Brothers of Charity Services Clare ' I. 'H, I ~ Drugs Policy. Policy Statement No Signed: Date: 6 1h July, 2012

Transcription

1 I ~ Brothers of Charity Services Clare ' I. 'H, Drugs Policy Policy Statement No Signed: Date: 6 1h July, 2012 Policy No: Implementation Date: 6 1h July, 2012

2 DRUGS POLICY Policy Statement No TABLE OF CONTENTS Review Group Members...2 Status of Drugs Policy...2 Review of Policy Introduction Prescribing of Drugs Dispensing of Drugs Administering of Drugs Procedures for Oxygen Adminsitration and Storage Procedures for Drug Administration Self-Administration of Drugs Recording of Drugs Storage of Drugs Non-Prescription Medication Transportation of Drugs Procedures in the Case of an Accident with Drugs or Substances Parents, Guardians and Family Participation General Recommendations Appendices

3 DRUGS POLICY Policy Statement No Vision Love and Respect for All towards a Full and Valued Life. Review Group Members Mary Coghlan - Community Co-Ordinator, Kilrush Karen Downes - Community Co-Ordinator, Kilrush Patricia O Meara - Family Support Co-Ordinator Louise Skerritt - Community Co-Ordinator, Ennistymon The Drugs Policy Review Group Members consulted with the Consultant Psychiatrist to the Brothers of Charity Services Clare, the Management Team and a number of staff throughout the Clare Region. Purpose of this Policy This policy document sets out the procedures for the safe administration and management of medication. Scope of this Policy This document applies to all staff, students and volunteers (if applicable). Throughout this document the term staff is used and includes all persons paid or unpaid who support people using our service. Status of Drugs Policy Year/No Type Description Status Policy Drugs Policy Obsolete Policy Drugs Policy Obsolete Policy Drugs Policy Current This policy will apply retrospectively to all issues that occurred prior to its introduction. References to other Policies/Documents Mis-Use of Drugs Act, Self-Medication Assessment Guidelines Developed by Kathy O Grady, Senior Psychologist, Sisters of Charity of Jesus and Mary Services, Midlands. Policy Approved By This policy (and Appendices) have been agreed and approved by the Chief Executive Leader and the Management Team. Policy Review This policy will be reviewed on a yearly basis. More frequent reviews may take place if deemed warranted. This policy will be reviewed in line with current legislation and standards of good practice. 2

4 DRUGS POLICY Policy Statement No INTRODUCTION The Brothers of Charity Services are responsible for the safe administration of drugs to individuals receiving supports and services. The purpose of the Drugs Administration Policy document is to provide guidelines which: o o Promote and facilitate opportunities to support individuals to have increased independence in relation to the day to day administering of their medication. Will ensure that drugs can be administered without risk to the individual. All persons involved in drugs administration are urged to adhere carefully to the policies outlined in the Drugs Policy document. Drugs must always be administered in a professional and confidential manner. This is particularly important where drugs are administered in public places e.g. restaurants or cafes. All persons supporting the individual must undergo training on drug administration before they can administer medication. 2. PRESCRIBING OF DRUGS 2.1 All drugs administered to individuals will be prescribed by a Medical Doctor, Consultant or Dentist. 2.2 Only drugs covered by a current prescription can be administered. 2.3 Prescriptions will always be signed by the prescribing doctor. 2.4 Prescriptions will contain the name of the individual and his/her address. 2.5 Prescriptions will contain the name of the prescribing doctor, his/her address and telephone number for contact. 2.6 Prescriptions will specify: - name of the drug; - date prescribed; - dose to be taken; - strength (if appropriate); - frequency of administration; - route of administration; - duration the drug is to be taken for, and; - total quantity of drug to be dispensed or the number of dosage units to be supplied. 3

