DRAFT 3
Checklist to Ensure that Robust Systems of Medicine Management exist in Care Homes
Name & Address of Care HomeFloor/ unit (if applicable)
Pharmacy Name & Address
Pharmacists Name
Signature / Date / ……./……./…….
PART 1
Ordering and Receipt of Medicines
Medicines are valuable and costly, It is unacceptable to return unused medicine each month to the supplier and at the sametime request more supplies.
It is important not to over-order and this can happen:
• When medicines are taken infrequently, for example, pain relief prescribed ‘when required’
• For creams and ointments when it is difficult to predict how much the person will need to
last four weeks
A robust communication channel must exist at all times with the dispensing pharmacist. In particular, information should be supplied to the pharmacist when
• They initially take up residence
• They return from a period in hospital
• There is any change to the medicines .
This information will be helpful before prescription forms are sent for dispensing. It should include
all regular medication ordered from the GP surgery and any other items such as ‘when required’medication.
Is stock checked before orders are placed? / Always Usually Rarely
Is a record kept of medicines ordered? / Always Usually Rarely
Are prescriptions checked by staff against orders to enable them to raise queries before prescriptions go to the pharmacy1? / Always Usually Rarely
Is sufficient time given for each step of the ordering process? / Always Usually Rarely
Do staff follow a clear written procedure to order urgent items? / Always Usually Rarely
When ordering non-urgent items, do staff follow a clear written procedure? / Always Usually Rarely
Are all current prescribed medicines for all residents in stock? / Always Usually Rarely
Is the pharmacist informed of changes to medication regimes as they occur?And is this set out in a written protocol? / Always Usually Rarely
Is sufficient time given for staff to check in medication properly? / Always Usually Rarely
Is a record of receipt kept? / Always Usually Rarely
Are new Medication Administration Records (MAR) checked against the previous month’s MARs for accuracy and to check for changes? / Always Usually Rarely
Are all available medications listed on the MAR? / Always Usually Rarely
Is newly prescribed medication usually received within 24 hours? / Always Usually Rarely
Are the MARs up to date including removal of discontinued lines? / Always Usually Rarely
Are alterations dated,signed and linked to documented prescribing decisions? / Always Usually Rarely
Is information on allergy status and date of birth filed with the MARs? / Always Usually Rarely
Is there a set procedure to order repeat medication? / Always Usually Rarely
Is the procedure to order repeat medication undertaken by the staff of the home? / Always Usually Rarely
Are the prescriptions received from the GP, checked against the order to ensure that everything is received? / Always Usually Rarely
A quick & efficient process exists for obtaining ‘acute’ medicines? / Always Usually Rarely
With regards to verbal orders, a robust process exists for communicating changes? E.g. dose changes / Always Usually Rarely
Storage Areas and Supplies of Medicines
Is the storage area clean, tidy, secure, and <25oC? / Always Usually Rarely
Are medicines kept safe from other residents at all times?Including receipt, disposal and administration? / Always Usually Rarely
Is there a procedure to be followed if the keys go missing? / Always Usually Rarely
Are keys to medicine cupboards on responsible person1? / Always Usually Rarely
Is secure storage available for residents who wish to self-administer3? / Always Usually Rarely
Do staff know how to check when a medicine has to be kept in a fridge or not? / Always Usually Rarely
Are fridge lines stored appropriatelyi.e. in fridge not on trolley1? / Always Usually Rarely
Are fridge maximum and minimum temps monitored daily1? / Always Usually Rarely
Is a record kept of the person who takes the temp. readings? / Always Usually Rarely
A separate and secure fridge is used only for medicines that require cold storage? / Always Usually Rarely
Is appropriate action taken when fridge temperatures are outside recommended limits1? And is this done according to a written procedure? / Always Usually Rarely
Is the fridge cleaned and defrosted regularly? / Always Usually Rarely
Is the ‘flu vaccine, if stocked, in a medicine fridge? / Always Usually Rarely
Is all medication fully labelled with clear, concise directions? / Always Usually Rarely
Are short life medicines dated on opening? / Always Usually Rarely
Are all labels unaltered, or initialled by the GP? / Always Usually Rarely
Are supplies of all medicines available without overstocking? / Always Usually Rarely
Are compliance aids / Monitored Dosage Systems filled by a pharmacy? / Always Usually Rarely
Are all medicines in their original labelled container until administration? / Always Usually Rarely
Internals and externals are stored separately? / Always Usually Rarely
Administration
Whenever possible people in care settings should be responsible for looking after, and taking their own medicines, but some will be given medicines by care workers.
Staff should only give medicines that they have been trained to give. Care workers can give or assist
people in:
• Taking tablets, capsules, oral mixtures
• Applying a medicated cream/ointment
• Inserting drops to ear, nose or eye
• Administering inhaled medication.
