registered nurse who is responsible for the accuracy of the information. Page 14 of 80 September 2011

15 When a prescription is changed it is the responsibility of the registered nurse updating the care record to ensure the medication information reflects the change. d) The transcribing of written medication prescriptions by a registered nurse onto a medicines administration record. This situation only occurs when a service user is admitted as a non-acute admission e.g. into a rehabilitation unit, and there is a delay in the medical practitioner attending to write up the prescription card. The fax from the surgery or a copy of a repeat prescription must be available. Within the Trust the transcribing of medication prescriptions by a registered nurse onto a medicines administration record in order to facilitate administration of medication is only carried out in exceptional circumstances following a local standard operating procedure agreed with the Medicines Management Team. The fax from the surgery or a copy of a repeat prescription must be attached to the record. The transcribing of prescriptions must not include Controlled Drugs (including temazepam). The transcribing can only be carried out by a registered nurse (with a minimum of three years post registration experience). The nurse must record the instructions in black ink in the appropriate place on the medicines administration record with the date and time, noting the fact that it is a transcribed prescription from a named doctor. A second registered nurse should witness this procedure and countersign the entry Transfer of service users between Wards/Units When a service user is transferred to another ward/unit within the Trust, the current prescription chart should be used until a new prescription chart is written; the ward/unit identification amended; and any individually dispensed medicines for the service user sent with them Prescription Review Inpatients It is good practice to review PRN medication at every medical review. If the BNF/BNFC dose of the PRN medication is exceeded in 24 hours, and the service user requires further treatment, the doctor must be called to review the PRN medication. All medication should be reviewed and rewritten at least every three months. All reviews to be recorded in the service user's care record. Community Services Service users using the community/outpatient service should normally have their medicines reviewed at least annually by the medical practitioner or during the Care Programme Approach review meeting whichever is soonest. All people over 75 years should have a medicines review by the prescriber annually and 6-monthly if the person is taking four or more medications in line with the National Service Framework for Older People, DOH Page 15 of 80 September 2011

16 Discharge Prescriptions, Weekend Leave and Visits (TTO/TTAs) a) The prescription is usually written by a doctor on an official discharge prescription form unless standard operational procedures are in place for agreed circumstances. b) Items supplied for inpatient use should not be issued unless a TTO has been written for the item and a pharmacist has authorised the supply. c) Fourteen days supply is provided for ongoing medication unless the duration of the course is less. Original packs should not be split if possible. Service users being treated for mental illness, with a history of self harm in the last three months before discharge must receive an appropriate length of supply of medication and covering no more than two weeks. 3 d) The pharmacy should be given advance notice of the discharge medication requirement as per standard operating procedures. e) For return of service users own drugs on discharge these should be returned to Pharmacy for checking with the TTO. f) Standard operating procedures apply for service users discharged g) Drugs for service users to take on a visit should be specifically dispensed by the pharmacy for that purpose Out-Patient Prescriptions a) Treatment given in Out-patient Departments must be documented in the care record. b) Prescriptions for out-patient users to be dispensed by the hospital pharmacy are written on the official out-patient prescription form, e.g. clozapine or hospital only supplied medication. c) FP10 (HP) prescriptions are used according to local standard operational procedure. d) The duration of treatment prescribed should be fourteen days supply for ongoing medication unless the duration of the course is less. Original packs should not be split if possible. Standard operating procedures arrangements can be made with the pharmacy to dispense in smaller quantities for service users with a history of self harm. d) The prescriber should record details of the prescription in the care record FP10 (HP) prescriptions An FP10 (HP) prescription is used if: this is the agreed system with the Head of Medicines Management and the service pharmacy. 3 Twelve Points to a Safer Service, Safety First 5-year report of the National Confidential Inquiry into Suicide and Homicide by people with Mental Illness, Department of Health, Page 16 of 80 September 2011

17 it is the agreed method of supply for community teams or where there is no access to hospital pharmacy services e.g. community based clinics, where a medicine must be prescribed by the Trust rather than by a GP prescription An FP10 (HP) prescription should not be used if the medicine is not on the Trust Formulary, unless agreed by the Head of Medicines Management. The supply of FP10 (HP) prescription pads is governed by local standard operational procedure. The FP10 (HP) prescription pads may be subject to misuse and for security purposes are classed as controlled stationery. Identification is required when pads are issued and a signature obtained. The pads must be locked away after use and a record maintained of the prescription issued according to Policy for Security of FP10(HP) Prescription Forms If blank prescription forms are found to have been lost or stolen the prescriber must take the following action: The Senior Finance Manager, Trust Head Office, (or their deputy) must be informed without delay by the prescriber with details of the prescriber, the approximate number of scripts stolen and their identification numbers. If the prescriber is not available, the line manager must take responsibility for notification. The Senior Finance Manager will then inform the East of England Strategic Health Authority who will take the appropriate action to prevent fraudulent use. The Senior Finance Manager will instruct the prescriber on any further steps that are required. The prescriber will inform the manager of the unit who will follow the Trust Untoward Incident Procedure (HPFT Learning from Adverse Events Policy) For additional monitoring during the introduction of non-medical prescribing to the Trust, refer to the policy Supplementary Prescribing by Non-medical Personnel within Hertfordshire Partnership NHS Trust Page 17 of 80 September 2011