5 DRUGS POLICY Policy Statement No DISPENSING OF DRUGS 3.1 Drugs will be dispensed by qualified pharmacists. 3.2 Dispensed drugs will be clearly labeled and the label will contain: - name, address and telephone number of the pharmacist; - individual s name; - name of the drug; - dose to be administered; - frequency of administration; - expiry date, and; - storage regulations (if necessary). 3.3 Only identified personnel employed by the Brothers of Charity Services can collect prescriptions/drugs. It must be decided and agreed at a team meeting, the identified and named person who will take responsibility for the collection of prescriptions /drugs. Where it is the wish of the individual to collect their own prescriptions/drugs, this will be supported and facilitated by the organisation as outlined in the individual s plan. All prescriptions/drugs must be counted and signed for by the person collecting them upon checking that they are as per the prescription when they return to the location where the individual s medication is stored. Medication must be counted weekly on the same day and time and recorded and signed. 4. ADMINISTERING OF DRUGS 4.1 All prescription drugs administered to individuals in the Brothers of Charity Services must be prescribed by a medical doctor, consultant or dentist. 4.2 A named person identified at an individual s team meeting will take responsibility to inform the individual regarding medication prescribed. On a regular and ongoing basis the named person will discuss any concerns/ questions the individual may have in relation to their medication. 4.3 Where there is more than one individual s medication stored in the drug press, it will be the responsibility of the staff member to remove a drug from the drug press. The staff member will then be responsible for its administration and recording, except when away from the location the individual is supported 1. 1 No 6. Procedures for Drug Administration (Point 6.6) 4

6 DRUGS POLICY Policy Statement No Decisions made regarding alternative medication/treatment must be discussed at the team meeting and must also be discussed with the medical practitioner or consultant. Individuals/Parents/Guardians/Next of Kin who request that alternative medications be administered must discuss this with the Manager/Co- Ordinator and sign the standard Disclaimer Form Drugs may be administered when an instruction is provided by fax, provided it is signed by the prescribing doctor. The original will be forwarded for insertion into the individual s file. 4.6 Requests, either verbal or written, from parents, guardians or family members regarding commencement or change in individual s drugs will not be accepted without a prescription from a doctor, consultant or dentist. 4.7 Drugs will not be administered to children under 16 years unless the standard Brothers of Charity Service s Clare Consent Form for Drugs Administration has been signed by parents or legal guardians 3. The signing of a similar consent form for adults is also necessary. 4.8 All persons supporting the individual must undergo training on drug administration before they can administer medication. People who support individuals with Epilepsy must undergo training on Epilepsy Awareness and Rescue Medication (i.e. Midazolam/Epistatus, Stesolid, Diazepam). 4.9 Training includes step by step instruction/demonstration by a nominated competent trained team member or the individual s family Nominated staff can undertake the administration of: - all oral drugs; - rectal drugs in suppository form (which do not have to be mixed or prepared); - nutrients or drugs through a gastrostomy button (with training); - inhalations and topical drugs; - nebuliser treatment (with instruction); - oxygen therapy (with training); - insulin pen (with training) Blister Packs The Brothers of Charity Services Clare supports the use of Blister Packs for the administering of medication. The following process must be followed and documented: 2 Appendix 1 Consent Form for the Administration of Alternative Medication 3 Appendix 2 Consent Form for General Medical Care and for the Administration of Drugs 5

7 DRUGS POLICY Policy Statement No Consult and discuss the use of blister packs with the individual s GP and the pharmacy It must be decided and agreed at a team meeting, the identified and named person who will be responsible for the collection of the blister pack(s) from the pharmacy The nominated person will ensure that all the blister pack(s) have been double checked by the pharmacist as per prescription All prescription drugs dispensed in blister packs must be checked and signed for by the person collecting them upon checking that they are as per Kardex or MAR (Medication Administration Record) sheet when they return to the location where the individual s medication(s) are stored Any errors in the dispensing of the medication by the pharmacist must be rectified immediately and the blister pack(s) returned to the pharmacy for correction. These errors must be reported to the Manager/Co-Ordinator Where it is the wish of the individual to collect their own prescription(s)/drug(s), they will be supported and facilitated by the organisation as outlined in their individual plan In the event of a change in the individual s medication, the blister pack(s) will be returned to the pharmacy to dispense the new prescription The use of blister packs does not negate the need for all staff to be aware of the medication the individual takes. 5. PROCEDURES FOR OXYGEN ADMINISTRATION AND STORAGE 5.1 Oxygen will not be stored in a location, where the individual is supported unless prescribed by a doctor. 5.2 When stored, the instructions that accompany the storage of oxygen cylinders will be carefully followed: - The cylinder will be kept in a secure place. - The cylinder will not be stored near any combustible material and will not be subjected to extreme heat or cold. 5.3 When oxygen is in use, smoking is prohibited and no naked flames will be allowed. Warning notices prohibiting naked lights will be posted clearly. Caution will be necessary when using certain other materials such as a burner with aromatherapy oils. 6

8 DRUGS POLICY Policy Statement No The person supporting the individual will record the administration of oxygen on the drugs chart. 5.5 All persons supporting the individual to administer oxygen will be nominated and trained. They must ensure that there is an adequate supply and that the equipment is in good working order. 5.6 Empty oxygen cylinders and out of date cylinders will be returned to the oxygen suppliers without delay. 6. PROCEDURES FOR DRUG ADMINISTRATION 6.1 Drugs will not be administered by staff unless they are in the container in which they were dispensed by the pharmacist or doctor and have the dispensing label on the container. Drugs must not be removed from their original container until the time of administration. In the event of an individual expressing a wish to self-administer this will be supported by the organisation and an individual training plan will be put in place. 6.2 Before administering a drug, the person administering it will refer to the Kardex or MAR (Medication Administration Record) sheet and check the following: - name of the drug; - name of the individual; - dose to be administered; - time and frequency of administration, and - expiry date. 6.3 When there is any concern about the legibility of a prescription or label, the person administering the drug will consult the medical practitioner who prescribed the drug or the pharmacist who dispensed it or the doctor on call, before administering the drug. 6.4 At the time of drug administration, the person administering it will initial the drugs chart, in accordance with the guidelines outlined in the Recording of Drugs section. 6.5 The person administering an oral drug will ensure that the drug has been swallowed by the individual. 6.6 If people have concerns about the administration of drugs in public places, they must contact their Manager or a member of the Drugs Policy Committee. 6.7 All persons, supporting the individual must undergo training on drug administration before they can administer medication. 7

9 DRUGS POLICY Policy Statement No Adverse reactions will be recorded on the drugs chart in red, and a medical practitioner must be informed. Further administration of the drug will be withheld until medical consultation. Parents, guardians and relevant staff will be informed. 6.9 If the individual received any drugs (prescription or non-prescription) other than his/her daily drugs, Parents/Guardians and the person supporting the individual, should be informed (preferably in writing) on the day. Information given verbally must be recorded in the person s home or location where they receive support and services All individuals on medication must be reviewed annually and the Kardex updated. On an individual basis each team needs to be responsible for the reviews which can occur more frequently. 7. SELF-ADMINISTRATION OF DRUGS 7.1 Children under the age of 16 years will not administer drugs to themselves, however, if someone under the age of 16 expresses a desire to selfadminister, the self-administration procedure must be followed. Parental/Guardian consent is required. 7.2 The organisation supports individuals expressing a desire to administer their own drugs. Individual support plans identifying support and training needs will be put in place to support individuals to achieve their wish or goal. It may be necessary to consult with medical personnel in relation to these issues. Self-Medication Assessment Guideline Form is attached for use if required 4. All prescription drugs must be stored in a locked container within a locked press. It is recommended that for those self-administering, their prescribed medications are collected weekly RECORDING OF DRUGS 8.1 All drugs administered will be recorded in the Drugs Recording Charts. These charts must be kept for five years The person administering drugs will initial the drugs chart immediately following administration. An up to date record of all staff names (signature and initials) must accompany each drug recording sheet 7. 4 Appendix 3 Self-Medication Assessment Guidelines 5 Appendix 4 Consent Form for General Medical Care and the Self-Administration of Drugs 6 Appendix 5 Record Sheet for Short Term Prescriptions; Appendix 6 Record Sheet for Long Term Prescriptions; Appendix 8 Record of Staff Name(s), Signature(s) and Initial(s) 7 Appendix 8 Record of Staff Name(s), Signature(s) and Initial(s) 8

