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MEDICATION POLICY AND PROCEDURE FOR HOME CARE STAFF
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Document Sample
Guidance
Domiciliary Care Medication
Sefton Social Services.
Version 1.1 Date of Issue September 2004
Number
Authority for Peter Pattenden – Head of Adult Services Review Date: January
issue 2006
Drive Departmental Policy Committee Item Statute
Document(s)
Adults Division
Files to update Area Residential Day Care Other
Replaces Pages File Section Service User
Key Words Service User Domiciliary Care
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LIST OF CONTENTS
Page
2 Introduction
3 Aims of the Policy
4 Definitions
5 Roles & Responsibilities
7 Risk Assessment & Consent
8 Obtaining Supplies of Medication
10 Storage of Medicines
10 Transportation of Medicines
11 Procedure for Prompting Service Users to take Medication
12 Procedure for Assisting Service Users to take Medication
14 Procedure for Administering Medication
15 Covet administration/Disguising Medicines in Food/Fluids
15 Refused Medicines/Disposal & Return of Medicines
17 Documentation
17 Advice on Medical Issues & Adverse Reactions
18 Controlled Drugs
18 Non prescribed medication /Illicit Substances
19 Errors
19 Lost or Stolen Medicines
20 Training
21 Glossary
22 Useful telephone numbers
Appendices
1 Medication Risk Assessment Form
2 Medication Prompt / Assistance Record
3 Managers Checklist for Errors
.
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Introduction
The purpose of the medication policy is to safeguard the interests of Service Users and staff, by setting out the practice to be
followed and the responsibility of all concerned in regard of medication and related tasks where appropriate. The policy applies
to all staff employed by or on behalf of Sefton Social Services Department. For staff to ensure good practice, the appropriate
involvement and co-operation of GP's, Community Nurses and Community Pharmacists should be sought.
All medicines are potentially harmful and care must be taken in their storage, management, control and disposal. The policy
follows the guidelines provided by the Royal Pharmaceutical Society of Great Britain and will meet the requirements of the
National Care Standards Commission.
All practice must be in compliance with legal requirements.
Current Legislation
The Medicines Act 1968
The Misuse of Drugs Act 1971
The Misuse of Drugs (Safe Custody) Regulations 1973 S11973 No. 798
The Nursing and Midwifery Council Guidelines for the Administration of Medicines.
The Care Standards Act 2000.
In accordance with the guidance laid down in national standards this document should be readily available to all staff and should
be complied with at all times.
All providers must have an up to date copy of the British National Formulary (BNF), which provides detailed information on all
medicines available with or without prescriptions. This can then provide staff with any information they may require regarding
medicines and their administration. If staff are still unsure after consulting the BNF, they can contact various sources for
information including the Service Users usual Pharmacy. A list of such numbers is listed on page 28 The BNF is published every
6 months and providers must ensure that staff have access to an up to date copy at all times.
The term Domiciliary Care Staff relates to those care staff who have direct contact with Service Users in community based
settings. It is this group of staff who will be guided by this policy. Previously there was limited guidance in place for Domically
Care Staff relating to medication and its administration. Clearly this was not an acceptable situation and these policies and
procedure are aimed at giving Domiciliary Care Staff clear advice and guidance on this matter. The policy and procedures are
in accordance with best practice and maintain a clear differentiation between what constitutes nursing as opposed to social care
support.
Where assistance with medication is required, Domiciliary Care Staff should only assist with the administration of medication
where it is included in the Service User’s Care Plan, under instruction from their Line Manager.
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Documentation
It is essential for all staff involved in management and delivery of services to ensure that adequate documentation is maintained
and shared appropriately. Documentation must be accurate, concise and legible and written in ink. Correction fluid must not be
used; in the event of mistakes in documentation occurring they must be crossed out, amended and marked with the initials of
the person completing the documentation.
Aims of the Policy
Standard 10 — Medication and Health-Related Activities relates to medication and other health-related activities. The Standard
places the following requirements on agencies providing domiciliary care.
1. To ensure that there is a clear, written policy and procedure which is adhered to by staff and which identifies
parameters and circumstances for assisting with medication and health-related tasks and identifies the limits to
assistance and tasks which may not be undertaken without specialist training.
2. To include in the policy procedures, if required, for obtaining prescriptions and dispensed medicines and for recording
the information.
3. To ensure that staff should only provide assistance with taking medication, or administer medication, or undertake
other health-related tasks, when it is within their competence, when they have received any necessary specialist
training and when the activity is:
(a) with the informed consent of the service user or their relatives or representative
(b) clearly requested on the care plan by a named assessor
(c) with agreement of the care or support workers' line manager
(d) not contrary to the agency's policy.
4. To identify required assistance with medication and other health-related activities which should be identified in the
Service User's care plan, also as part of the risk assessment (Standard 12 - Risk Assessment ) and detailed within
the Service User Plan.
5. To ensure that care and support staff should leave medication at all times in a safe place which is known and
accessible to the Service User or, if not appropriate for the Service User to have access, where it is only accessible to
relatives and other personal carers, health personnel and domiciliary care staff.
6. To ensure that care and support workers should follow the agency's procedures for reporting concerns, responding to
incidents and seeking guidance.
7. To ensure that care and support workers should record, with the Service User's permission, observation of the
Service User taking medication and any assistance given (including dosage and time of medication and undertaking
any other health-related tasks) on the record of the care visit kept in the home and/or the home care medication
record and the personal file of the Service User held in the agency — any advice to the service user to see or call in
their General Practitioner or other healthcare professional should also be recorded and the record signed and dated
by the care worker and the Service User or their representative.
8. To agree and follow a policy on medication and health-related tasks where the delivery of the care package to the
Service User involves multiple agencies, including healthcare — except for employment agencies solely introducing
workers — a key worker, generally a healthcare professional from one agency who visits on a regular basis, should
be identified as responsible for taking the lead on medication whist all care and support workers should retain
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responsibility for their own actions in accordance with the policy. (Legal responsibility rests with the prescriber but only
in respect of prescribing, not administration)
9. Where necessary and agreed the policy and procedures should be approved by a suitably experienced pharmacist, if
appropriate, and the functions undertaken by staff in this context need to be covered by the employer's insurance
policy, except for employment agencies solely introducing workers.
These Standards are supported by Section 14.6 of the Domiciliary Care Agencies Regulations 2002 which state that
the registered person must "specify the circumstances in which a domiciliary care worker may administer or assist in the
administration of the Service User's medication, or any other tasks relating to the Service User's health care, and the
procedures to be adopted in such circumstances."
Definitions
Prompt = Prompt Service User by enquiring if they have taken their medication.
Assist = Pass the container to the Service User to self-administer / to assist the Service User to access
medication via a monitored dosage system, ideally a blister pack
Administer = to select, measure or give medicine to a Service User, as specified in the care plan, and risk
assessment, where the Service User is unable to make the decision on medication for themselves or
the care plan identifies the level of help required, such as the Service User is unable to physically put
medication into their own mouth due their manual dexterity, condition or ill health.
Exceptional
Circumstances = exceptional circumstances refer to situations whereby the level of assistance required to assist a
Service User does not fall within the usual remit of Domically Care Staff. In this situation a thorough risk
assessment must be performed and the level of assistance clearly stated in the care plan. There must
be agreement between the Care Manager and Care Provider regarding the involvement and role of the
staff.
Designated
Person = the designated person referred to within this policy is the person responsible for ensuring adequate
and accurate supplies of medication are available. In most circumstances this will be a relative , or
friend. Should a relative etc not be available to perform this role an agreement must be made between
the Care Manager, Service User and Provider as to who will perform the role as the designated person.
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ROLES & RESPONSIBILITIES
Medication Policies and Staff Roles
Involvement by Domiciliary Care Staff in the administration of medicines is a contentious issue. Domiciliary Care Staff are
increasingly coming under pressure to help out in this regard. A common example is in the care of someone who is
forgetful and where the care worker may be asked to give out medication prescribed by a GP at certain times of the day.
However, owners and managers of domiciliary care agencies and organisations should take care that their staff are
being asked to perform only appropriate duties which they are competent to perform and for which they are trained. They
must also be covered by appropriate policies, procedures and insurance and supported by appropriate systems of
recording. All medications are potentially dangerous if taken wrongly and mistakes in this area, perhaps the
administration of the wrong tablet, can have serious and even fatal results.
The involvement of Domiciliary Care Staff in helping with medication should be clearly stated and understood by all staff as well
as by purchasers, Service Users, their families and by care colleagues such as GPs, District Nurses and social services staff.
Domiciliary Care Staff should never attempt to provide care for which they are not trained or equipped. In addition, the National
Minimum Standards for Domiciliary Care Agencies makes the point that the provision of personal care for people who live in
their own homes is changing and that the interface between health and personal care is becoming blurred. This means that, as
the health and care needs of people living in their own homes become more complex, so Domiciliary Care Staff come under
pressure to undertake increasingly complex health-related activities. The National Minimum Standards make the point that, if
this is the case, then it should never happen "by default" but only with the written agreement of all parties and when the
Domiciliary Care Staff have received the appropriate and necessary training. Clarity in the roles, if any, in relation to medication
and other health-related activities is therefore essential.
Where administering or helping with medication is part of the role of a care worker, this should be carefully documented and
agreed between all involved in the care, particularly by the Service User and their relatives and by the GP and relevant key care
worker. The care plan should state exactly what the involvement of the care staff should be and they should be clear that they
should not extend that role without further agreement and documentation. They should also be appropriately trained and
capable to perform the role safely and covered by a suitable insurance policy.
Service Users
In general Service Users will be expected and supported, to manage their own medication i.e. to be self-medicators. Where this
is not possible (e.g. due to mental incapacity) the situation will be subject to a review involving the G.P and/or Consultant, Social
Worker, Service User, the Service Users family and the appropriate Domiciliary Care Manager/Supervisor (this can be
conducted by phone as long as the discussion is recorded and any decisions are clearly documented in the Care Plan and Risk
Assessment) .
Responsibility for the administration, monitoring and taking of medication rests with the Service User, the Domiciliary
Care Staff role is only to assist with reminding the Service User and monitoring the taking of the medication.
GP/Consultant
The responsibility for prescribing medication rests with the Service User's GP or Hospital Consultant.