18 Private Prescriptions Hertfordshire Partnership NHS Foundation Trust FP10 (HP) s must not be used for personal prescriptions for medical staff or for private service users, under any circumstance. Private prescriptions should not be written for NHS service users. Prescribers must not order medication through the Trust for their own use Service User Information a) When medication has been prescribed, the service user or carer will need to know the following information as appropriate. This may require, with the agreement of the service user, the involvement of advocates and/or carers to facilitate informed discussion. The name, form and strength of the medication The reason for using it When and how to take it How to know if it is effective and what to do if it isn't What to do if one or more doses are missed How long to continue taking it The risk of stopping it The most likely side effects, those unlikely but important and what to do if they occur Whether other medicines can be taken at the same time Whether other remedies alter the medicines effect What foods or drink, e.g. alcohol, should be avoided while taking the medication Any lifestyle changes e.g. smoking cessation that may affect the medication. Advice on how to get repeat prescriptions Provide a contact number (e.g. of the pharmacy, specialist nurse, doctor or NHS Direct) for more information and to check on any concerns about side effects. A good source of information about medicines may be obtained from choiceandmedication website which can be accessed via useful links on Trust website or Trustspace or by accessing and selecting Hertfordshire or an alternative site for a patient information leaflet (PIL) or a summary of product characteristics (SPC). b) If the medication is to be self administered, the risk of incorrect administration is greater. Where necessary, labels and other information regarding the medication should be made available in translated form, for example, "patient information leaflets" (PILs). Contact your local medicines information service to check the availability of these leaflets in different languages. Page 18 of 80 September 2011

19 c) Language interpreting services including sign language are available within the Trust. The HPFT Policy on Communicating with Service Users from Diverse Communities gives full information on the service provided and how to access it. d) It is a legal requirement to issue a patient information leaflet with every dispensed medicine. These are supplied by the pharmaceutical companies and distributed by the pharmacy. Information leaflets for service users are also available from e) The College of Mental Health Pharmacists medication advice leaflets (previously called UKPPG leaflets) are available from the choiceandmedication website via HPFT home page or Trustspace and selecting useful links. g) Services may wish to have their own material on medication issues, especially with regard to service users who have reading difficulties and require other forms of communication e.g. audio or pictorial. The Trust encourages staff to meet the needs of service users, however the Trust is responsible for the service user information it produces and staff must ensure that the content of such material is checked by a specialist. The Head of Medicines Management, Trust Head Office to be notified and invited to comment on any Trust information on medicines produced for service users. For further information refer to the Trust "Policy, Procedure and Guidance for the Production of Information for the Public". The manufacturer s patient information leaflet still needs to be issued in addition to other leaflets. h) To ensure equality of service, the use of translations into languages other than English, large print and audio versions should be considered. i) All service user information documents must be authorised by the Trust Information for the Public Group who can be contacted via the Communications Department, Trust Head Office. For further information refer to the Trust Policy, Procedure and Guidance on the production of information for the public Process for the monitoring of side effects of medication prescribed a) The prescriber is responsible for informing the nursing team administering the medication to a service user: of any monitoring for specific side effects and any schedule of physical observations that are required to be carried out during the treatment. b) These instructions must be recorded in the care record and brought to the attention of the nursing team. c) The outcome of monitoring to be recorded by the nursing team in the care record and made available at clinical review. d) The registered nurse administering the medication should know the therapeutic use of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications. Page 19 of 80 September 2011

20 e) Where medication is administered by a non-registered member of staff e.g. a community support worker, it is the responsibility/accountability of the registered staff member who is directing the unregistered member of staff, to monitor an individual patient prescription and to draw to the attention of the unregistered member of staff to specific known side-effects or risks associated with individual medicines. f) When prescribing for a service user in non-hpft residential homes, any monitoring required should be specified by the prescriber to both the home and the service user s GP Monitoring of Prescriptions The Clinical Pharmacist will screen prescription charts for accuracy and record interventions. The interventions will be collated into quarterly reports and reported to the HPFT Drugs and Therapeutic Committee. Page 20 of 80 September 2011