10 DRUGS POLICY Policy Statement No Short-term drugs i.e. anti-biotic, anti-inflammatory and analgesics (less than two weeks) can be administered without the prescription being written on the drugs chart by the doctor, provided the drug is in the container in which the pharmacist or doctor dispensed it and has the dispensing label attached. The person administering the drug will record the name of the drug and the dosage as well as the name and address of the dispensing pharmacy on the Drugs Chart Long-term drugs will not be administered without a prescription and must be written in the drugs Kardex by the prescribing doctor All drug prescriptions will be reviewed and rewritten annually, and the old prescriptions will be cancelled by the doctor. 8.6 The drugs chart, together with all prescriptions, recordings sheets and instruction letters from doctors will be held in the individual s working file. All records must be kept for five years. 8.7 When an individual no longer receives support from the Brothers of Charity Services Clare, all records on drug administration including consent forms, will be transferred to the individual s central file by the Manager or Co- Ordinator. 8.8 Clear written instructions must be written into the Kardex to govern the use of P.R.N. (Pro Re Nata) (as required) Drugs. The frequency and reasons for administration must be closely monitored by the managers of each area, using the forms provided, and brought to the attention of medical personnel Before administering Rescue Medication (i.e. Midazolam/Epistatus, Stesolid, Diazepam) protocol must be followed and adhered to When an individual is administered P.R.N. medication, the family or the person supporting the individual should be informed as soon as possible by the person that administered the medication. 9. STORAGE OF DRUGS 9.1 Drugs will be stored in the original container only in a locked press, within a locked press, which will be attached to a wall. Only currently prescribed drugs should be stored in this press. Where an individual is living on their own, it is recommended that their medication is kept in a locked press. 8 Appendix 5 Record Sheet for Short Term Prescriptions 9 Appendix 6 Record Sheet for Long Term Prescriptions (Drug Kardex) 10 Appendix 9 P.R.N. (as required) Drugs 11 Appendix 10 Protocol for Emergency Medication 9

11 DRUGS POLICY Policy Statement No Drugs will be stored in an appropriate environment, as indicated on the dispensing label. It is recommended that drugs requiring refrigeration should be stored in a locked fridge which is not used for other purposes. If such a facility is not available then the drugs should be stored in a locked box within a fridge. 9.3 The monitoring of drugs in storage will be the responsibility of a designated person in each area, who will ensure that discontinued drugs and drugs which have passed their expiry date, will be returned to the unused medication bin in the pharmacy. 9.4 Missing drugs will be recorded on the relevant form. Any unusual frequent loss of/or disappearance of drugs must be reported via the Manager to the appropriate Senior Personnel NON-PRESCRIPTION MEDICATION In keeping with the ethos of ordinary living, a limited supply of non-prescription drugs and lotions should be available for individuals in a location where they receive supports and services, for the systematic relief of minor ailments, headaches, cuts and/or, grazes. These must be used strictly in accordance with the instructions on the packaging. Any symptoms requiring persistent use of nonprescription medication must be reported to the relevant Medical Doctor. These drugs, lotions, creams etc., should be stored in a locked press, but separately from prescribed drugs. The person administering these medications must keep record of same. Individuals requesting access to and/or a supply of non-prescription medication will be facilitated and supported in consultation with the Co-Ordinator/Manager or representative. 11. TRANSPORTATION OF DRUGS Drugs for use when at home or in respite must be sent in their original containers. 12. PROCEDURES IN THE CASE OF AN ACCIDENT WITH DRUGS OR SUBSTANCES 12.1 In the event of accidental mis-administration, or overdose of drugs, the G.P. will be informed immediately. If this is not possible, contact the Poison Advice Unit, Beaumont Hospital, Dublin at or in an emergency The Manager will be informed and parents/guardians will be notified as soon as possible. 12 Appendix 11 Missing Drugs/Drugs Discrepancy 10

