Consultation Draft

Policy on the Management and Administration of Medication

(Large Print and Easy to Read Version)

Consultation 19.07.13 – 16.08.13

Contact:

Ms Zhan McIntyre

(01292) 612916

Purpose

Aims and Objectives

Policy Scope

Service Specific Guidelines

Definition of Medication

Legal and Policy Framework

The Legal Position and Attaining Consent

Equality and Diversity

Roles and Responsibilities

Senior Managers and Corporate Responsibilities

Health Personnel

Community Pharmacists

Nursing Personnel

Specialist Nursing

Assessment Process

Management and Administration of Medication - General Standards

Reporting Errors

Data protection/ Handling Confidential Information

Indemnity Statement

Compliance

Complaints

Monitoring and Evaluation

Consultation Questions

Purpose

The purpose of the policy is to set out South Ayrshire Council’s approach to helping individual’s with their medication.

This allows the Council to meet regulations and obligations set out in the National Care Standards and Guidelines.

Aims and Objectives

The aims of this policy are to:

  • support individuals who need help with their medication;
  • provide support and guidelines for employees who support individuals with medication.

The objectives of the policy are to:

  • encourage individuals to stay independent and carry out as many self-care skills in relation to medication;
  • reduce the risk of errors in relation to medication;
  • ensure clear, concise and robust systems are in place that promote effective communication;
  • standardise documentation;
  • ensure employees receive training, instruction and information relating to medication;
  • ensure levels of help required by an individual is determined by an appropriate assessment and is outlined in a care plan.

Policy Scope

This Policy applies to all employees who provide assistance in the management and administration of medication to the individuals of South Ayrshire.

This includes employees in:

  • Early Years Establishments and Schools
  • Care Homes
  • Home Care
  • Respite Services
  • Day Care Services

Service Specific Guidelines

In the Council, the manager with overall responsibility for each service will complete and submit Service Specific Guidelines.

These guidelines will meet and comply with Care Inspectorate and other relevant guidelines and best practice.

Partners must have Guidelines / Procedures which are no less robust than the Councils. The Council have a check list that all guidelines / procedures will be measured against.

Definition of Medication

For the purposes of this policy, medication is defined as prescribed substances which can be taken orally, inhaled or absorbed through the skin.When used correctly, medication can fight infection, relieve pain and other symptoms, as well as control disease and disorders.

For some people, prescribed medication is not their preferred or primary health care system, and may therefore access other health care systems, such as homeopathic medicines. While the Council values diversity and respects the individual’s users right to such choices, Council employees or staff providing service under contract, cannot participate in any activity other than for those medicines / treatments prescribed by a legally registered medical practitioner.

Legal and Policy Framework

The Council and Partners have a legal duty of care towards individuals receiving services and a duty of care towards employees who deliver those services.

Some of the laws the Council has to work within include:

  • The Social Work (Scotland) Act 1968 (as amended by the Regulation of Care Act 2001)
  • The Medicines Act 1968
  • The Misuse of Drugs (Safe Custody) Act1973
  • Health and Safety at Work Act 1974
  • The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009
  • Reporting of Injuries, Diseases & Dangerous Occurrence Regulations (1995)
  • The Data Protection Act 1998
  • The Human Rights Act 1998
  • Managing Health & Safety at Work Act (1999)
  • Adults with Incapacity (Scotland) Act 2000
  • The Regulation of Care (Scotland) Act 2001
  • Mental Health (Care and Treatment) (Scotland) Act 2003
  • Adult Support and Protection (Scotland) Act 2007
  • Education (Scotland) Act 1980
  • Additional Support for Learning (Scotland) Act 2009

There are a range of organisations and regulations that govern care services including:

  • Care Inspectorate
  • Scottish Social Services Council
  • Scottish Government National Care Standards
  • Guidance on the Administration of Medicines in Schools

All of the Service Specific Guidelines will comply with these guidelines and regulations.

South Ayrshire Council is committed to adhering to six main principles which underpin the National Care Standards which include:

Dignity / treat individuals with respect at all times
Privacy / respect the personal privacy and property of individuals
Choice / give individuals the opportunity to choose, and letting them know what choices they have
Safety / help individuals to feel safe and to enjoy a safety without being over protected
Realising Potential / help individuals to make the most out of life
Equality and Diversity / help individualsto live in an environment free from bullying, harassment and discrimination and in a way theychoose.

The Royal Pharmaceutical Society has published eight core principles which the Council is also committed to applying in all care settings.

  • people who use social care services have freedom of choice in relation to their provider of pharmaceutical care and services including dispensed medicines;
  • care staff know which medicines each person has and the social care service keeps a complete account of medicines;
  • care staff who help people with their medicines are competent to do so;
  • medicines are given safely and correctly, and care staff preserve the dignity and privacy of the individual when they give medicines to them;
  • medicines are available when the individual needs them and the care provider makes sure that unwanted medicines are disposed of safely;
  • medicines are stored safely;
  • the social care service has access to advice from a pharmacist.;
  • medicines are used to cure or prevent disease, or to relieve symptoms, and not to punish or control behaviour.