21 5.2 Process for the Administration of Medication and Recording in all care environments Responsibility for the Administration of Medicines It is the Team Leader/Manager's responsibility to ensure that members of his/her team and/or carers have received the relevant training, supervision and experience before being given responsibility for the administration of medicines. It is the nurse s responsibility to report to the Team Leader/Manager any concern about his/her personal competency level with regard to the administration of medicines in line with the requirements of the Nursing & Midwifery Council, the most recent Standards for Medicines Management and Code Standards of conduct, performance and ethnics for nurses and midwives. If required, a registered nurse should assess and record whether the service user/or informal carer is able to take responsibility for administration of medicines Who Can Administer Medicines a) Registered Nurses A registered nurse who is registered with the Nursing & Midwifery Council and has shown an agreed level of competency, may be given the responsibility for the administration of medicines. The HPFT Preceptorship Guidelines & Workbook sets out the specific requirements with regard to medicines management for newly qualified nurses/nurses returning to practice. Registered nurses may administer medicines to adults without a second checker with the exception of intravenous drugs and controlled drugs. In the following circumstances it is good practice for two registered nurses to be involved: In the administration of medicines to inpatients under sixteen years of age outside children's services. Where the practitioner is unfamiliar with the medicines to be given or unsure of the calculation, route or any other aspect of checking and administering the medicine. Agency registered nurses are registered practitioners accountable for their actions but the registered nurse delegating the tasks to them must be sure they have the knowledge and skill. Page 21 of 80 September 2011

22 b) Student Nurses Hertfordshire Partnership NHS Foundation Trust The administration of medicines is an important part of professional practice and it is essential that student nurses in order to achieve the outcomes and standards required for registration are provided with relevant experience of this activity. During their placements student nurses (Common Foundation and Branch) need to gain the skills as set out in their Skills Schedule. Student nurses must never administer/supply medicinal products without direct supervision. Student nurses need to be assessed by a registered nurse in the same or sub-part of the register (NMC Standards to support learning & assessment in practice current version) when administering medicines in a way which provides them with an understanding of the administration and management of medication The registered nurse is accountable for identifying the competency levels of the student to consider if the student is ready to undertake administration in whatever form. Equally a student may decline to undertake a task if they do not feel confident enough to do so. The relationship between the registered nurse and the student is a partnership and the registered nurse should support the student in gaining competence in order to prepare for registration. Specific requirements are set out in the Skills Schedule and the opportunities available within the unit which may include depending on the nature of the unit: Preparation for the administration of medication. Accurate reading of prescription sheets Calculate and administer accurately (i) oral medication e.g. liquid medicines and tables (ii) injections - intramuscular or subcutaneous e.g. insulin Administering Enemas Suppositories Instillation Eye drops and eye ointment Assist with the use of an inhaler, nebulisers, oxygen therapy Record administration of medicines Observe and report any contraindications and/or side effects Order and store medication in accordance with Trust and standard operating procedures. NB: Student nurses must not administer vaccinations, intravenous or cytotoxic drugs. The student nurse's participation in the administration of controlled drugs is confined to observation only. Throughout this process the Trust and any local standard operating procedures must be followed. Student nurses are also expected to follow the policies of their educational establishment. In all cases where a student nurse is involved with the administration of medicines, the registered nurse must remain with the student throughout the process. The student and the registered nurse must sign the service user s prescription sheet. Accountability for the safety of the service user and adherence to Trust and standard operating procedures remains with the registered nurse at all times. Page 22 of 80 September 2011

23 In any situation when the Trust or other relevant policy requires two registered nurses to be involved with the administration of a medicine, two registered nurses must directly supervise the student's involvement even when the student is administering the drug directly to the service users. If any doubt exists about whether a proposed involvement in the administration of medicines is appropriate, the University Link Lecturer/Ward Manager/Modern Matron should be contacted for advice. NB: If a student nurse is allocated to a unit within the Trust which does not employ registered nurses and the student is expected to be involved in the administration of medication, the placement support nurse must discuss the situation with the relevant lead nurse/unit Manager. c) Unregistered Practitioners Where a registered nurse is responsible for the delegation of any aspects of the administration of medicinal products they are accountable to ensure that the unregistered practitioner is competent to carry out the task. For the purpose of this policy this will include social workers and occupational therapists who are involved with handling medicines in any capacity. The role of the unregistered practitioner (support worker, drug worker, health care assistant as well as social workers and occupational therapists who handle medicines as stated above) is diverse within the Trust and they may be required to assist in medicines management. Their role should be stated in a local standard operating procedure or, for individual service users, stated in the care plan. A local standard operating procedure for signing for the administration of medicines must be in place. Training (including assessment of competency) appropriate to their role should be available and the support worker should have the support of clinical supervision by a registered health care professional, with consideration given for a joint visit from time to time as part of that supervision. For further information refer to the HPFT Policy relating to the role of a unregistered members of staff in the administration of medicines to service users. d) Carers In the community setting, with the agreement of the service user, a carer, having been given information, with clear and concise instructions, may assist in the administration of medicines to a named individual as deemed appropriate. A record of the administration should be kept. Where a registered nurse is responsible for the delegation of any aspects of the administration of medicinal products they are accountable to ensure that the carer is competent to carry out the task. e) Health Professionals registered under the Health Professions Council and Social Workers Health Professionals registered under the Health Professions Council and social workers who have the required competencies may carry out duties with regard to the administration of medication as appropriate to their role and as agreed with their manager. The NVQ Level 3 HSC 3047 Administration of Medication should be Page 23 of 80 September 2011