Crossroads CareAdults’ Medication guidance for care workers

B.02c

Adults’ medication guidance for care workers

1.0 SCOPE

1.1 This guidancerelates to adults aged 18 and over. There is separate guidance(C.03c) for children and young people aged 17 and under.The intended outcome of this document 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 canalso be given by specialised techniques, for examplethrough a percutaneous endoscopic gastrostomy (PEG).

1.4This guidance is relevant to all medication, whether itis prescribed or bought over the counter (see 2.3below).

1.5 This guidance will be read alongside:

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

2.0 INTRODUCTION

2.1 Wherever possible people with care needs have the right to manage and take their own medication. If the person’s condition means that they cannot take their medication themselves, or they need help to take it, you may beaskedto assist them.

2.2You are not allowed tooffer any kind of help or support with a person’smedication unlessyou havebeen trained to do so and it is writtenin their care plan.

2.3 This applies to medicines that have been bought over the counter (such as common pain killers and cough remedies) as well as to those that have been prescribed by a doctor.

  • Some over-the-counter medicines (for example Paracetamol and Ibuprofen)can cause adverse reactions if they are taken with other prescribed medication.
  • You must not offer service users any support with oradvice about over-the-counter medicines or how to treat minor ailments such as common coughs and colds.

3.0 THREE LEVELS OF SUPPORT

3.1 There are three levels of support with medication.These are:

  • general support with medication
  • administering medication
  • administering medication by specialised technique.

3.2 A designated staff member trained in risk assessment and care planning (referred to as a care planner) will assess what level of support, if any, each service user needs and this will be clearly written in their care plan.

3.3General support with medication

3.3.1This is the support given when the person with care needs is able to beresponsiblefor their own medication but needs some help to actually take it. When you are giving general support you will always be working under the direction of the person receiving the care.

3.3.2General support with medication may include, for example:

  • being asked by the person with care needs to open a bottle of tablets or to pour out a dose of liquid medicine
  • giving an occasional reminder to the person with care needs to take their medication– if you find that you are having to remind them frequently,report this to your line manager (see also 3.4.2 below).

3.4 Administering medication

3.4.1 This level of support is needed when the person with care needs is not able to be responsible for their own medication and needs your help to take it.

3.4.2 Administering medication includes:

  • selecting and preparing medication (such as tablets, capsules and mixtures) and helping the person to take it
  • selecting and measuringout a dose of liquid medication and helping theperson to take it
  • selecting ear, nose or eye drops and putting them in
  • applying a medicated creamorointment
  • applying a transdermal patch
  • selecting and giving medication through an inhaler or nebuliser
  • regularly prompting the person to take their medication when otherwise they would not do so.

3.5 Administering medication by specialised techniques

3.5.1 Administering medication by a specialised technique is referred to as a specialised task. Examples of specialised tasks include:

  • giving medication rectally (for example Diazepam for epileptic seizure)
  • giving medication buccally (for example Midazolam for epileptic seizure)
  • givingmedicationthrough a PEG
  • giving insulin using a pen device
  • givingapomorphine using anAPO-go pen for people with Parkinson’s Disease
  • applying transdermal patches
  • monitoring an infusion pump(such as a syringe driver)
  • giving prescribed additional doses of medication using the infusion device (for example by pressing the button on a syringe driver).

3.5.2 Before you can administer medication using a specialised task you will need tobe given client-specific training from a relevant professional and this training will need to beupdated every year.

3.5.3Once you have finished all the necessary training, the trainer will check that you are competent to carry out the task safely and feel confidentandcapable to do so. This will then be recorded in your personal training file.

3.5.4You need to be aware that you can opt out of giving medication using a specialised task if you prefer not to take on this responsibility but that this might affect the amount of work you will be offered.

4.0 STORAGE OF MEDICATION

4.1 It is important that a person’s medication is:

  • stored in a secure place
  • stored according to manufacturers’ instructions
  • kept safe from misuse during the times you are visiting
  • kept separate from medicine belonging to other people in thehousehold.

4.2 The person’s care plan will state where the medication is to be stored. If you are concerned about the safe storage of medication contact your line manager to let them know.

5.0 GENERAL RULES FOR HANDLING MEDICATION

The guidance below applies to allmedication.

5.1 You are required to:

  • onlyprovide the level of support with medication that is written in the care plan
  • only help with medication that is stored in theoriginal container supplied by the pharmacy(including pharmacist-filled, sealed blister packs) andintended for the person with care needs.
  • wash your hands before and after assisting with or administering medication.

