Delivery of Monthly Medication 7

Contents

Introduction...... 5

Delivery of Monthly Medication...... 7

Storage of Fridge Lines...... 7

Storage of Controlled Drugs...... 8

Unit Dose Systems...... 8

Label Information...... 9

Classification of Medicines...... 9

Generic V Branded...... 9

Medication Administrationand Recordkeeping...... 10

PRN Medication and Protocols...... 12

Disposal of Unwanted Medication...... 13

Information Sources...... 14

Deceased Residents Medication...... 15

Handwritten changes to MAR charts...... 15

Adverse Drug Reactions...... 16

Storage of Medicines...... 17

Ordering and Supply of Medicines...... 17

Acute, Interim Prescriptions...... 18

Wrapping Up & Next Steps...... 19

Dear Care Home Manager/Mentor;

Welcome to the Lloydspharmacy Managed Care System Care Training Support Programme. This programme has been designed as a tool to support you in thesystem training of your care workers, to safely handle and administer medicines during the course of administering medicines within the care home environment.

This guide outlines suggested topics to cover in a training session with your care workers using all the materials available to you. This guidance is flexible to allow you to introduce information specific to your home where appropriate.

This guide gives an overview of how to run a training session in which the contents of this booklet will be covered

•Discuss that this training is classed as set up or familiarisation training its does not meet the accreditation requirements.

•Discuss the Lloydspharmacy distance learning training pack

• Written by KeeleUniversity
• Meets Level 2 accreditation requirements
• Discuss how to obtain packs
• Discuss 3 units
• Discuss process
• Discuss how to obtain certificates.

Practical tips for preparing for and delivering atraining session

Working with the team:

In order to encourage team members to really get involved with and be committed to making the content of this trainingpart of their daily routine, you will need to reassure them that their contributions are valuable and respected. Team members who feel valued are more willing to share responsibility, confront challenges and adapt to change. You can encourage the team to be more confident and willing to make a contribution if you:

• Let them know what you expect of them
• Manage their expectations
• Let them know how they are doing
• Help them to understand how their work directly contributes to what the business is aiming to achieve
• Take an interest in their work
• Acknowledge their achievements, good thinking and ideas
• Express and show confidence in them
• Ask for their contributions
• Support them in their work
• Set achievable goals
• Measure outcomes

Remember – most people have high expectations about the jobs they do; they want to have a say in how they do them; they want to be involved in decisions that affect them; they value the opportunity to contribute to matters that affect them

Whilst delivering the coaching:

• Make the coaching as interactive as possible by encouraging theteam to participate fully, accept and support their ideas and show appreciation for their comments
• Aim for a 30:70 proportion of contribution where you do 30% of the talking and team members do 70% - this will increase involvement and ensure that you have an opportunity to assess the level of understanding that the team have already
• Confirm understanding throughout delivery by asking, for example, “Is that clear? Let me know if it isn’t”Confirm understanding by asking them to explain it back to you
• Be open and honest about the work involved, and the timescales for completing this
• Encourage the teamsto understand the benefits of the this trainingfor service users, for themselves, the team, and for the organisation as a whole

Guidance for running a training session:

Introduction

Time Suggested for this section:10 minutes

For each subject area covered in the reference guide you should have a discussion with your care workers about the individual subject area making reference to the specific policies and procedures of their care home.

It would be recommended that you ask the group questions to tease out their understanding rather than simply ‘telling’ them everything and the session feeling like a lecture, a facilitated discussion will be more engaging and ultimately your care workers will retain more of the information if they are more involved in the session

In your introduction cover the following areas:

•Discuss with the care workers that this training programme is part of their training to enable them to be competent in administration of medicines as required by CQC.

•Discuss the importance of adequate training as they must understand their actions and their accountabilities and where the boundaries are.

•Discuss what medicines are and that they

•can be administered as long as it is in accordance with the prescribers directions and they have consent of the service user

•Discuss the reference booklet “Handling Medicines in Social Care” and explain that this covers all social care settings from domiciliary care to care homes. Explain that this booklet provides practical guidance and tools in helping them to handle medicines safely this booklet can be found on the CQC website

•Discuss the 8 principles and what they mean in relation to Care Homes and the care workers role

•Principle 1 –this relates to the person having the freedom of choice to which pharmacy dispenses their prescriptions. Discuss that a care worker or agency may have a preference due to location or services offered but it is ultimately the service user’s choice to select which pharmacy they use.

•Principle 2 – Discuss the importance of care staff knowing what medicines the person they provide support for takes and that a record must be kept.

•Principle 3 – Discuss the principle which expects care workers who help people with medication that they are competent and that is the purpose of the training programme.