12 DRUGS POLICY Policy Statement No The Brothers of Charity Services Mis-Administration of Drugs 13 or the accident/incident form will be completed. The incident form and report will be submitted to management. 13. PARENTS, GUARDIANS AND FAMILY PARTICIPATION 13.1 When an individual/family receive notification that the organisation will provide supports and services, h/she or his/her parents, guardians or appropriate family members will be informed of the Drugs Policy document and relevant points will be explained to them by the Co-Ordinator/Manager As part of the admissions procedure, the individual, parents, guardians or appropriate family members will be requested to sign the relevant consent form. In the case of children under the age of 16 years, parents or legal guardians will sign the consent form for drugs administration. In the case of adults (over the age of 16 years) who are unable to give an informed consent on their own behalf and whose families have maintained regular contact with them, parents or guardians will sign the Consent Form 14. If the parents or guardians are deceased or unable to sign the consent form, a family member who has the closest relationship with the individual will sign. 14. GENERAL RECOMMENDATIONS o o o o It is the responsibility of Managers/Co-Ordinators to ensure that staff and people supporting individuals reporting to them have read and understood the Drugs Policy document and that staff have access to the document. When an individual s supports commence his/her parents, guardians or appropriate family members will be informed of the Drugs Policy document and relevant points will be explained to them. It is the responsibility of all involved in the administration of drugs to follow this policy. All persons supporting the individual can administer medication with training from a nominated person who has undergone training and works with the individual. 13 Appendix 12 Mis-Administration of Drugs 14 Appendix 2 Consent Form for General Medical Care and for the Administration of Drugs 11

13 DRUGS POLICY Policy Statement No o o o Times on prescription sheets must match the times that drugs are actually administered i.e. most morning administration occurs around 8.00a.m. Medication used personally by staff during working hours must be stored in a safe place and where necessary discussed with their Manager. The use of controlled drugs is governed by specific requirements and if using seek advice from the Pharmacist once prescribed. 12

14 Appendix 1 Consent Form for the Administration of Alternative Medication

15 CONSENT FORM for the Administration of Alternative Medication Individuals, Parents/Guardians/Next of Kin who are requesting that alternative medications, which have not been prescribed by a medical doctor, be administered to the individual must sign this form disclaiming any responsibility by the Services. I/We give my/our full permission to have (Name(s) of Alternative Medication(s)), administered to (Name of Individual), (Date of Birth). I/We understand that a Medical Doctor has not prescribed these medications and I/We take full responsibility for the consequences. I/We understand that this form must be discussed with a doctor/consultant before commencing any new alternative medication. Signed: Date: (Individual/Parent/Guardian/ Next of Kin) Signed: Date: (Signature to be Witnessed) Drugs Policy (Policy Statement No )/Version I/06/07/2012

16 Appendix 2 Consent Form for General Medical Care and for the Administration of Drugs

17 CONSENT FORM for General Medical Care and for the Administration of Drugs Individuals, Parents/Guardians/Next of Kin are required to sign this form prior to an individual receiving a service from Brothers of Charity Services Clare. I/We give my/our full permission to have (Name of Individual), (Date of Birth), examined and treated by a medical doctor if this is deemed necessary, while he/she is in the care of the Brothers of Charity Services Clare. I/We also give my/our full permission to have drugs that are prescribed by a medical doctor administered to him/her by the Brothers of Charity Services Clare staff and all persons who provide support to the individual. This consent remains valid until I/We notify the Brothers of Charity Services Clare in writing that I/We am/are withdrawing my/our consent. Signed: Date: (Individual/Parent/Guardian/ Next of Kin) Signed: Date: (Signature to be Witnessed) Drugs Policy (Policy Statement No )/Version I/06/07/2012

