Guidelines and Procedure for the Safe Administration and Management of Medicines

Transcription

1 Appendix 7 Guidelines and Procedure for the Safe Administration and Management of Medicines 1. INTRODUCTION 1.1 This procedure must be read in conjunction with the Policy for the Administration of Medication and the Medication Administration Training Pack for Domiciliary Care Assistants. 1.2 This procedure promotes the safety and well being of the service user and provides a framework of safe practice for the Care Worker. 1.3 This procedure must be followed when Care Workers are required to assist with medication, or administer medication to service users who are not able to manage their medication themselves. This requirement will be stated in the Service Delivery Plan as a level B or C 2. OBTAINING PRESCRIPTIONS AND DISPENSED 2.1 Obtaining prescriptions If the personal plan of care requires a repeat prescription to be ordered, the Care Provider will indicate on the Service Delivery Plan that 5 days prior to expiry of the MAR chart, the Care Worker is to order /MAR chart from the GP/Pharmacist. Care Worker must not over order or stockpile. The Care Worker: must clearly indicate on the repeat request slip only which medicines are required must take into account the expiry date of the MAR chart and order from the GP/Pharmacist 5 days the Care Worker must only use the service users preferred Pharmacy which will be documented on the personal plan of care (NB the chosen Pharmacy must be able to provide a MAR chart to allow Level C administration by Care Workers) 2.2 Obtaining dispensed medication In cases where the service user or service users representative is unable to obtain dispensed medication, one of the following methods of obtaining medication will be documented in the Service Delivery Plan: the prescription requires collecting from the surgery and taking to the Pharmacy for dispensing the Pharmacy will collect the prescription from the surgery and the dispensed medication should be collected from the Pharmacy the Pharmacy will collect the prescription from the surgery and arrange delivery of the dispensed medication to the service users home Where the care provider is responsible for obtaining supplies of medicine on behalf of the service user, the Care Worker should check that there is enough to last for the next few days and to order medicines as agreed in the Service Delivery Plan. All unused regular and refused medication should be returned to the Pharmacy at the end of the month. HOWEVER, all as required medication which is unused should be retained and used as directed on the new replacement MAR chart. This should be documented in:

2 Level C: the Medicines Administration: Additional Information Record Level B: Record Book It is important not to over-order medicines. Before ordering, the Care Worker should check the amount of medicines the service user has and only order what is required rather than every item. Particular care should be taken when ordering as required medications. Running out of a medicine because of bad housekeeping should not be an excuse to contact emergency services. 3. STORAGE OF MEDICINES 3.1 Medicines must be stored in a cool, dry place unless otherwise stated on the label (for example some medicines must be stored in a fridge). 3.2 All medicines must be kept out of the reach of children. 3.3 Locked boxes will be provided (while current stock lasts) via the Medicine Management Nurse to those service users at high risk of over medicating if they have free access to their medications. However, it will be the responsibility of the Provider service to supply locked boxes (standard 10.6 of the National Minimum Standard). Other service users will be asked to provide a suitable sized lidded box e.g. plastic food storage container, shoe box etc. These boxes will be used to store the medication and MAR chart. Any special storage instructions for medicines will be identified on the label and should be followed e.g. keep in fridge. In certain cases where a service user has particularly large numbers of medicines, a second lockable box may be needed to store spare stock, particularly during the period of overlap where repeat medications arrive as the remaining previous stock is still being used up. In such cases the second box should be clearly labelled as box 2 Spare Stock, and noted on the Service Delivery Plan. To minimise the need for this, please ensure medicines are not over ordered. 3.4 It is advisable that medicines should not be stored in kitchens or bathrooms due to high temperature and humidity. (Unless to do so would significantly cause the service user to become confused and so lose independence). 3.5 Medicines must be kept in their original container as provided by the Pharmacy and must not be removed until the time of administration. This means that doses of medicines should not in general be put out in advance of administration in egg-cups or medicine pots as it can lead to accidental mix-ups and errors. However, it may be appropriate for a service user to have access to medicines in between care calls, e.g. sleeping tablets or medicines for pain relief. In such circumstances doses may be left out for that individual to take at a later time. This can only be undertaken where it has been risk assessed as appropriate, agreed with the service user, and it is documented in the Plan of Care. Doses administered 4 later are recorded on the MAR with the number 4 instead of the Care Worker s

3 initials. The next Care Worker to visit should check that this 4 later medication has been taken by the service user. Where the service user has not taken this medicine, the Care Worker must dispose of them as they would for any refused medication (see Disposal of refused medication page 18), and this should be recorded on the Medicines Administration: Additional Information Record.