5.2NEVER:

  • give anykind of help withany form of medication if itis not written on the person’s care plan for you to do so
  • give medication to a service user against their wishes
  • try to disguise medication,(for example by hiding it in food or drink) unless it is written in the person’s care plan to do so
  • alter the timing or dosage of medication
  • buy over-the-counter medication (such as Paracetamol or Ibuprofen) on behalf of a service user
  • carry medication belonging to a person with care needs, except when authorised to do so on the care plan, (for example when required on trips outside the home, collecting prescriptions, or disposing of unwanted medication)
  • use a service user’smedication for yourself
  • give your own or anyone else’s medication to a service user
  • transfer medication from an original container to another
  • fill or assist a service user to fill compliance aids or dosage systems
  • crush or otherwise tamper with medication before giving it to the person with care needs unless directed to do so in the care plan
  • give support with or administer medication where the label has become detached from the container or is illegible
  • alter or re-attach labels to medication containers.

5.3 Touching medication

5.3.1 When giving any kind of help with medication, avoid directly handling it wherever possible in order to protect both you and the person you are looking after.For example, push the tablet or capsule out of its packaging directly into a medicine pot / onto a spoon / into the service user’s hand.

5.3.2 If the care planner has risk assessed that handling the medication cannot be avoided, you will be directed in the care plan to wear disposable gloves to do so.

5.3.3 Some medicines may be harmful if you come into direct contact with them. In such circumstances you will be directed on the care plan to wear disposable gloves when giving any kind of help with that particular medication.

5.3.4 If you are directed on the care plan to applymedication to a service user’s skin in the form of a lotion, cream or ointment, you will be required to wear disposable gloves for the protection of both yourself and the service user.

5.4Giving general support with medication or administering medication

5.4.1 Readthe care plancarefully. Only do what it says about helping with medication.

5.4.2 If you are in any doubt about what to do, contact your line manager or the person on callfor advice. Always record this on the client report form.

5.4.3 Always check:

  • that the medication has not already been givenby someone else
  • that it is the correct time to give support withorto administer the medication
  • that in the case of prescribed medicationthe name of the person with care needs matches that on the medication container
  • the dose of the medication and that this matches the details in the care plan and on the drug administration form
  • the use-by date (do not give support with or administer medications that are out of date)
  • instructions for use.

5.4.4. Before giving support with or administering‘as required’ (PRN) medication you needalso tocheck that:

  • giving support withor administering the dose will not exceed the maximum dose permitted over 24 hours
  • there has been sufficient time between doses by checking written records and asking the person with care needs and / or their carer when the medication was last taken.

Make sure you record the date and time (using the 24 hour clock) of giving support with or administering ‘as required’ medication.

5.4.5. Once you are sure that you are giving the right dose of the right drug to the right person at the right time, proceed to give support withor administer the medication according to the instructions.

Remember:if in doubt, don’t proceed – contact your line manager or the person on call for advice.

5.4.6 Whatever level of support with medication you are giving, always record youractions on the appropriate record sheets (see 6.0 below).

6.0 DAILY RECORD KEEPING

6.1 Whatever level of support you are providing with medication, you need to keep a record of it

  • Records need to be written in black ink.
  • Always sign or initial all individual records.
  • When you sign or initial the drug administration form you are confirming that you have personally observed the person with care needs take the medication.

6.2Recordsneed to be kept of:

  • all unsuccessful administrations of medication (see 8.0 below for further details)
  • all suspected adverse reactions to medication(see 12.0 below for further details).

6.3You arenot allowed to copy details of medication onto adrug administration formunless you have been trained to do so.

6.4Alldrug administration formsneed to betransferred to the Crossroads Care office routinely (for example at the end of each month or as directed by your line manager) or when care discontinues.

6.5 Inform your line manager if supplies of client report forms or drug administration forms are running low in the home.

6.6General support

6.6.1 Record exactly what you did on the client report form. For example:

  • if you remind a person with care needs to take their medication, record it (but remember, if this is happening frequently, inform your line manager)
  • if you open a container for them, record what you did, including details of which container you opened.

6.7Administering medication (including by specialised techniques)

6.7.1 Acare planner will record on the drug administration form:

  • the name of the person taking the medication
  • the name of the medication
  • the dose of the medication
  • the time it is tobe administered
  • any further special instructions.

6.7.2 You need to sign or initial the appropriate section on the drug administration formagainst each medication, given each time you give it.

6.8 Blister packs

6.8.1 If you are administering medication from a pharmacist-filled sealed blister pack, the following information will be documented on the drug administration form:

  • the name of the person taking the medication
  • precise details of the blister that tablets are to be administered from (for example “lunchtime” dose)
  • the name of the medication
  • the dose of the medication
  • the time the medication is to be given
  • any further special instructions.

6.8.2 You manager has to make sure that you are able to identify each tablet within a blister before you give it to the person to take. For example, the pharmacist may provide a description of the medication, including size, shape, colour, dose and inscription of each individual tablet.You will be instructed how to identify tablets as part of your medication training.

6.8.3 You are required to:

  • identify each tablet within a pharmacist-filled blister pack before giving it to the person to take
  • check to make sure the contents of the blister match the drugs recorded on the drug administration form
  • sign or initial the drug administration form for each individual tablet given
  • inform your line manager / the person on call immediately of any discrepancies or if you are not able to identify the contents of a blister
  • record that you have / have not administered medication on the client report form.

Do not:

  • administer any drugs you are not able to positively identify
  • administer any drugs where there is a discrepancy between the contents of a particular blister and the medication listed on the drug administration form

6.8.4Please note: you are not allowed to administer medication to a person with care needs from an unsealed container that has been filled by a carer / family member.

7.0 COLLECTION OF PRESCRIPTIONS

7.1 You will not normally be expected to collect a service user’smedication for themfrom the pharmacy. However, in some circumstances, where a family member is not able to collect it, the care planner may ask you to do so.

7.2 Details of what you have to do will be written in the care plan. You may be asked to:

  • collect the prescription from the doctor’s surgery and take it immediately to the pharmacy (though this will not be necessary where there is an Electronic Prescription Service )
  • produce proof of identity before being handed the medication.

7.3 Once you have collected the medication:

  • keep the it out of sight whilst you are in charge of it (for example in a bag or in the boot of your car)
  • take it immediately to the person’s home
  • check the medication with the person with care needs and / or carer (as specified in the care plan) to ensure that it is correct
  • place the medication in a safe place as agreed with the family and as detailed on the care plan (see 4.0 above).

7.4If you have any questions about a prescription you have been asked to collect, discuss the matter withthe person with care needs and / or their carer,and if necessary get in touch withyour line manager or the person on call for advice.

7.5If you are asked by a service user to collect a prescription in an emergency and it is not written into the care plan, contact your line manager or the person on call and ask them what to do.

8.0 UNSUCCESSFUL ADMINISTRATION OF MEDICATION

8.1 If you are supposed tobe giving medication to a person with care needs but for some reasonare not able to do so, or if the person refuses to take their medication:

  • record what happenedon both the client report form and on the drug administration form
  • report the matter tothe person’s carer and / or toyour line manager / the person on call.

9.0 MEDICATION ERRORS

9.1If you make a mistake (or think you have made a mistake) with medication:

  • report the matter to your line manager / the person on call straight away
  • tell the person with care needs and /or to their carer what has happened
  • record the mistakeon the drug administration form and the client report form.

9.2 Your line manager / the person on call will need to consult the person’s General Practitioner (GP) for advice on how to manage the error and will ask you to complete an incident report form (DT.03).

9.3 If you fail to report a mistake, try to cover it up or make false entries on records, this may be dealt with under the disciplinary policy.

10.0 DISPOSAL OF UNWANTED PRESCRIBED MEDICATION

10.1 You will not usually be expected to dispose of unused prescribed medication. However, in some circumstances you may be asked to do so, in which case details will be documented in the care plan.This will involve:

  • taking the unused medication directly to the pharmacy from the service user’s home
  • asking the pharmacy for a receipt which you then needto pass on to your line manager
  • recording details of what you did (including the name of the medication) on the client report form.

11.0 CHANGES TO MEDICATION

11.1Where you aregiving any level of support with medication, the person with care needs or their carer has tolet the Crossroads Care officeknow if the medication gets changed in any way.The care planner willthen have torecord the changes in the person’s care plan and medication records.

11.2 If you notice that a person’s medication has been altered, politely remind either them or their carer (as appropriate) that they need to let the Crossroads Care office know and if necessary, check with your line manager that they have done so.

11.3Situations may arise where a service user tells you that changes have been made to a person’s medicationat short notice and there has not been time for these changes to be written up in the care plan or on the drug administration form. This could include for example:

  • changes to the dose
  • medication being stopped
  • new medication being prescibed
  • short-term medication being prescribed, such as a course of antibiotics.

In these circumstances, it is important that you:

  • first check out that the changes you are being told about are correct
  • donotact solely on the verbal instructions of the service user
  • contact your line manager / the person on call to let them know the situation so that they

can look into it and get back to you to tell you what to do.

12.0 IDENTIFYING SIDE EFFECTS OF MEDICATIONS.