18 Appendix 3 Self-Medication Assessment Guidelines

19 Self-Medication Assessment Guidelines 1.0 Purpose 1.1 In keeping with the objectives of promoting independence, autonomy and self-direction and balancing facilitating these objectives with our need to ensure the best quality care, health and safety the following best practice guideline was developed. It has the twin aim of directing staff to undertake a measure of the focus person s capacity and giving the focus person an opportunity to demonstrate their capacity. 1.2 The purpose of this document is to outline the procedures to be followed to evaluate an individual s level of ability to self-medicate and to establish if the person is capable of benefiting from a programme of training in self-medication and to provide guidelines for follow up on individuals who presently self-medicate, over time. 1.3 The information gleaned from completing a self-medication assessment guideline will support the decisions made by service users, parents and carers and staff directly. 2.0 Scope 2.1 This guide applies to all service users who aim to self-medicate and the interdisciplinary team involved with that person. 3.0 Responsibility 3.1 It is the responsibility of the interdisciplinary team, in conjunction with the service user, to determine the feasibility of the service user to self-medicate and the conditions under which this takes place. 4.0 Self-Medication Assessment 4.1 Cognitive evaluation will take place during the course of which an ability rating on a person s capacity to self-medicate will be given. 4.2 The team will determine in conjunction with the Service User, at interdisciplinary level, the feasibility of a person engaging in self-medication. 4.3 If it is felt that the Service User is capable of learning to self-medicate, and selfmedication is a priority, than a training programme will be administered as part of the Individual Care and Person Centred Plan with outcomes measured and reviewed. 4.4 When a person is undertaking training to self-medicate programme this will be reviewed at agreed intervals e.g. three times a year, or as necessary. 5.0 Criteria to Determine a Person s Ability to Self-Medicate 5.1 The self-medication assessment guideline should be completed with a positive determination. Drugs Policy (Policy Statement No )/Version I/06/07/2012

20 5.2 The person must be monitored over an agreed period of time i.e. three to six weeks and must demonstrate an ability to medicate consistently with accuracy. 5.3 The interdisciplinary team in partnership with the service user, parent and carers (if appropriate) will decide the conditions under which self-medication takes place such as: In the presence of a staff member; When the person is using drug administration aids etc., or Without any stipulation. 6.0 Follow Up 6.1 Given that a person may vary over time in terms of his/her ability to self-medicate, follow up is essential and it would be important that within the individual person centred/care plan that cognisance is taken of self-medication performance. Drugs Policy (Policy Statement No )/Version I/06/07/2012

21 Self-Medication Assessment Guideline Form Part I - Record 1. Details of Individual Self-Medicating: Name: Date of Birth: Telephone No.: 2. List of present medication (include format i.e. liquid, tablets etc.): Medication Dosage Times of Administration 3. Details of Doctor prescribing medication: Name: Address: Telephone No.: 4. Who is presently administering medication? (Please list all people) Please list the reason(s) why medication is necessary: Drugs Policy (Policy Statement No )/Version I/06/07/2012

22 6. Does the person have any allergies? Yes No If Yes, please list: 7. Does the person have any other physical/medical condition that may effect medication regimes? Dietary (i.e. celiac, eating problems) Yes No Respiratory (asthma) Yes No Epilepsy Yes No Other Yes No If Yes, please list: 8. Are there any factors that will impact on his/her ability to self-medicate? Yes No If Yes, please expand: 9. Does the person want to participate in self-medication? Yes No 10. Does the person have a history of self-medicating reliably? Yes No Drugs Policy (Policy Statement No )/Version I/06/07/2012

23 Part II Cognitive Skills Re: Self-Medication Literacy 1. Can the person read? Yes No If Yes, please give reading age equivalent: R.A.: 2. Can the person recognise their name as typed on the medication container? Yes No Numeracy 1. Is the person able to recognise written number? Yes No (Test on sample instructions such as take 2 tablets 3 times a day ) 2. Can the person count? Yes No Size Please circle how high Can the person discriminate by size? Yes No (Test by presenting a little and big tablet and ask the person to show you the small and large tablet over a number of trials) Colour 1. Can the person readily identify colour? Yes No (Test colour reliability on at least 4-5 different colour tablets e.g. white, pink, yellow, blue, two tone by matching coloured cards to colour tablet, or by asking the person to point to the named colour, repeating this 2-3 times to ensure consistency) Shape 1. Can the person discriminate by shape of medication? Yes No (to Test, present tablet/pill and capsule in round and oval format and ask the person to point to the correct shape when named) Liquid 1. If the person is on liquid suspension show the person two or more bottles and ask the person to pick their bottle. 2. If the liquid suspension has to be measured out, does the person demonstrate an ability to prepare the current dosage? Yes No Drugs Policy (Policy Statement No )/Version I/06/07/2012