Care workers should not undertake the following unless they have satisfactorily completedadditional training:
• Rectal administration, e.g. suppositories, diazepam (for epileptic seizure)
• Injectable drugs such as insulin
• Administration through a Percutaneous Endoscopic Gastrostomy (PEG)
• Giving oxygen.
There must be a process in place for selecting the right medicines, preparing the right dose and giving it the right way to the right person.
Is there a robust procedure in place for giving medicines? E.g. ‘The Handling of Medicines in Social Care’ > Page 51 / Always Usually Rarely
Is the record of administration complete, i.e. no gaps on the MAR? / Always Usually Rarely
Is the record keeping clear and accurate inc. externals and ‘when required’ (prn) medicines? / Always Usually Rarely
Is the appropriate code used to explain non-administration? / Always Usually Rarely
Do the records correspond to the monitored dosage system (if used)? / Always Usually Rarely
Is the actual dose administered for variable dose medication recorded? / Always Usually Rarely
Is an indication and frequency stated for “as required” drugs? / Always Usually Rarely
Is the MAR signed immediately after administration? / Always Usually Rarely
Are dispensed items inc. dressings, appliances, nutritional supplements only used for the person for whom it was prescribed1? / Always Usually Rarely
Are medicines such as suppositories, insulin, PEG feeds administered by staff trained in such techniques? / Always Usually Rarely
Is the sample list of initials to enable identification of the person who administered the medication kept up to date1? / Always Usually Rarely
Minor Ailments
Are all Homely Remedies agreed with and signed by the GP? / Always Usually Rarely
Is it clear what conditions can be treated? E.g. headache, cough / Always Usually Rarely
Is there a protocol for staff to refer to? / Always Usually Rarely
Are records kept of the purchase, administration and disposal? / Always Usually Rarely
Disposal of Medicines
Is there a written policy for the safe disposal of surplus, unwanted or expired medicines? / Always Usually Rarely
Is unwanted medication promptly removed, and disposed of,in accordance with the above policy? / Always Usually Rarely
Does a witness countersign the record of disposal? / Always Usually Rarely
Are unwanted medicines segregated and stored appropriately? / Always Usually Rarely
Advice
Is the pharmacist easily contactable for queries re medications ie supply, side effects, interactions, etc? / Always Usually Rarely
Is there a named person at the pharmacy for the home to contact? / Always Usually Rarely
Are arrangements in place for locums to cover the pharmacy service? / Always Usually Rarely
Is there a named person, and deputy, in the home, for pharmacy to contact? / Always Usually Rarely
Is there a named person at the surgery for home to contact? / Always Usually Rarely
Where residents have been prescribed ‘as required’ drugs, is there an indication and frequency stated? / Always Usually Rarely
Is a pharmacist’s advice sought before medication is crushed? / Always Usually Rarely
Is medication review prompted on a regular basis for all residents? / Always Usually Rarely
Staff Training
All care workers have undertaken training in the handling and use of medicines and had their competency assessed? / Always Usually Rarely
How often is the competency of care workers, regarding their handling and use of medicines, assessed? / Always Usually Rarely
Is staff training documented for each care worker? / Always Usually Rarely
2 points for “Always”; 1 point for “Usually”;
0 points for “Rarely” / Score Achieved ………….
PART 2
Medicine Policies
Is there a comprehensive medicine policy covering all of the above areas updated since July 2003? / Yes No
Are staff aware of the home’s medicine policy? / Yes No
Was there pharmacy input when developing the medicines policy3? / Yes No
Do the policies reflect the practice in the home? / Yes No
Is there a policy on covert administration? / Yes No
Is there a policy on self-administration, including risk assessment? / Yes No
Is there a policy on medicines supply for periods of leave? / Yes No
Are the pharmacist, and care home staff, aware of, and work within, the latest guidance from the RPSGB and the NMC / Yes No
Is there an effective, blame-free incident and error reporting system7 / Yes No
Are audits of medicines including action plans completed regularly? / Yes No
Controlled Drugs
Does the CD cupboard comply with regulations? / Yes No
CD cupboards are only used for the storage of CDs? / Yes No
Only those with authorised access hold the keys to the CD cupboard? / Yes No
Are all CDs (including schedule 3) kept in the CD cupboard? / Yes No
Do care workers know which prescribed medicines are CDs? / Yes No
Does the CD register balance agree with the quantities of CDs kept? / Yes No
Scoring: 2 points for “Yes” & 0 points for “No” / Score Achieved ………….
Total Score
(For Part 1 & 2)
……………
PART 3
Advice Given (this maybe something not mentioned above, or something of a significant nature)
Action Plan
Completed forms should be posted, faxed, or e-mailed to:
Beverley Moore
Pharmacy Admin Assistant
Primary Care Commissioning
Louis Freedman
St Leonard’s, Nuttall Street
London
N1 5LZ
Tel. No. 020 7683 4483
Fax No. 020 7683 4464
E-mail: