Crossroads Care Adults’ medication procedure

B.02b

Adults’ medication procedure for managers

1.0 SCOPE

1.1 This procedure and accompanying policy and guidance (B.02a and B.02c) relate to adults aged 18 or over. Please see the separate children’s medicationpolicy, procedure and guidance(C.03a, C.03b and C.03c) regardingchildren and young people aged 17 and under. The intended outcome of this set of documents is to protect both staff and service users by ensuring the safe and effective handling of medication within Crossroads Care schemes.

1.2 General medication includes:

  • all tablets, capsules, mixtures and liquids to be taken orally (by mouth)
  • liquids, lotions, creams and ointments for topical application (including ear, nose and eye drops)
  • transdermal patches
  • inhaled medication, including the use of inhalers and nebulisers

1.3 Medication may also be administered byspecialised techniques, for example via a percutaneous endoscopic gastrostomy (PEG).

1.4 This procedure and the accompanying policy and guidance will be read in conjunction with the following:

  • adults’ personal care policy, procedure and guidance (B.01a, B.01b and B.01c)
  • autonomy and independence policy (D.08)

2.0 responsibilities OF MANAGERS

2.1 Managers are required to have systems in place to ensure that all staffwork according to the adults’ medication policy, procedure and guidance when planning or providing care.

3.0 service planning and review

3.1 A designated staff member trained in risk assessment and care planning (referred to as a care planner) willcarry out a suitablerisk assessment (BT.02) of tasks involvingmedication and prepare a detailed care planbefore care commences.

3.2 At the initial assessment visit the care plannerwill determine whethermedicationcan be taken by the person with care needs unaided and if not,whether it can be administered by their carer prior to the commencement of an episode of care. If there is no alternative, the care planner willassess what help with medication is required and whether this can be provided byCrossroads Care staff.

3.3 Where care workers are required to offer support with or administer medication, the risk assessment willinclude and clearly document the following:

  • a current list of medicationbeing taken by the person with care needs (including the name of the drug, thedose, route and frequency of administration)
  • how the medication is to be taken, for example orally, topicallyor by specialised technique
  • the nature and level of support the care worker is required to provide (see 6.0 below)
  • common side-effects of the prescribed medication
  • arrangements for storage of and access to medication in the person’s home
  • arrangements for the filling of compliance aids if these are used (see 6.5.3 below)
  • how the person with care needs communicates (including non-verbally), particularly how they indicate unhappiness, pain or distress
  • arrangements for the supply of medication, for example by use of a repeat prescription service
  • any other ‘need to know’ information relating to associated hazards, risks and relevant precautions or actions to be taken in an emergency.

3.4 Staff are not authorised to administer medication unless they are trained and competent to do so and the task is specified in the care plan.The care plan needs to clearly state whether any help with medication is required and if so, the level of support to be provided.

3.5 Medication will only be listed in a service user’s care plan where:

  • staff are involved in providing support with or administering it
  • there is a reliable system in place to ensure the list is kept up to date at all times.

3.6 It is recommended as good practice that where possible care planners identify the location of an up-to-date current list of medication for each person with care needs (for example the repeat prescription list supplied by the pharmacy) that staff could access in case of emergency.

3.7 Requests for support with non-prescribed or general sale medication will only be agreed with the written instruction of an authorised prescribing practitioner (for example General Practitioner (GP), pharmacistor Registered Nurse) to confirm it is safe for the service user to take. Details will be documented in the care plan.

3.8If the person with care needs asks for their medication to be given in food or drink, the care planner will need to first seek confirmation from the person’s GP or pharmacist prior to agreeing to administer the medication in this way. This is necessary to ensure that mixing the medicine with food or drink does not reduce its efficacy or render it harmful.

3.9 Crushing or otherwise altering medication can also affect its efficacy and any requests to administer medication in such ways need tobe referred to the person’s GP or pharmacist for approval.

3.10 Covert administration of medication

3.10.1Disguising medication (for example, providing medicine in food or drink) without the consent and knowledge of the person with care needs is referred to as ‘covert administration’ and could potentially be regarded as assault. Covert medication is sometimes assessed as being justifiable and necessary but must never be given to anyone who has the mental capacity to decide whether and how to take their medication.

3.10.2 The covert administration of medicines will only take place under the specific written direction of the person’s GP or other relevant medical practitioner following a best interests assessment and within the context of existing legal and best practice frameworks, such as the Mental Capacity Act,to protect the person receiving the medicines and the staff involved in giving the medicines. In such cases it is important that the GP provides this advice in writing – verbal advice is not sufficient.

3.10.3 Action agreed following the ‘best interest’ consultation process will be fully recorded in the person with care needs’ care plan and medical records. Seethe autonomy and independence policy (D.08) for further details regarding ‘best interests’.

3.11 Medication records will be reviewed, updated and where necessary, amended annually or whenever there is a change to the person with care needs’ medication, to ensure they remain valid.