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District Nursing Staff
Nursing staff retain the responsibility for the management of intervention required to ensure safe medication practice whereby
this intervention constitutes nursing as opposed to social care support. Examples of this would be:
Invasive Procedures
Administration or assistance with controlled drugs
Application of transdermal medication i.e. fentanyl patches
Advice and guidance regarding medication (as part of multidisciplinary health team)
Managers of Domiciliary Care Services
The Managers of the Domiciliary Care Services are responsible for the development and monitoring of the medication policy
and for arranging training for their staff. This is the basis of developing best practice in a domiciliary care setting.
Maintaining strict adherence by staff to the procedures for the administration of medication.
Contracted Domiciliary Care Agencies must ensure that the appropriate personal liability insurance is in place for all staff,
especially those who are self employed. Contracted Domiciliary Care Agencies should check that their insurers are aware of
the procedure which will be adopted and that they are covered by insurance.
Pharmacy Services
The dispensing and sale of medicines in community pharmacies has, by law, to be supervised by a qualified pharmacist whose
role is to comply with the legal requirements for the safe storage, dispensing and disposal of medication within the shop.
Community pharmacies have always acted as advisers to the general public wherever medication is concerned and this role is
becoming increasingly extended with many pharmacists now being actively involved in managing drug therapies for Service
Users. It is therefore good practice to refer back to the pharmacist any queries or concerns relating to medication and
domiciliary care staff are encouraged to build a relationship with the Service User's pharmacist, especially if they are also the
ones to collect the medication.
The responsibility for delivery of oxygen supplies rests with the Community Pharmacist.
Care Manager (Social Services)
The role of the Care Manager is extremely important as it will dictate the involvement of all other staff. It is essential that as part
of this role the Care Manager performs a thorough risk assessment which will define the level of involvement required in order to
meet the needs of the Service User.
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RISK ASSESSMENT & CONSENT
In the case of Service Users' self-administration of medication there are obvious risks to independence in some cases. Common
risks include overdose — either deliberate or accidental — or of not taking essential medication because of forgetfulness or
confusion, especially in Service Users who are elderly, infirm or mentally impaired. Other risks include medication being mislaid
or stolen. All Service Users should therefore be assessed as to their ability to administer their own medication. Any identified
problems or risks should be discussed and a care package developed jointly between all of the agencies working in support of a
particular Service User. Any part to be played by a domiciliary care worker should be entered in the Service Users Plan.
It is most important that whatever role is planned for the Domiciliary Care Staff is appropriate and is within the policies of the
agency or organisation. The agency or organisation must then ensure that whatever domiciliary care staff are placed in the
home are competent and adequately trained or qualified to perform the role asked of them.
Risk assessment must be completed by the Care Manager (Social Worker) for every Service User who requires prompting or
assistance with medication, in order to ensure compliance with the National Minimum Standards. This should be completed
with the full co-operation of the Service User, or where the Service User is unable to provide the information, the next of kin or
carer should assist in completing the form. The form must be kept with the Care Plan and must be updated at each Service
User’s review or when there is a change in the Service User’s physical or mental health. The risk assessment should be
included with the Service User Care Plan and made available to the Care Provider prior to commencement of the service. In
long term service provision the risk assessment should be updated by a suitably qualified member of the care team acting for
the Provider And any changes to be passed onto the Care Manager.
Where staff are required to handle medicines, a Control of Substances Hazardous to Health (COSHH) Regulations assessment
should be undertaken of those medicines which must be handled. Examples include external applications such as steroids and
cytotoxic medicines such as methotrexate and cyclosporin. If you are not sure, contact your community pharmacist for advice.
The manager must ensure that these are completed by an appropriate person. "Blanket" risk assessments will be acceptable for
the most common medicines being stored. The community pharmacist will not necessarily inform staff that medicines may be
toxic; therefore, it is essential that the patient information leaflet (which should be supplied with all medicines) must be read
carefully. If there are any queries staff must contact the appropriate professional for advice.
Consent
Written consent for the prompting, assistance or administration of medication should be obtained from
the Service User by the Social Worker following completion of a risk assessment and a copy forwarded to the appropriate
Domiciliary Care Manager. If the Service User is unable to give informed consent the form should be signed by a relative or
authorized person acting on behalf of the Service User i.e. Guardian, Power of Attorney. Where consent is refused medication
must not be administered and the refusal reported to the GP.
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OBTAINING SUPPLIES OF MEDICATION
Service Users should be encouraged to order repeat prescriptions from their GP themselves and use the prescription collection
and delivery service provided by many Pharmacists alternatively relatives or a friend etc should be identified on the risk
assessment as the person who takes responsibility for collection of medication. In addition the pharmacy used should be stated
on the risk assessment form.
For those not self-medicating, the medication should be supplied as follows
a) Monitored dose system (ideally blister packs).
b) Clear instructions on the timing of doses. Instructions for administration would be specific, avoiding the use of "As before" or
"As required". Where this cannot be avoided please follow procedure for administration of medication .
c) Legible and meaningful labeling including name of Service User, name of drug, amount of drug to be administered.
d) Duration of course of treatment (when applicable).
e) In the absence of a relative, the Domiciliary Care Staff should ensure continuity of supplies.
f) Ideally, G.P.'s should only prescribe medication for a maximum period of twenty- eight days.
g) The Service Users' GP should ensure that medication is reviewed at regular intervals.
h) Should the Domiciliary Care Staff become aware of any adverse side effects whilst in the Service User’s home, this must be
reported immediately to the Manager, who will inform the GP/ Pharmacist / Social Worker immediately.
i) It is the responsibility of the Service User / Service Users family to ensure that unused medication is disposed of safely.
j) Under no circumstances should Domiciliary Care Staff offer advice on non-prescribed medicines and remedies. "IT IS
DANGEROUS TO DO SO". The individual Service User concerned may be allergic to the treatment or be taking other
medication, which may cause an adverse reaction. The Domiciliary Care Staff should advise the Service User to seek
advice from the GP / Community Pharmacist and inform their Line Manager.