•Principle 4- Discuss that medicines need to be given correctly in accordance with the prescribers directions and are given in a safe manner. It is also important to discuss that when medicines are given the care worker must protect the dignity and privacy of the individual – this may be due to race, cultural or different members of sex carers for example an elderly female may be embarrassed if a male carer asked about bowel movements.

•Principle 5- Discuss in relation to the ordering and supply of medication to ensure the correct medicines are available when they are needed. This principle also covers safe disposal of unwanted medication.

•Principle 6 –This relates to where medication is stored for example out of the reach of children, in the correct temperature, out of direct light or heat.

•Principle 7 –the pharmacist is an invaluable link in providing care in order for the individual to remain independent. They are a valuable source of information regarding the medication, dosages, special cautions or warnings, any side effects or storage requirements.

•Principle 8 – It is important to discuss that medicines are powerful substances that should be treated with care and respect. They are used to treat or prevent disease and should never be abused by using them for any other outcome for example giving someone a sleeping tablet to sedate/quieten them

Delivery of Monthly Medication

Time Suggested for this section:5 minutes

•Discuss Delivery:

•What day in the cycle is the delivery made

•Discuss protected mealtimes

•Discuss who is authorised to receive a delivery

•Discuss where deliveries should be left

•Discuss how the delivery will be packaged i.e. totes, green bags

•Discuss security tags

•Discuss Delivery notes and audit trail

Storage of Fridge Lines

Time Suggested for this section:5 minutes

•Discuss Delivery of items requiring refrigeration:

•Discuss examples of items requiring storage in a refrigerator

•Discuss separate medication refrigerators

•Discuss process if separate medication refrigerator is not available

•Discuss the correct operating temperature of a refrigerator

•Discuss the Min” 2 degrees-Max 8 degrees

•Discuss the frequency of checking this temperature

•Discuss recording of temperature

•Discuss the reasons behind this requirement

•Discuss defrosting

•Discuss mechanical breakdowns and actions to take

Storage of Controlled Drugs

Time Suggested for this section: 5 minutes

•Discuss delivery of controlled drugs:

•Discuss examples of CD’s

•Discuss the fact that CD’s can be very potent, addictive or abused and therefore very strict legislation surrounding prescribing, dispensing and storage and use

•Discuss “The Misuse of Drugs Act “

•Discuss what special actions need to be taken with CD

•Discuss CD Delivery slip

•Discuss process of receiving CD deliveries within the home

•Discuss Storage requirements

•Discuss CD Registers

•Discuss best practice

Unit Dose Systems

Time Suggested for this section: 5 minutes

•Discuss the system:

•Discuss 28 day unit dose

•Discuss individual medication per pack

•Discuss unique label per pack

•Discuss separate packs for each dose

•Discuss hoops and system of separate hoops for each dose time

•Discuss colour scheme

•Discuss Sunrise-Sunset theory

•Discuss reminder cards

•Discuss why certain medication cannot be blistered e.g. size, properties etc

•Discuss Alert strips

Label Information

Time Suggested for this section: 5 minutes

•Discuss legal requirement that all medication dispensed by a pharmacy must have a label attached to it.

•Discuss what information should be included on a label

•Discuss good practice for any product containing an outer box and inner container should have a label on both e.g. creams or eye drops

•Discuss all items such as sip feeds should contain a label on each individual carton

•Discuss “MDU” instructions and that these are not acceptable in a care home environment and why

•Discuss the use of Date Opened labels

Classification of Medicines

Time Suggested for this section:5 minutes

•

•Discuss the different classes of medicines begin the discussion by asking for some examples of medicines

•Discuss where these medicines are obtained from is it on a prescription via the GP, purchased from a pharmacy or bought from a supermarket, petrol station etc.

•Discuss the categories CD, POM, P and GSL Medicines

•Remind the group or delegate that prescribed medicines are the personal property for the person for whom they were prescribed and that they are powerful substances that should be treated with care and respect and not to be given or shared with anyone for whom they were not prescribed.

Generic V Branded

Time Suggested for this section: 5 minutes

•

•Discuss that medicines can have at least 2 names

•Discuss what generic means

•Discuss what branded means

•Discuss some examples

•Discuss how they can verify if uncertain

Administration and Record Keeping

-The AuditTrail-(R.A.D.I.O.)

Time Suggested for this section:20 minutes

•Discuss Principle 2 of “The Handling of Medicines in Social Care” which states that Care staff know which medicines a person has and the social care service keeps a complete account of medicines.“

•Discuss the importance of record keeping, from the records kept; anyone should be able to understand exactly what the care worker has done and to be able to account for all of the medicines they have managed for an individual. It is up to the service provider to decide what format these records are recorded in however they do need to be Complete, Legible ,Up to date, Written in ink , Dated and Signed.

•Discuss how MAR charts are used. Further generic advice can be found on page 56 in “The Handling of Medicines in Social Care” publication.

