/ CHHS17/134

Canberra Hospital and Health Services

ClinicalProcedure

Self Medication Program (Justice Health Services)

Contents

Contents

Purpose

Scope

Section 1 – Self Medication Program Risk Assessment

Section 2 – Medications excluded from self-medication program

Section 3 – Medications requiring MO / Psychiatrist approval

Section 4 – Issuing Weekly Dosage Administration Aid to Person

Section 4 – Diversion of Medications

Implementation

Related Policies, Procedures, Guidelines and Legislation

References

Definition of Terms

Search Terms

Purpose

Justice Health Services (JHS) has a responsibility to ensure that all adults that are taking their own medications unsupervised (self medication program) have been assessed as having the capacity (cognitive and physical) and motivation to self-medicate.

The selfmedication program provides a multidisciplinary approach to care with input from Medical Officers (MO), Registered Nurses (RN), pharmacists and other health professionals. It offers suitable people the opportunity to be actively involved in their health care while in a custodial setting.

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Scope

This procedure applies to all MOs / psychiatrists, RNs, enrolled nurses and pharmacists working within Justice Health Services at the Alexander Maconochie Centre (AMC) and Dhulwa Mental Health Unit (DMHU).

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Section 1 –Self Medication Program Risk Assessment

Equipment

Self Medication Program Risk Assessment Tool (available on the Clinical Forms Register)

Self Medication Program Brief Cognitive Assessment Tool (available on the Clinical Forms Register)

Roles/Responsibilities

The person is responsible for the safe storage and use of medication within therapeutic parameters.

Nurses / MOs will be responsible for scanning the person’s current medication charts with changes to prescription sent to the JHS pharmacy.

Pharmacy will be responsible for providing all people with prescribed medications, as per the persons medication chart, in a dosage administration aid.

The decision to let a person who is managed by JHS take their own medication unsupervised must only be made by the prescribing MO / psychiatrist, senior RN (RN2 or RN1 with >3 years nursing experience) or pharmacist.

Procedure

  • All adults that would like to take their own medications unsupervised MUST have a risk assessment completed / signed by the prescribing MO, senior RN (RN2 or RN1 with >3 years nursing experience) or pharmacist.
  • Persons will be assessed for suitability for the program during their induction health assessment, generally around 7 days in a secure setting.
  • If a person answers “yes” to any of the suitability selection criteria question, a further review for suitability will need to be done by a JHS MO / psychiatrist to determine their suitability for the self medication program.
  • All person’s MUSTbeinformed of their responsibilities, such as:
  • Collecting their medications.
  • Taking their medications as prescribed.
  • Not giving their medications to anyone else.
  • Returning unused or unwanted medications to nursing staff.
  • Advisingstaff of any medication related problems.
  • Advising staff if they wish to discontinue the self-medication program.
  • All people MUSTbe informed that if they do not fulfil their responsibilities they may be removed from the program to ensure their wellbeing.
  • If there is doubt about the person’s capacity / motivation to fulfil their responsibilities they should be immediately withdrawn from the self medication program and given counselling / education.
  • The person MUSTdemonstrate to the MO/nurse/pharmacist that they understand how to correctly use a dosage administration aid (DAA). This is assessed by the person answering “yes” to all questions on the Self Medication Program Brief Cognitive Assessment Tool.
  • People that are deemed suitable to participate in the self medication program will be educated by the MO, nurse or pharmacist about their medications including indication, dosage and storage requirements.
  • All people on the program will be reviewed quarterly for their suitability for program inclusion. This review will be completed by a MO/nurse/pharmacist.
  • All people on the program will be advised that if their health needs change or they become unwell, their suitability for the self medication program may be reviewed.
  • Persons will be informed that information such as Consumer Medicines Information (CMI) is available for medications (CMIs are brand specific, manufacturer produced information about medication products that conforms to specific provisions set out in the Therapeutic Good Regulations). JHS nurses will direct requests from persons to the JHS Pharmacy Department.
  • The person will be advised that they will begin the program on the next DAA weekly delivery from pharmacy.
  • People that are deemed not suitable to participate in the self-medication program will be advised that they will receive their medications on a daily basis from the JHS nurses.

Section 2 – Medications excluded from self-medication program

Medications that are excluded from the self-medication program include but are not limited to:

  • Tricyclic antidepressants (e.g. Amytriptilline, Doxethipin);
  • Monoamine oxidase inhibitors (e.g. Moclobemide);
  • Warfarin;
  • Quetiapine(unless authorised by treating psychiatrist and primary nurse)
  • Any injectabe drugs including insulin except in insulin approved person’s;
  • All S4D and S8 medications ;
  • Digoxin;
  • Lithium;
  • Theophyline;
  • Hyosine Bromide;
  • Gabapentin and Pregablin;
  • Liquid medications;
  • Clozapine initiation and retitration;
  • Lithium
  • Other
  • If the the MO/RN/pharmacist has reason to believe that a certain drug should not be taken unsupervised by a certain person
  • Antiviral drugs (e.g. hepatitis C treatments, anti-retrovirals)
  • People prescribed hepatitis B treatment will initially receive their medications on a daily supervised basis. After a period of approximately two weeks the person will receive further education from a MO/senior RN where non compliance with treatment is explained. The person may then progress to having their treatment provided in a weekly DAA. This will be documented in the person’s medical record.