4.0 storage of medication

4.1 Medication needs to be kept safe from inappropriate or accidental misuse during the period of care.

4.2The care planner will ascertain whethermedicationis stored in an identified secure place away from sources of direct heat and according to manufacturers’ requirements.

4.3Where medication is to be administered it is preferable that it is kept separate from anymedicines belonging to other people in the household.

4.4 If care planners are not satisfied that medication is being stored safely and no suitable arrangement can be made to address this, they may decide to withdraw the service or may decline to provide assistance with medication during the period of care.

4.5Care workers will be instructed that if they find storage arrangements are not in accordance with the care planor have become lax, they are required to refer the matter to their line manager.

5.0 CONSENT

5.1 Where possible, the written consent of the person with care needs will be obtained for all levels of assistance with medication (see 6.0 below). This includes consent for any support with or administration of medication (including by specialised techniques) that the person takes either on a regular or on an “as required” basis. A model care plan, which incorporates an appropriate consent form is available at BT.03.

5.2 If the person with care needs is unable to give written consent, but is assessed as having the mental capacity to give or withhold consent, then the care planner needs to consider other ways the person might indicate their agreement, for example by:

  • witnessed verbal consent
  • clear, active assent (for example nodding the head)
  • consensual behaviour (cooperating with the administration of the medication).

5.3 If there is any doubt as to the mental capacity of a person to give consent to any aspect of support with or administration of medication, this will be reported to the relevant health / social care professional/s who will carry out an assessment of capacity. Crossroads Care staff will not be responsible for reaching any conclusions regarding mental capacity.

5.4 If the person with care needs is assessed as lacking capacity to give consent tomedication, the care planner needs to confirm what medication the person is currently prescribed, for example, by consulting with their carer and checking details on the repeat prescription supplied by the pharmacist. Where there is any uncertainty or cause for concern, the care planner will need to consult a relevant healthcare professional (such the person’s GP or pharmacist) to confirm details. In some cases a multi-disciplinary ‘best interests’ meeting may be held, comprising professionals involved in the care of the individual, their carer / close family members as appropriate, to decide what medication it is in the person’s best interests to take.

5.5 If the person with care needs has made an Advance Decision or there is a Lasting Power of Attorney, this will be noted and acted upon appropriately. All decisions taken will be recorded in the person with care needs’ file and all necessary information regarding the administration of medication entered into their care plan and medical records.

6.0 THREE LEVELS OF MEDICATION SUPPORT

6.1 There are three different levels of support with medication depending on the needs of the person receiving care. These are:

  • general support
  • administering medication
  • administering medication by specialised techniques.

6.2 The levels of support apply to:

  • prescription only medication[1] (POM)
  • pharmacy only items[2] (P)
  • general sale list medication[3] (GSL).

6.3There is a risk thatnon-prescribed remedies / GSL medicines (for example Paracetamol, Ibuprofen)may cause adverse reactions when taken with other prescribed medication. Therefore support with or administration of non-prescribed remedies / GLS medicines will only be included in a care plan with the written authorisation from a prescribing practitioneror pharmacist.

6.3.1 If added to the care plan, non-prescribed remedies / GSLs will be treated as if they were prescribed medication and recorded accordingly.

6.3.2 Managers need to instruct care workers that they are not permitted to:

  • provide support with or administer non-prescribed remedies / GSL medicines unless they are included in the person with care needs’ care plan
  • offer advice on the treatment of minor ailments.

6.4Please note that some nurses and pharmacists are now authorised to prescribe certain types of medication (see 3.7 above).

6.5 Generalsupport with medication

6.5.1 This level of support is given when:

  • the person with care needs takes overall responsibility for their own medication
  • the care worker has not been required to select the medication.

6.5.2 General support includes:

  • manipulation of a container (for example opening a bottle of tablets or liquid medication) at the request of the person with care needs
  • an occasional reminder or prompt from the care worker to the person with care needs to take their medication (a persistent need for reminders may indicate the person with care needs does not have the capacity to take responsibility for their medication).

6.5.3A person with care needs may be able to retain independence to administer their own medication by using a compliance aid, for example if they find it hard to open packs and bottles or are havingdifficulty remembering whether or not they have taken their medication.

  • If the compliance aidis a pharmacist-filled, sealed blister packthe care worker may offer general support to the person with care needs to access and take their medication as described in 6.5.2 above.
  • If the compliance aidis an unsealed, compartmentalised container filled by a carer / family member, the care planner will need to assess that the necessary arrangements are in place to minimise the risk for potential error. They will then need to document in theservice user’s care plan that the care worker is allowed to offer general support to the person with care needs to access and take their medication from the unsealed container.

Please note: care workers are only allowed to offer general supportwith medication from an unsealed containerfilled by a carer / family member when the person with care needs is able to takeoverall responsibility for their own medication.