In addition to the principles outlined above, the Council is committed to the five recognised principles should be applied as a checking system on every occasion that medication is administered to an individual.

Right Personthe medication is for that specific individual

Right Medicationit is the specified medication as designated by the prescriber

Right Timethe medication being administered is given at the specified time as detailed by the prescriber

Right Dosethe dose being administered is the correct dose as detailed by the prescriber

Right Route the prescribed medication is administered via the route indicated by the prescriber.

The Legal Position and Attaining Consent

Employees can help individuals with medicine, other than injections and inserting suppositories, if the medicine has been prescribed for that person and the written directions of the prescriber are followed. These directions will be on the medicine label and the Medication Administration Record ( MAR) chart.

Individuals should be helped to stay independent with all daily living skills including management of their medication.

Where anindividual is not able to manage aspects of their medication then consent should be obtained by the service using the relevant Consent Form included in the Service Specific Guidelines.

Consent Forms must be updated with any change in needs, or annually at the specified review date.

An individual always has choice but there may be occasions where their right can be overruled; but there is a legal process to follow, which is outlined below.

Where an individual has been formally declared not to be able to give consent, whether by physical or mental problem, an appropriate representative such as Power of Attorney/Welfare Guardian can provide the written consent for support on that person’s behalf.

Consent should also extend to the disposal or destruction of medicines, as these remain the property of the person the medicines are prescribed for.

Equality and Diversity

The Equality Act 2010 places a duty on local authorities to help eliminate unlawful discrimination, harassment and victimisation; advance equality of opportunity; and to foster good relations between people who share protected characteristics and those who do not share them.

To help do this, the Council and Partners will:

make sure servicescan be accessed by all individuals, taking into account the needs of vulnerable groups;

make sure we learn from other areas who are doing a good job – ie look at and incorporate best practice into our own procedures;

make sure our documents are available and easy to read;

make sure our information and document are available in different formats and community languages on request.

Individual’s cultural and religious requirements should be fully and carefully considered and may include:

  • vegetarians and people from some religious groups who do not want gelatine capsules (made from animal products);
  • having medicines given to them by people of the same gender;
  • taking medicines during religious festivals, including fasting;
  • taking account of modesty and respect and other cultural practices including due regard for ‘unclean’ substances.

Roles and Responsibilities

Specific roles and responsibilities of employees in each service are outlined in the Service Specific Guidelines.

Senior Managers and Corporate Responsibilities

It is a corporate responsibility to collate and communicate consistently to all relevant personnel any issues that arise which cannot be resolved locally.

Health Personnel

General Practitioners (GPs) have a responsibility of care for all of their listed patients to provide general health and medical care, or refer for specialist health care or social care.

In looking after an individual’s health and well-being, the GP or other non-medical prescriber will prescribe medication to their patient to prevent, treat or relieve medical conditions.

GPs are also expected to undertake medication review and identify any compliance problems. They are also responsible for providing medicines at the frequency most appropriate for the service user.

Within primary care, suitable qualified nurses or pharmacists are also able to prescribe.

Community Pharmacists

Community Pharmacists have a professional responsibility to supply medication prescribed by GPs and other recognised prescribers. The medication must be of a suitable quality and comply with legal and ethical requirements for the packaging and labelling.

Pharmacists also have a responsibility to ensure that the individual receives appropriate information and advice to support them in gaining best effect from any medicines supplied.

Responsibility for providing MAR charts rests with the care provider. Neither the pharmacists or/nor the dispensing GP is responsible but may be prepared to provide them on request.

Nursing Personnel

Nursing Personnel will provide nursing and clinical care to individuals, which includes (not exhaustively):

  • Caring for wounds
  • Care for pressure sores
  • Changing of dressings
  • Carrying out invasive procedures such as injections and bladder irrigations and matters relating to feeding tubes

During such provision nursing personnel will also monitor the health status of the individual and report any changes in circumstances to the GP.

Specialist Nursing

Specialist nurses support and educate individuals in coping with their particular condition and assist them in dealing with equipment drug treatments or therapy necessary to their condition.

Specialist nursing includes (but not exclusively):

  • Respiratory Nurses
  • Stoma Nurses
  • Palliative Care Nurses

Assessment Process

As part of a referral for services individuals will be subject to a full assessment of their overall needs. This assessment would include an accurate assessment of needs with regard to their medication.

This assessment must be undertaken by a suitably trained employee – details of which are outlined in the Service Specific Guidelines.

All aspects of the individual support needs with regard to their medication should be captured and incorporated into the individual’s Care and Support Plan.

