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Service User Medication Risk Assessment

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									                      Service User Medication and Health Care Tasks Risk Assessment
                            Only completed if Providers are to be involved in the tasks listed


Service User:                                            Address:

DOB:
GP:                                                      Address:
Tel:
Pharmacy:                                                Address:
Tel:
Obtaining         Y   N   N/A   Comments                                       Action
Supplies

Is service user
able to obtain
their own
meds

Are care
providers to
be involved

Taking            Y   N   N/A
Medication

Does service
user need
prompting

Does service
user need
assisting

Does service
user need
medication
administered
(includes
liquid
medication)
- See
guidance
below

Where is the
medication to
be kept

Are family or
friends
involved


Are care
providers to
be involved




23/10/07
                                                            1
Applying          Y   N   N/A
Topical
Applications
Does service
user apply
their own
creams,
ointment, eye
drops.

Is service user
able to use
their own
Inhaler/
nebuliser


Are care
providers to
be involved

Health Care       Y   N   N/A
Tasks
Does service
user empty
Catheter

Does service
user change
own stoma

Does a D/N or
relative
assist


Are care
providers to
be involved

Guidance notes
 Where administration of medication is required (including Liquid Medication) an individual protocol
    will need to be drawn up in all cases. This protocol should be signed by the GP or D/N and should be
    drawn up by the multidisciplinary team
 For controlled drugs providers will prompt only (not assist or administer). If in any doubt about
    whether a drug is controlled please contact the Community Pharmacist
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 domiciliary care, to include, if necessary, either being prompted to take
medication, assisted in taking medication or being administered medication.

Care Manager`s Recommendations




Completed By:                                                      Date:
Service User/ Representative:                                      Date:

23/10/07
                                                   2
Consent Statement

“ The service user is unable to give informed consent. The service user has no relatives/advocates
available to assist in this regard. The service user, in their own interests, will require prompting, assistance
or administration of medication and it is therefore appropriate and necessary that this be done.”




23/10/07
                                                       3

								
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