Prescriptions for continuous treatment should be issued for periods of 28 days. The designated person (as identified in the risk
assessment and Care Plan) must check that the seal on each blister pack is intact upon receipt. If there are any discrepancies
with the contents of the blister pack, the pharmacist must be contacted immediately. If the GP is required to treat the service
user and a prescription is supplied, the designated person should arrange for the prescription to be collected and the medication
delivered (when possible by the collection and delivery service stated on the risk assessment).
Should the agreed person fail to request repeat medication or collect the same the Domiciliary Care Staff should follow the
following procedure
1. Contact the line manager for advice and to inform them of the situation
2. The Line Manager should then attempt to contact the agreed person to request that the situation be rectified
3. Should the agreed person or no other suitable person be available the Line Manager should contact the Social
Worker or the Emergency Duty Social Worker to request authorisation to intervene
4. Once authorisation has been provided preferably in writing the Service Users GP should be contacted and a
repeat prescription requested (usually 48 – 72 hour turnaround)
5. Medication should be obtained from the usual pharmacy as identified on the risk assessment document
6. The Domiciliary Care Staff should be informed of the outcome and any assistance required.
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7. A review should be set up to discuss the event and plans made to prevent future reoccurrence.
Emergency Supplies
Emergency supplies of a Prescription Only Medicine (POM) may be requested from the Community Pharmacist, for a named
service user, before a prescription is supplied. As a supply in response to such a request should be seen as a private
transaction, one of the procedures set out below must be followed.
1. The designated person on duty must contact the GP and request an urgent prescription. Ideally this should be
delivered to the pharmacist before the supply is made.
2. If this is not possible, the pharmacist can respond to an emergency supply request from a GP. The law
permits POMs to be supplied at the doctor's request in the absence of a prescription on the proviso a
prescription is supplied within 24 hours.
3. If the GP cannot be contacted the pharmacist can respond to an emergency supply request from the service
user. The law states that the pharmacist must personally interview the Service User and be satisfied that:
• There is an immediate need for the POM and that a prescription cannot be obtained.
• The medicine has been prescribed previously for the Service User and that the dose is appropriate.
• That the medicine is not a Schedule 2 or 3 Controlled Drug (except for phenobarbitone for epilepsy).
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STORAGE OF MEDICATION
The storage of medication is the responsibility of the Service User and his or her family and is the legal property of the
patient (Service User). Occasionally it is necessary to make special arrangements for the storage of medication to
prevent misuse as directed by the G.P. and this will be noted by the Social Worker in the Care Plan and risk
assessment. It should be established that the storage place is appropriate for the medication to be stored i.e. clean and
dry.
All medication should be kept in a designated place as specified in the risk assessment. If staff are assisting a Service
User to take their medication it is imperative that they return the medication to the agreed storage place in order to
prevent confusion.
Medicines must be stored in the original packaging or compliance aid supplied by the pharmacist. Excess stock of
medicines must be stored separately from the ones currently being used, until they are required - this will prevent the
same medicine being dispensed twice. It is advisable for excess stock of medication to be kept to a minimum for this
reason.
Creams, drops and lotions must be stored in their original container, including the box, if applicable, as the box usually
contains the name of the Service User and instructions for use. If boxes are disposed of, a cream may be applied to the
wrong area of the body. E.g. Canestan blue topical application being applied where Canestan red should be used.
Medication requiring to be kept at a low temperature must be placed in a refrigerator as per instructions given on the
container. Ideally this medication should be stored in a container away from food and drink to avoid contamination.
Whereby the Care Plan requests that storage methods such as the use of locked cupboards or other safe storage are
required Domiciliary Care Staff will be thoroughly briefed regarding its use.
TRANSPORTATION OF MEDICATION
This refers specifically to all Service Users for whom responsibility for medication is taken by Domiciliary Care Staff. All
Service Users who self-medicate must take responsibility for their own medicines at all times. Staff who assist a service
user to take their medication using the monitored dosage system must not dispense tablets to be taken on a journey, but
must send the complete package. The relevant day care staff will take responsibility for the safe return of medication.
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PROCEDURE FOR PROMPTING SERVICE USERS TO TAKE MEDICATION
Self Medication
Service Users administering their own medicines should be monitored to ensure that they are doing so correctly.
It is the duty of the Domiciliary Care Staff to report to their Line Manager any difficulties which Service Users may be
experiencing in self-medicating. If a Service User is no longer able to continue to safely self medicate, the Domiciliary
Care Manager would then discuss this situation with the G.P., Service User and relative or Social Worker as necessary.