Appropriate Risk Assessments (Appendix 2) should be completed and also incorporated into the individual’s Care and Support Plans.

The assessment should be conducted with the individual having full participation in the assessment process using appropriate methods of communication and support from their nominated representative where required.

The assessment should recognise and identify the individual’s preferred method of support, and recognise existing supports in place from family and friends. Further to this the assessment should incorporate information on the preferred pharmacy used by the individual, detailing the pharmacy name and contact details.

Specialist support tasks that are delivered by Health Professionals involved in the care of the individual should be accurately recorded and incorporated into the individual’s care and support plan.

The individual should be advised that as part of the provision of support services to assist with their medication needs that their consent or that of their nominated representative is vital to allow services to be implemented.

Service Specific Procedures - General Standards

This policy is supported by a range of service specific procedures.

For each area of service, procedures must be in place which outlines the approach to a range of issues, including:

  • Consent
  • Recording
  • Safe Storage
  • Safe Disposal
  • Refusal of Medication
  • Adverse Reactions / Side Effects
  • Covert Medication
  • Missing Medication
  • Medication Errors
  • Individuals and Alcohol
  • Mid-cycle and Discontinued Medication
  • PRN (as required) Medication
  • Prescribed Controlled Drugs / Illicit Drugs
  • Variable Dose Drugs (egWarfarin)
  • Minor Ailments
  • Self-Administering
  • Transfer of Medicines
  • Specialist Training
  • Not able to Swallow
  • Compliance Aids

Reporting Errors

Employees should fully comply with the policy and this should reduce the potential for errors when assisting with administration.

As highlighted in Section 12, Service Specific Procedures outline the action employees must take when an error is discovered. While these procedures outline which senior employee to advise of the error, the recording and handling of the incidents should involve the steps listed below.

Too much medicine, missing out medication, dispensing and prescribing errors constitute “incidents” and as such need to be recorded using a South Ayrshire Council Internal Incident Report Form AR1 and any other service specific form outlined in the Service Specific Guidelines. In addition to sending the AR1 form to Corporate Health and Safety, the responsible officer should also send the completed form (using CC function on the email) to XXXXXXXX (this will be set up shortly).

‘Near misses”, defined as incidents where a mistake was made but was recognised and rectified before an actual error in administration resulted, should also be reported.

The Service Manager or their nominated representative will investigate any error or incident to determine the root cause of the error. This will allow the investigating officer to identify if systems errors, poor practice or non-compliance was the underlying cause of the error and help the investigating officer to determine if procedural change, policy change or further training for the individual or all employees is required.

Where it has been established that the error has been caused by an employee, the Service Manager or their nominated representative has discretion to decide if the employee is able to continue to help with medication and/or if there is a need for disciplinary action.

If the employee requires further training, including observational assessment in the field, the employee’s competence recorded prior to the employee being allowed to undertake support tasks independently again.

External regulatory bodies (eg Care Inspectorate, SSSC) should be advised if deemed appropriate by Senior management.

Data protection/ Handling Confidential Information

The Data Protection Act 1998 is the law which protects confidential information and this places specific duties on the Council to protect confidential/sensitive information.

To comply with this law the Council and Partners will:

  • not disclose information that has been given to us in confidence without the express consent of the individual. Where the individual cannot give consent, their appropriate representative must agree to any information sharing;
  • control access to any personal information and will only share relevant information when interacting with other agencies;
  • respect an individual’s right to confidentiality in dealing with their information;
  • not discuss an individual’s medication and care support needs with any other party unless there is written permission from the individual/or appropriate representative to do so;
  • promote, support and protect the privacy, dignity and rights of the individual;
  • follow good practice guidelines with regard to information handling;
  • ensure individuals can access the information held about them should they express the wish to do so;
  • investigate any breach of confidentiality and take appropriate disciplinary action where necessary.

Indemnity Statement

The Council will, subject to the exceptions set out below, indemnify its employees against liability at law, in the pursuit of their duties on behalf of the Council whilst acting within the scope of their authority provided always that all policies and procedures are adhered to.

Employees must not administer prescribed medication where they are unclear about any aspect of the administration.

The indemnity will not extend to liability directly or indirectly arising from personal fraud, dishonesty, wilful negligence, deliberate wrongful act or criminal offences

Compliance

South Ayrshire Council requires all employees and Partners involved inhelpingwith medication to comply fully with their duties and responsibilities as detailed within this policy.

Any failure to do so may result in an employee’s action/inaction being construed as behaviour which could be deemed as gross misconduct.

All instances of failure to comply will result in investigation and possible action under the Council’s formal Disciplinary Policy and procedures.

Any failure on the part of Partners who acts on behalf of the Council to comply with provisions of this policy, may invoke a review of the Partner agency contract with the Council.