•Discuss the importance of audit trails and how correct completion of a MAR chart will provide an audit to trail of what happens to the medication from the time it enters the home to administration/destruction.

•Discuss the importance of an accurate record- use the scenario of a book that anyone should be able to look at a Mar and be able to understand what has been done and if not its like pages missing from a book.

•Discuss what type of ink should be used to complete a MAR chart

•Discuss what should not be used on a MAR include pencil, coloured inks, tippex, labels etc

•Discuss how long a completed MAR chart should be kept-

•Consider guidelines min 3 years

•Good practice 7 years as legal action can be taken after death of a resident

•If under 18 min of 75 years or life time of child.

•Hand out copies of a MAR chart and discuss including

•Laser Printed

•Personal Information

•Allergies should contain drug allergies or statement “None Known”

•Start date and cycle period

•Discuss what audit trails a correctly completed MAR demonstrates:

•Receipt of Medication

•Administration

•Destroyed/Disposed Medication

•Information supporting ad- hoc events such as refusals

•Ordering Information

•Discuss process for booking in received medication include

•Checking orders against current MAR

•Checking scripts against orders

•Checking received medication against New MAR and script

•Discuss importance of recording brought forward /carried forward balances

•Discuss Administration

• Principle 4 of Safe Handling of Medicines in Social Care states that “Medicines are given safely and correctly and care staffs preserve the dignity and privacy of the individuals when they give medicine to them”.

• Discuss The Medicines Act 1968 state that anyone can administer a medicine to a third party as long as it’s in accordance with the prescribers directions.

• Discuss administration is a single person process; therefore, one person must complete all of the following tasks,

•Checking they have the correct person , correct drug correct dose , correct time, correct route,

•Discuss the dispensing (popping out)

•Offering (to the service user)

•Witnessing

•Recording

•If they do have a policy of 2 persons administering meds, one should be for observation only.

•Discuss the full process including 5 rights –Person, Drug, Dose, Time, and Route.

•Discuss and demonstrate the” No touch “Method of Pack to Pot to Person

•Discuss what type of liquid should be offered – water explains hot drinks can react so can milk or fruit juices and give examples e.g. certain antibiotics will react with milk

•Discuss what position the resident should be in -remind them upright position and awake

•Discuss Refusals and non-administration and what should be recorded and who should be informed.

•Discuss the codes for non-administration and examples of when they should be used.

•Discuss Carers notes and the importance of utilising this facility

PRN Medication and Protocols

Time Suggested for this section: 5 minutes

•Discuss PRN is a Latin abbreviation for “When Required”

•Discuss what types of medicines are commonly prescribed as PRN

•Discuss examples

•Discuss what frame works should be in place

•Discuss PRN protocol and information that should be included

• Who for
• Why
• When
• Medication
• Dose
• Route. including area of application for creams etc
• How often (with time scale)
• Maximum Dose
• Do you need to contact on call first
• What to do if doesn’t work
• How long before contact GP
• Any other treatments to be tried first
• Anything to watch out for e.g. side effects/ cautions/ warnings
• Written By
• Status
• Review Date

Disposal of Unwanted Medication

Time Suggested for this section:5 minutes

•Principle 5 In Safe Handling of Medicines in Social Care states that the care provider should make sure that unwanted medicines are disposed of safely.

•Discuss the circumstances in which medicines may need to be disposed of

•Discuss importance of recording destruction/disposal both in the returns book, and also onto the MAR sheet.

•Demonstrate Returns envelope and book.

•Discuss the regulations if the home is a care home it will go back to the pharmacy, if it’s a nursing home or dual registered home, it must go back through a clinical waste contractor.

•Discuss the changes in clinical waste legislation, in July 2005, explain why and consequences of non adherence

• If Sent back to pharmacy from a care setting that offers some nursing care could risk a £20k fine for both home and pharmacy and pharmacist is at risk of prison sentence.

• Discuss shelf life of medication- if blistered, 56days (8 weeks) Non blistered -3months from the date of dispensing exceptions include eye drops. Creams and Ointments with active ingredients 28 days

Information Sources

Time Suggested for this section: 10 minutes

•Discuss that the Care worker should know what medicines a person has and should be aware of what they have been prescribed for, how they should be stored and any cautions, warnings and side effects.

•Discuss that some of this information will be found on the label but there is too much for it all to be included and the carer needs to gain this from alternative sources

•Ask where could the information be found and discuss the groups responses

•Draw attention that it is European Law that at the time of dispensing a pharmacist must supply a Patient Information Leaflet (PILS)

•That Principle 7 of “The Handling Medicines in Social Care” states that access to advice from a pharmacist should be available, and that the contact details of the pharmacy that dispensed the medication will always be on the labels of the dispensed medication.