Prompting a Service User to take medication
Should a Service User require prompting to take their medication this should be detailed on the Service User Care Plan
and risk assessment supplied by the Care Manager (Social Worker.)
Guidance supplied to Domiciliary Care Staff should indicate when the prompt is required i.e. morning call. There is no
requirement for the member of staff to be made aware of the type of medication or any other details as the Service User
will have been assessed as competent to manage their own medication with prompting only.
Staff should inform their Line Manager of any concerns or queries that they may have regarding the service users ability
to continue to self medicate
The action of prompting must be entered into the Service User documentation used by the organization. The details
should also be entered onto the medication prompt/assistance record. The detail required on this form should be the
date, time, a comments section (entries should read ―Service User prompted to take medication‖) a section whereby
other issues can be recorded (i.e. refusal) and the staff signature.
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PROCEDURE FOR ASSISTING SERVICE USERS TO TAKE MEDICATION
Domiciliary Care Staff assisting with medication will have received suitable training. Domiciliary Care Staff should only give
assistance with medication under instruction from their Manager in accordance with the Service User’s Care Plan.
When undertaking this task it is essential to ensure
a) Right Drug
b) Right Dose
c) Right Time
d) Right Service User
It is not the responsibility of Domiciliary Care Staff to control the drug and dosage that a Service User receives when
using a monitored dosage system such as a blister pack. The only respect in which Domiciliary Care Staff have any
control over this aspect of medication is to ensure the following
a) The correct blister pack is used
b) The blister pack has not been tampered with
c) The contents of the blister pack are fully emptied and care is taken to ensure that medication is not dropped, damaged
or crushed
After the Service User has taken medication, the Domiciliary Care Staff must enter their actions into the service user
documentation used by the organisation. The details should also be entered onto the medication prompt/assistance
record. The detail required on this form should be the date, time, a comments section (entries should read ―Service User
assisted to take medication‖) a section whereby other issues can be recorded (i.e. medication refused) and the staff
signature.
If a Service User refuses to accept their prescribed medication they must never be forced to take it against their will. The
refusal will be recorded on the record sheet and the Domiciliary Care Staff must inform their Line Manager, who will
inform the GP and the Social Worker.
It must be remembered that assistance may only be given with orally or externally applied medication by Domiciliary Care
Staff. Other forms of medication administration e.g., invasive procedures, must be referred by the Care Manager to the
District Nursing Service.
On no account must assistance with eye drops be offered without prior training, this is because each Service User has
individual needs and requirements will differ from person to person. If assistance with eye drops is requested, the
Domiciliary Care Staff must report this to their Line Manager.
Some Service Users use oxygen in their own homes because they have diseases, which affect the respiratory system.
On no account must the Domiciliary Care Staff interfere with these supplies. For example, if supplies are kept close to the
fire or radiator, the Service User must be advised of the risk of explosion. If the Domiciliary Care Staff has reason to be
concerned about health and safety issues regarding the position of an oxygen cylinder they must report this to their Line
Manager. This is particularly important when the Service User refuses to move the oxygen cylinder to a safer location.
Supplies of oxygen will be monitored by the Service User, their family or the Pharmacist. This is not the duty of the
Domiciliary Care Staff, but if it is noticed that supplies appear to be low, the Service User or their family will be informed
about the situation. Supplies of oxygen are normally obtained through the Pharmacist. Domiciliary Care Staff are allowed
to pass the oxygen mask to a Service User and to ensure that equipment is conveniently positioned however they are
not allowed to turn on the oxygen supply.
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Likewise should a Service User require medication via a nebuliser the staff member may assist with the preparation of
the equipment but not enter the medication into the nebuliser. Should the service user have difficulty in opening their
nebules of medication to be used in the nebuliser the member of staff may assist provided that this assistance is agreed
in the risk assessment and Care Plan.
AS REQUIRED MEDICATION
Staff may prompt or assist Service Users to take ―as required medication‖ (also know as PRN medication) however this
must be blister packed and labelled with the instructions for use. The member of Domiciliary Care Staff will ensure that
any PRN medication given is taken from the appropriate date and time on the blister pack and documented on the
medication record. The prompting or assistance of Service Users to take PRN medication MUST be included on the risk
assessment and the Care Plan. The administration of ―as required ‖ medication that cannot be blister paced would be
addressed as an exceptional circumstance and would only be allowed following appropriate planning and risk
assessment.
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PROCEDURE FOR ADMINISTERING MEDICATION
In all care settings, staff will only administer medicines in accordance with the Service Users care plan. Agreement on
the administration of medicines must be reached with staff, Service Users and carers as appropriate. The Line Manager
is responsible for ensuring that all staff who use the system in operation are appropriately trained and familiar with the
process for using it.
Only a designated person may administer medicines. The term "designated person" means a suitably trained member of
staff responsible for the administration of medicines. It is the responsibility of the Manager to ensure that the designated
staff have received sufficient instruction and preparation to undertake this role safely and in accordance with the policy.
Continued effort is required by everyone involved in the process to ensure that the right medicine is given to the right
person, with the correct dose at the prescribed time. This will be guaranteed by ensuring that all staff administering
medicines adhere to the policy and procedures. Medicines that have been prescribed and dispensed for one Service
User must not, under any circumstances, be given to another Service User, or used for a purpose that is different from
that which they were prescribed for.