24 Part III Communication Skills Expressive Language 1. Can the person talk freely? Yes No 2. Does the person initiate communication with others? Yes No 3. Does the person ask for help when they need it? Yes No Receptive Language 1. Can the person follow simple one-step instructions? Yes No 2. Can the person follow complex (two or more step) instructions? Yes No Time 1. Can the person relate time to daily events (e.g. meal times)? Yes No 2. Does the person know what time to take his/her medication? Yes No 3. Can the person recognise and explain the written time on medications? Yes No (e.g. 8.00am, 6.00pm etc.) 4. In the case of P.R.N. s, can the person deduce the next dosage time? Yes No (e.g. every four hours) Physical Barriers 1. Can the person get and open medication? Yes No 2. Can the person choose and put away medication? Yes No (have the person demonstrate this skill; check what adaptations/assistive technology can be used to diminish physical barriers e.g. placing meds in one unit container) 3. Does the person wear eye glasses? Yes No Is the person visually impaired? Yes No 4. Does the person wear a hearing aid? Yes No Is the person hearing impaired? Yes No 5. Can the person get a drink to take with the medication? Yes No 6. Does the person have any difficulty swallowing? Yes No Drugs Policy (Policy Statement No )/Version I/06/07/2012

25 Health Maintenance 1. Does the person know basic first aid? Yes No 2. Does the person know the desired effect of each medication? Yes No 3. Does the person know the possible adverse effects of each medication? Yes No 4. Does the person recognise an emergency situation? Yes No 5. Does the person know what to do in an emergency? Yes No 6. Can the person use a telephone? Yes No 7. Can the person state his/her name? Yes No 8. Can the person state his/her address? Yes No 9. Can the person state his/her phone number? Yes No Thank you for completing this Self-Medication Assessment Guideline Please tick the conditions under which a named service user can self-medicate: Is competent to self-medicate without supervision Is competent to self-medicate with supervision Is competent to self-medicate with verbal/physical prompts Is not capable of self-medication at the present time, but might do so given training Is not capable and is unlikely to do so at any stage N.B. It will be necessary to reassess a person(s) capacity to self-medicate at regular intervals. Name (block letters): Signature: Date of This Review: Date of Next Review: Drugs Policy (Policy Statement No )/Version I/06/07/2012

26 Appendix 4 Consent Form for General Medical Care and the Self- Administration of Drugs

27 CONSENT FORM for General Medical Care and the Self-Administration of Drugs Individuals, Parents/Guardians/Next of Kin are required to sign this form prior to an individual receiving a service from Brothers of Charity Services Clare. I/We give my/our full permission to have (Name of Individual), (Date of Birth), examined and treated by a medical doctor if this is deemed necessary, while h/she is in the care of the Brothers of Charity Services Clare. I (Individual s Name) agree to take responsibility to selfadminister my medication. This consent remains valid until I/We notify the Brothers of Charity Services Clare in writing that I/We am/are withdrawing my/our consent. Signed: Date: (Individual/Parent/Guardian/ Next of Kin) Signed: Date: (Signature to be Witnessed) Drugs Policy (Policy Statement No )/Version I/06/07/2012

28 Appendix 5 Record Sheet for SHORT Term Prescriptions

29 RECORD SHEET FOR SHORT TERM PRECRIPTIONS Name: Date Name of Drug Dosage Name and Address of Dispensing Pharmacy Time Time Time Time Comments Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Time Time Time Time Initial Initial Initial Initial Drugs Policy (Policy Statement No )/Version I/06/07/2012

30 Appendix 6 Record Sheet for LONG Term Prescriptions

31 RECORD SHEET FOR LONG TERM PRESCRIPTIONS Name: Date of Birth: Date 8 am 10 am 12 md 2 pm 6 pm 8 pm 10 pm Other Times Comment/ Discrepancy Initial. Initial. Initial. Initial. Initial. Initial. Initial. Initial. Initial. Initial. Drugs Policy (Policy Statement No )/Version I/06/07/2012

32 Appendix 7 Long Term Prescription Sheet (Sample of Kardex Card)

33 USE PRE-PRINTED KARDEX CARD

34 Appendix 8 Record of Staff Name(s), Signature(s) and Initial(s)

35 RECORD Staff Name(s), Signature(s) and Initial(s) Staff Name (Print) Staff Signature Staff Initials Record Updated Date: Signed: Date: (Line Manager) Drugs Policy (Policy Statement No )/Version I/06/07/2012

36 Appendix 9 P.R.N. (as required) Drugs

37 P.R.N. (as required) DRUGS THIS FORM MUST BE COMPLETED AND RETURNED TO THE RELEVANT LINE MANAGER AFTER THE ADMINISTRATION OF ANY P.R.N. DRUGS. Service Area: Name of House/Location: Name of Individual: Time Administered: How Long it took to Work: Did it Work: P.R.N. Medication including Dosage: Reason for Administration: Effect it had on the Person: Signed: Signed: Line Manager Date: Date: Drugs Policy (Policy Statement No )/Version I/06/07/2012

38 Appendix 10 Protocol for Emergency Medication

39 PROTOCOL FOR EMERGENCY MEDICATION Name: D.O.B.: Address: Medical Card No.: DESCRIPTION OF SEIZURE(S) REQUIRING EMERGENCY MEDICATION: If. has a seizure as described above which lasts longer than minutes, or a cluster of within minutes Give.ml ( mg) of... (bucally/intra-nasally) Wait 10 minutes If the seizure shows no sign of stopping give a second dose of ml ( mg) of CALL 999 If: The seizure does not stop minutes after the administration of 2 nd emergency medication OR If another seizure occurs within 6 hours When the seizure has stopped or you call 999, call s Parent/Carer to advise them that you have given emergency medication. Doctor s Signature: Phone No.: Print Name: Date: Parent/Guardian s Signature: Phone No.: Print Name: Date: (Agreement to the implementation of the guideline) DOCTOR S STAMP: REVIEW DATE: (Annually from date prescribed) Drugs Policy (Policy Statement No )/Version I/06/07/2012

40 Appendix 11 Missing Drugs/Drugs Discrepancy

41 MISSING DRUGS/DRUGS DISCREPANCY THIS FORM SHOULD BE COMPLETED AND RETURNED TO THE LINE MANAGER IF THERE IS AN UNEXPLAINED DISCREPANCY/LOSS OF DRUGS. THE FORM MUST BE SENT TO THE LINE MANAGER FOR SIGNATURE PRIOR TO GOING TO THE REGIONAL MANAGER. Service Area: Name of House/Location: Name of Individual: Name of Drug Unaccounted for: Amount of Drug Unaccounted for: Additional Relevant Information/ Action Taken: Signed: Signed: Line Manager Date: Date: Date sent to Regional Manager: Drugs Policy (Policy Statement No )/Version I/06/07/2012

42 Appendix 12 Mis-Administration of Drugs

43 MIS-ADMINISTRATION OF DRUGS THIS FORM SHOULD BE COMPLETED AND RETURNED TO THE LINE MANAGER IF DRUGS ARE MIS-ADMINISTERED AND/OR IF THERE IS AN UNEXPLAINED DISCREPANCY/LOSS OF DRUGS. THE FORM MUST BE SENT TO THE LINE MANAGER FOR SIGNATURE PRIOR TO GOING TO THE REGIONAL MANAGER. Service Area: Name of House/Location: Name of Individual: Name of Drug Mis-Administered: Amount of Drug Mis-Administered: Doctor Notified: Name of Doctor: Additional Relevant Information: Signed: Date: Signed: Date: Line Manager Date sent to Regional Manager: Drugs Policy (Policy Statement No )/Version I/06/07/2012