6.5.4 Although care workers are not taking responsibility for the administration of the medication when offering general support, they need to be instructed to remain vigilant to ensure the person with care needs takes their medication correctly and to contact their line manager / the person on call immediately with any concerns.

6.5.5 A person may qualify to receive their medication in a pharmacy-filled, sealed blister pack as a free service from the community pharmacist if they meet criteria under the Disability Discrimination Act.

6.6 Administering medication

6.6.1 This level of support involves care workers giving medication to the person with care needs. It will only be offered if an assessment identifies that the person with care needs is unable to take responsibility for their own medication and needs assistance.

6.6.2 Medication will only be given from the original container into which it was dispensed and only to the person for whom it is prescribed. An original container includes:

  • a pharmacist-labelled bottle or packet
  • a pharmacist-filled, sealed blister pack (restrictions apply – see 7.10 below).

Care workers will not administer medication from containers filled by anyone other than a prescribing practitioner or pharmacist.

6.6.3Administration of medication by the care worker may include:

  • selection and preparation of amedication for immediate administration
  • selection and measurement of a dose of liquid medication for the person with care needs to take
  • selection and administration of sub-lingual medication
  • selection and instillation of ear, nose or eye drops
  • application of a medicated cream/ointment
  • application of a transdermal patch
  • selection and administration of medication via an inhaler or nebuliser
  • regularly prompting a service user to take their medication when they are not able to take responsibility for their own medication.

6.6.4Care workers are not permitted to administer medication if they have not received the necessary information, instruction and training or do not feel confident and competent to do so. It is the responsibility ofmanagers to ensure that care workers are not given duties they are not capable of carrying out.

6.6.5 When informed by a care worker that there is a problem with medication, including the contents of a blister pack, the line manager / person on call will contact the service user’s pharmacist / duty pharmacist for advice on what action to take to resolve the issue.

6.6.6 Where a label becomes detached from an individual item of medication or is illegible, the medication must not be used and will need to be returned to the pharmacist. Care workers will be instructed never to alter labels or re-attach them to containers.

6.7 Administering medication by specialised techniques

6.7.1 Administration of medication by specialised technique is referred to as a specialised task.

6.7.2 Specialised tasks involving medicationinclude:

  • rectal administration(for examplediazepam for epileptic seizure)
  • buccal administration (for example midazolam for epileptic seizure)
  • administration of medication through a percutaneous endoscopic gastrostomy (PEG)
  • administration of insulin using a pen device
  • administration of apomorphine using a pen device (APO-go pen) for people with Parkinson’s Disease
  • monitoring of infusion pumps (such as syringe drivers) for volume and battery life.

Please see Appendix 1 at the end of this document for the full list of specialised tasks.

6.7.3 The care planner will ensure that the specialised task protocolis followed before agreeing to administer medication using a specialised task and prior to commencing care. Please see Appendix 2 at the end of this document for full details of the specialised task protocol, including training requirements.

6.7.4 Specific model protocols are available for the following specialised tasks:

  • administration of insulin using a pen device (DT.06)
  • administration of apomorphine using a pen device (APO-go pen) for people with Parkinson’s Disease (BT.07)
  • administration of buccal midazolam (DT.08).

6.8 ‘As required[4]’ (PRN) medication

6.8.1 General support with / administration of ‘as required’ medication needs to be subject to a suitable risk assessment. Details, including the indications for offering the medication, will be recorded in the care plan, explaining the checking procedure to be followed.

6.8.2 Care workers will be instructed to follow the accompanying adults’ medication guidance (B.02c). This states that, before giving support with or administering ‘as required’ medication, care workers need to check:

  • administrationwill not exceed the maximum dose permitted over 24 hours
  • there has been sufficient time lapse between doses.

In practice care workers will do this by referring to written records as well as by asking the person with care needs and / or their carer, in order to establish how much medication has already been taken and when.

7.0 DAILY RECORDS

7.1 Whatever the level of support agreed (see 6.0 above), detailed records of allmedication handling will be entered on the client report form, including general support, administration of medication and administration by specialised technique.

7.2 When medication has been administered(including by specialised technique), this will be recorded on the drug administration form (DT.02) as well as on the client report form.

7.3 Records will also be kept of:

  • all prompts to take medication
  • non-successful administrations of medication
  • any suspected adverse reactions to medication.

7.4.Wherestaff from anotherorganisation (for example community nurses), also administer medication it may be assessed as appropriate to share forms. Copies of allcompleted drug administration forms will need to be taken in order to ensure that full and accurate medication records are available in the Crossroads Care office. Where another organisation’s forms are used (including those supplied by the pharmacistwith sealed blister packs) the care planner will ensure that they record all necessary information as outlinedat 7.9 and 7.10below.

7.5Records will be written in black ink. Care workers will always sign or initial their records. A list of all staff signatures and initials will be kept in the office for cases where verification may be required.

7.6Care workers need to inform their line manager if record sheets (including client report forms and drug administration forms)are running low in the service user’s home so that arrangements can be made for new forms to be issued.