Where a Service User is unable to actually place medication into their own mouth Domiciliary Care Staff will be permitted
to carry out this process provided:
A risk assessment has been carried out.
Blister packs or another secure monitored dosage system is available
There is no one else available or willing to undertake this task as described above.
A valid consent has been obtained from the Service User. If the Service User is unable to communicate their
consent, rather than withhold necessary medication assistance may still be given in its administration or it may be placed
into individual's mouth so long as the Service User by his or her actions is clearly prepared to co-operate with the
administration of the medication or clearly raises no objection. In such circumstances, it is advisable to obtain the
approval of an appropriate relative or carer. Medication should not be administered where it clearly against the Service
Users will.
That the details of the administration of the medication are included in the Care Plan and risk assessment.
N.B. Administration procedures will also need to be instigated for all medication that can not be blister packed due to the
nature of the medication i.e. omeprazole.
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COVERT ADMINISTRATION/DISGUISING MEDICATION IN FOODS/FLUIDS
Covert Administration of Medicines
Where a Service User is unable to give consent due to the nature of his/her illness or disability, consent must be sought
from the next of kin and GP. A written risk assessment must also be completed and signed.
Staff must not disguise medication to be given to Service Users without their knowledge. Only Service Users detained
under section 3 of the Mental Health Act can legally be given medication against their will, anything else can be
construed as assault. Where a medicine is essential for a Service User’s well being, every effort should be made to find
an acceptable way for them to take it, or to find a suitable alternative. With Service User consent, making the medicine
more palatable by taking it with food or drink is not the same as disguising it without the persons consent. This consent
must be in writing on the risk assessment.
Advice must be sought from the dispensing Community Pharmacist or GP to ensure that the food or liquid in which the
medicine is placed does not interfere with the properties of the medicine. They may also advise on more palatable forms
of the medicine.
REFUSED MEDICINES/DISPOSAL & RETURN OF MEDICINES
Refused Medicines
If a Service User is frequently unwilling or unable to take their prescribed medicine, i.e. 3 or more consecutive doses
or repeated intermittently over several days, it is the duty of the member of Domiciliary Care Staff to notify the person’s
carer / Community Pharmacist or GP and their Line Manager. Service users must not be forced to take their medicine
against their will.
In some cases it would be detrimental to the Service User to miss a single dose of medication . When this is the case the
details will be highlighted in the Risk Assessment and Care Plan and must be communicated to all staff involved. In this
instance refusal of single doses must be reported to the Line Manager who will in turn report this to the person’s carer /
Community Pharmacist or GP.
Any medicine that is refused or unused must be disposed of and not returned to the container/ dosage system.
Disposal of Medicines
Medicines belong to the Service User and can only be disposed of with the consent of the Service User. Responsibility
for the safe disposal of medicines rests with the Service User, their family or the person identified on the Risk
Assessment .
Any unused tablets, which have been removed from the monitored dosage system by a member of Domiciliary Care
Staff, should be placed in a sealed envelope and the Domiciliary Care Staff member must write the following details onto
the envelope:
Service Users name
The date and time
Reason i.e. refused by service user/dropped on to the floor
Signature of the Domiciliary Care Staff member who has put the tablet in the envelope.
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Reasons for Disposal
Service User refuses medication
Service User no longer taking medicine
Medicine dropped on the floor
Medicine out of date
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DOCUMENTATION
All intervention by staff such as prompting, assisting and administration must be recorded in ink at the time by signing
the record sheet and including it in their documentation in the Service User’s record. If the Service User does not have
the medicine for any reason, the details must be entered and accompanied by the signature of the designated person.
Any errors made on the record sheet must be scored through, using ink. Under no circumstance must any liquid paper or
correction fluid be used.
ADVICE ON MEDICAL ISSUES & ADVERSE REACTIONS
Guidance Notes on Medical Issues
It is the responsibility of the GP or Hospital Consultant to explain the reason for the treatment and the likely effects
(including side effects) of any medication prescribed to their patient.
The Medical Practitioner makes a judgement on whether or not to explain to a patient, the nature of an illness and the
implications of any treatment.
Domiciliary Care Staff must not disclose a Service User's medical history or treatment to a relative or any other person
unless they have been identified within the Care Plan and Risk Assessment or with the express permission of the
Service User. Any questions must be directed to the Service User or the GP.
Adverse Reactions
Service Users may experience adverse reactions to medication. Adverse reactions vary in severity and form.
Service Users must be observed for apparent adverse reactions during the duration of the visit. This is particularly
important if it is the first time the individual has been prescribed the medicine.
If an adverse reaction is suspected and the situation is not urgent, the Domiciliary Care Staff should inform their Line
Manager who will inform the GP, Social Worker and relatives. If the individual's condition deteriorates and becomes
urgent e.g. individual develops difficulty in breathing or complains of chest pains, then an ambulance must be called
immediately, with details written in the individual's case notes.
Some medicines cause individual's skin to react when exposed to sunlight. A written risk assessment must be completed
and all staff must be made aware of the risk. Details must be recorded in the individual's case notes.
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CONTROLLED DRUGS
CONTROLLED DRUGS
To find out if a drug is controlled, contact your community pharmacist. A list, if included, would soon be out of date.