4 Medication Administration Procedure Level B administration: Reminding 2. Check the Service Delivery Plan for instructions on medication 3. Remind the service user to take their medications and observe that they carry this out. 4. The exact assistance given on each visit should be documented in the Neath Port Talbot Medication Record Book. Assisting 2. Check the Service Delivery Plan for instructions on 3. Discuss with the service user their medication requirements. 4. Taking directions from and in the full view of the service user, give assistance to the service user as requested by them. 5. Ensure that the service user is able to remain in control of their own medication. 6. The exact assistance given on each visit should be documented in the Neath Port Talbot Medication Record book. NB. If at any time you feel that the service user is not aware of the medication they are taking STOP ASSISTANCE AND PHONE YOUR LINE MANAGER FOR ADVICE AND REASSEMENT. Level C administration using a dosette box (MDS) 2. Ensure the environment is free of distractions e.g. ask the service user to turn the television off if this helps you to concentrate better 3. Check Service Delivery Plan for instructions on medication 4. Choose the appropriate compartment, remove tablets and give to the service user to take. Record medication given from dosette box in the NPT Medication Record Book. There will be no requirement for a MAR chart Level C administration using a MAR Chart and original containers 2. Ensure the environment is free of distractions e.g. ask the service user to turn the television off if this helps you to concentrate better 3. Check Service Delivery Plan for instructions on medication 4. Explain that you will need to check the medication to see if any is to be given prior to food. 5. Find a clean area free from clutter 6. Open medicines box - ask service user if they have taken any medication already and check the MAR chart to ensure that none of the medicines have already been given/signed for. If you have reason to believe medicines have been taken already STOP PROCEDURE and inform line manager. Other wise continue as follows:

5 7. Remove all medicines from the box, checking as you do that they all have the service user s name on them. 8. Assemble all of the equipment needed to administer the medication such as 5ml spoon, MAR chart,, gloves etc. 9. Organise the medications as follows: Using the MAR chart in conjunction with the labels on the medication boxes, go through each checking the five rights (Right Service user, Right time, Right medicine, Right dose, Right route), ensuring that the instructions on the MAR and labels match. Check the label for any special instructions before administering the medicine e.g. does it need to be taken before or after food? Should the service user avoid alcoholic drink? Does the medicine need to be dissolved or mixed with water before taking? Should it be swallowed whole not chewed? Etc. Please ensure that these additional instructions are followed. Some medicines should only be taken when required to relieve symptoms e.g. pain killers, laxatives, sleeping tablets, inhalers, GTN spray for angina. The service user will need to be asked whether they need these medicines and they should not be given routinely. (If you are not sure what a when required medicine is for, please consult the patient information leaflet insider the medicines container or contact the Community Pharmacist. As you are doing the above, place the medicines as follows: Medication to be taken before food -placed to one side on the lid. Medication to be taken with or after food -on the other side of The lid, along with any other to be taken at this time. Medication not required at this call placed inside the box out of the way. Where there is more than one container of the same put spare containers into the box and the pack to be used on the lid Any medication that needs further clarification: place this in the box and make an immediate written note to contact line manager, Community Pharmacist or out of hours services (as appropriate) for further information. If you always do this the same way then if you become distracted for any reason it is easy to see where you have got to. Always use the MAR chart AND the medication boxes as your point of reference. (if then for any reason you have missed something it will be left outside of the box for you to clarify) Wash and dry hands and put on gloves Before administering, check any expiry dates highlighted on the label e.g. for eye drops and liquids. Also check when removing strip from the box that the name of the drug on the strip matches that on the container.

6 10. Following the MAR chart AND the boxes administer any medication that should be given before food, one medicine at a time, and sign the MAR chart after each is administered. 11. Continue to assist with other activities, such as personal care, and if more medicines are to be taken after food, ensure that service user has something to eat. 12. Wash and dry hands and put on gloves 13. Following the MAR chart AND the boxes administer any medication that should be given after food, one medicine at a time, and sign the MAR chart after each is administered. NB with As Required medicines, ask the service user whether they need these medicines as they should not be given routinely. 14. Once all medication has been administered check that no boxes/bottles are left over, wash and dry any utensils, and return everything to its original place ensuring box is locked (if appropriate). Refusal The Care Worker must never force a service user to take medication. However, if they are refusing a medicine it is useful to ask them why they do not wish to take it, as this may need to be discussed with GP. The health of the service user may be affected if medication is not taken. It is recommended that the Care Worker seeks advice from the Pharmacist either directly or via the Care Worker s line manager. Any advice given will be recorded. 1. If the service user refuses the medication, record this on the MAR chart using the appropriate code indicated at the bottom of the chart (this may be different for each Pharmacy) 2. If medication has not been removed from the original container then leave in place. 3. If medication has been removed from the original container then place in the refused/dropped bottle which should then be returned to the Pharmacy at the end of each month for disposal. 4. All changes in the service user s condition including refusal of regular medication should always be reported to Service users GP (This does not apply to refusal of medicines which are taken only when required). REMEMBER DO NOT administer medicines from unlabelled containers. For Level C service users DO NOT administer dosette boxes (MDS) that have not been filled by a Pharmacist If you are in doubt about anything, DON T administer and seek advice

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