Service Users must self-medicate controlled drugs otherwise assistance may only be provided by relatives, a carer or a
health care professional. Domiciliary Care Staff MAY NOT assist Service Users to take controlled drugs.
NON-PRESCRIBED MEDICATION/ILLICIT SUBSTANCES
HOMELY REMEDIES
Homely remedies are medicines that can be purchased over the counter from a community pharmacy, without a
prescription from a doctor. Service Users and carers may obtain homely remedies at their own discretion. Staff will not
be allowed to obtain on behalf of, prompt the use of, assist or administer homely remedies.
Care at The Chemist
South Sefton Primary Care Trust runs the "Care at the Chemist" scheme. In this scheme, South Sefton residents who
are exempt from prescription charges are able to get medicines free from the community pharmacy instead of seeing a
doctor.
Certain medicines are all included in the "Care at the Chemist" scheme, so will be available free to those exempt from
prescription charges. Contact your local pharmacy for details.
Dealing with Illicit Substances
Any member of staff who suspects that the Service User has in their possession or is using illicit drugs must report their
suspicions or findings to their Line Manager who will then inform the appropriate Care Manager. Any member of staff
who visits a Service User who is under the influence of illicit substances has the right to leave the Service User’s home if
they feel threatened. It is essential that they then inform their Line Manager immediately.
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MEDICATION ERRORS
No matter how high the standards of individual staff and how good the policies that they work to, drug errors can still
occur. This refers to errors made from medication wrongly administered, omitted doses and medication lost or stolen. It
is important in this respect that agencies maintain an open "no blame" policy, where staff are encouraged to report such
errors without delay. If you make an error you must report it immediately to your Line Manager who will notify the
Commission for Social Care Inspection.
If such a policy is not followed there is a danger of cover-up and concealment with potentially dangerous results. All
errors and incidents require a thorough and careful investigation, taking full account of the context and circumstances
and the position of the staff involved. Such incidents should receive sensitive management and a comprehensive
assessment of all circumstances before a professional and managerial decision is reached on the way to proceed. Care
should be taken to distinguish between those cases where the error was a result of reckless or incompetent practice or
was concealed, and where there was immediate honest disclosure in the Service User’s interest. Action must be taken
to prevent the error or incident occurring again. This could be through re-training or removing the person from assisting
with medication until the action has been decided. Action taken will depend on the individual circumstances surrounding
the error.
Medication Wrongly Administered or Omitted Doses
If you wrongly administer or omit to give a dose of medicine to a service user in your care, or you become aware that an
error has been made by another person, you must adhere to the following: -
Report the incident to your line manager immediately, who will inform you of any further appropriate action to be taken.
The Line Manager will then :
Immediately seek advice from the service users GP, pharmacist, Accident & Emergency Department or NHS Direct Tel:
0845 4647 and comply with any advice given e.g. call an ambulance.
Enter the details into the appropriate report book and Service User case notes. Make a note of any changes or
deterioration in service user’s health or behaviour.
Inform the Service User’s next of kin. They should be informed openly and honestly and must be informed of what is
being done to prevent reoccurrence.
Complete Commission for Social Care Inspection notifiable incident record.
Only negligent error would result in liability and it is the organisation that is liable, not the individual member of staff.
This refers to errors made from medication wrongly administered, omitted doses and medication lost or stolen. It is
important to acknowledge that while errors should not be made, the policy should not be seen as being blame culture. It
is equally important that an open culture exists in order to encourage the immediate reporting of errors or incidents in the
administration of medicines.
A Managers Checklist can be found appendix 3
LOST OR STOLEN MEDICATION
As soon as you become aware that medication belonging to a Service User has been lost or stolen, you must inform
your Line Manager, who, in turn, will speak to the relevant Care Manager and inform the Police. (If the medication is a
controlled drug this must then be recorded in the appropriate report book along with the incident number given by the
police). Contact the Service Users GP who may need to provide a prescription to replace the lost/stolen medication.
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TRAINING
All domiciliary care staff should read the agency's policy on medicines handling and keeping records of medicine
administration. Further training for domiciliary care staff regarding medication should be provided if it is relevant to their
role. It should include:
(a) basic knowledge about common medications and how they are used
(b) how to recognise and deal with problems in use such as side-effects and contra-indications
(c) procedures for the administration, giving and storing of medicines
(d) what to do in the event of an error in administration.
Awaiting guidance from training re requirements
REVIEW
These procedures will be subject to constant, close monitoring and periodic review.
THIS POLICY WILL BE REVIEWED ON __________________________
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GLOSSARY
Administration To select, measure or give a medicine to a service user
Approved Person A professional agreed by Social Services to assess managers and staff as competent.
Assist To assist a service user, pass the container to the service user
Care Manager Professional responsible for the care plan and risk assessment Social Worker
commissioning services
Care Plan The service plan agreed with the care manager, service user and agency - where
appropriate.
Community Nurse Includes district nurses, community nurses, community psychiatric nurses, health visitors,
other specialist nurses
Competent Assessed as able to do a particular task.
Container For example, blister pack, bottle or any other container
Designated Person A suitably trained member of staff responsible for the Domiciliary Care Staff
Drug Any substance used in the treatment & prevention of disease
Invasive Procedure Any clinical procedure which punctures the skin surface (e.g. injections) or which requires
the administration to or within intimate areas of the body (e.g. rectal diazepam).
Medication Record The form which has been agreed by management to record the administration of medicines.
Medication/Medicine Any substance used in the treatment & prevention of disease
NCSC National Care Standards Commission
NHS National Health Service
Pharmacist Chemist who advises on and dispenses medicines
POM Prescription Only Medicine
PRN As required abbreviation
Prompt To prompt a service user by enquiring if they have taken their medication.
Risk Assessment Systematically checks the risks and hazards for the service user and staff. Agree
and implement a plan to safely administer , assist or prompt medication.
Service User Any person who receives a service through Sefton
Service Provider Any organisation accredited to provide domiciliary service in Sefton
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USEFUL TELEPHONE NUMBERS
This is not intended to be a definitive list, but simply a guide to some of the organisations, which can provide additional
information and advice in relation to the administration of medicines.
In the first instance, to ask for general advice relating to medicines during office hours, contact the occupational health
nurses at the HEALTH UNIT in Merton House -
At other times contact NHS DIRECT - 0845 4647 - 24 hours telephone line.
If the situation is or could become urgent dial 999 for an ambulance.
May Logan Centre - 0151 922 8588 open 8 a.m. -8 p.m. Monday to Friday
9 a.m. - 6 p.m. Saturday, Sunday & Bank Holidays
Medicines Hotline - 0151 529 3209 - University Hospital Aintree
Emergency Poisoning Line - 0121 507 5588
0131 536 2300
University Hospital Aintree - 0151 525 5980
Southport & Formby District General Hospital – 01704 - 547471
Royal Liverpool University Hospital- 0151 706 2000
Royal Pharmaceutical Society of Great Britain - 020 7735 9141
Office of the Chief Pharmacist - 020 7210 5761
Home Office - 020 7273 3474
Medicines Control Agency - 020 7273 0000
Medical Devices Agency - 020 7972 8124
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Service User Address
DOB Allergies
GP Address Tel
Pharmacy Address Tel
Obtaining Supplies/Storage Y N N/A COMMENTS ACTION
Is the service user able to obtain supplies of
medication as needed
Can relatives/a neighbour etc collect supplies
Does the pharmacy used deliver
Is medication stored in a suitable place
Does the service user know where the
medication is stored
Can the family/service user tell you where
medication is stored
Is there excess medication in the house
Can the family/service user return all excess
medication to the pharmacy
Taking Medication Y N N/A COMMENTS ACTION
Does the service user remember to take their
medication
Does the service user take any non-
prescribed medication
Does the service user require oxygen therapy
Does the service user take medication via a
nebuliser
Does the service user take their medication
acurately
Are there any prompting aids etc used to
assist the service user to take their medication
Does the service user want to take their
medication
Can the service user read labels on the
medication
Can the service user get the tablets etc out of
the bottle, container etc
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Can the service user pick tablets up once out
of the container
If the service user has difficulty with packaging
could the medication be packaged in
alternative containers
Can the service user pick up a bottle and pour
out a dose of liquid medication
If the service user has difficulty with taking
medication could a relative/ friend etc help
Does the service user have any swallowing
problems
If the service user has swallowing difficulties
could the medication be dispensed in
soluble/liquid form
Applying topical applications Y N N/A COMMENTS ACTION
Can the service user use an inhaler
Can the service user instill eye drops
Can relatives/friend etc assist the service user
Would a compliance aid for inhalers/eye drops
etc help
Can the service user apply creams/ointments
etc
Can a DN/relative/friend assist
Care Tasks Y N N/A COMMENTS ACTION
Can the service user empty their catheter
Can the service user change their catheter
bag
Can a relative help the service user to
manage their catheter
Can the service user change their stoma
independantly
Can a DN/relative/friend assist
Statement by Service User/Next of
Kin
I confirm that I have provided all
necessary information to the Care
Manager to support the planning of any
necessary assistance with my
medication. I hereby consent to
assistance being given by staff as part of
arrangements made for my domicillary
care
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Care Managers Recommendations
Completed By Date
Service User/Representative Date
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Service
User:
Address: DOB:
Allergies:
GP: Tel:
Address:
Pharmacy Tel:
:
Address:
Date Time Signed Comments
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Date Time Signed Comments
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Checklist For An Error or Incident in the Administration of Medicines
Organisation
Name of Service User…………………………………………………………………..
Name of Staff Member……………………………………………………………
Names of any Witnesses……………………………………………………………….
…………………………………………………………………………………………….
Date of error/incident………………………. Date reported …………………………
Briefly describe what happened……………………………………………………….
…………………………………………………………………………………………….
Date & time emergency advice sought/from who?…………………………………..
What action was taken?………………………………………………………………….
………………………………………………………………………………………………
……………………………………………………………………………………………..
Have the details been entered into: -
The organisation report/ incident book? Yes/No Date……………………….
The service user’s case notes? Yes/No Date……………………….
Has the Medication Administration Record been amended? Yes/No
Has the service user’s next of kin been informed? Yes/No Date……………..
Have you informed your Resource Manager? Yes/No Date……………………..
Have you completed CSCI Incident Form? Yes/No Date………………………..
What action has been agreed?…………………………………………………………
……………………………………………………………………………………………...
Signature ………………………………………………………Date……………………
Print Name………………………………………………………………………………
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