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Section 3 – Medications requiring MO / Psychiatrist approval

Medications requiring MO / Psychiatristapproval for inclusion into the self-medication program include but are not limited to:

  • Mirtazipine;
  • Antipsychotics ;
  • Antiepileptic and mood stabilising medications, except for lithium (see above)Codeine containing medications that are not schedule 8 (e.g. panadine forte); and
  • Potassium supplements

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Section 4 – Issuing Weekly Dosage Administration Aid to Person

Equipment

  • Self Medication Program Collection of Dosage Administration Aide Form(available on the Clinical Forms register)
  • DAA
  • Person’s Medication Chart

Procedure

  • Dosage Administration Aids (DAA) for medication self management MUST be dispensed by the JHS Pharmacy Department for the person with the persons name and date of birth affixed to the DAA. The maximum quantity of medication which can be dispensed is one week at a time. Medications that are required to remain in their original packaging will be packed separately in a container, either weekly if in a blister pack, or original packaging if this is unable to be done. Inhalers, creams and other like items will not be supplied in DAAs and will be supplied in original packs.
  • On issuing the DAA, the nurse MUST document the delivery of the DAA to the person on the DAA Delivery Register. Completing the register acknowledges that the nurse has delivered one week’s medication to the person.
  • If after two days the DAA has not been collected by the person, the nurse will make an appointment in the nurse clinic to discuss with the person the reason for not collecting their DAA.
  • If medication is changed in anyway, ie post an appointment with a MO, the previously supplied DAA must be returned to nurses by the person. It is the responsibility of the MO to advise the person of this. This will then be reviewed by the nurse before they can be issued with a new DAA dispensed by the JHS Pharmacy Department. Nurses will not collect returned DAAs from the person until a new DAA is dispensed by the JHS pharmacy department.
  • Where possible imprest stock is to be used until the next weekly DAA delivery. A new pack will generally be supplied where a medication has been ceased. Whenever a persons medications have changed the treating MO, nurse or pharmacist should educate the person about their medication including indication, dosage and storage requirements.
  • It is the responsibility of the MO or nurse to provide the JHS Pharmacy Department with the person’s current medication charts to enable appropriate medication dispensing for the person. Pharmacy is unable to supply the correct medications if they do not have the current medication chart.

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Section 4 – Diversion of Medications

Procedure

  • Where a person is suspected to be hoarding, abusing or not taking the prescribed medication, an appointment will be made for the person to meet with a RN and discuss the reason for this occurring.
  • A RN will discuss the issue with the person prior to any decisions being made as there may be reasons why a person decided not to take a certain medication, for example due to an adverse drug reaction or side effect.
  • In consultation with the appropriate prescriber a decision will be made as to whether the person shall revert to having medication administration supervised by nursing staff.
  • The decision to supervise medication administration to people should be clearly communicated to the person, along with the reason, and the time frame for which it will be supervised. This will be documented in the person’s medical record.
  • The person will remain on supervised medications for a period of no less than two weeks to ensure their wellbeing.
  • Review of the need for medication supervision, via the Self Medication Program Risk Assessment being conducted by a MO or RNwill occur after the specified time frame has lapsed. .
  • If the person on review is deemed suitable to participate in the Self Medication Program, they will progress from supervised medications, to daily take away medications for a period of no less than two weeks and will then return to weekly DAA packs.

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Implementation

This procedure will be incorporated into JHS orientation processes, incorporated into staff training and circulated to the following exisiting staff:

  • JHS MOs and psychiatrists
  • JHS nursing staff
  • JHS Pharmacy Department staff

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Related Policies, Procedures, Guidelines and Legislation

Policies

  • Consent and Treatment
  • Clinical Record Management
  • Consumer and Carer Participation
  • CHHS Patient Identification and Procedure Matching

Procedures

  • Clinical Record Documentation
  • CHHS Patient Identification and Procedure Matching
  • Release or Sharing of Clinical Records or Personal Health Information p

Legislation

Health Act 1993

Human Rights Act 2004

Work Safety Act 2008

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References

  1. NSW Justice Health Services Medication Handling Guidelines 2016

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Definition of Terms

AMC – Alexander Maconochie Centre

DAA – Dosage Administration Aid

JHS – Justice Health Services

JHP – Justice Health Pharmacy

S4D – Schedule 4D medications

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Search Terms

Justice Health Services, DAA, Self medication program, AMC, DMHU

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended / Section Amended / Approved By
Eg: 17 August 2014 / Section 1 / ED/CHHSPC Chair
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/134 / 1 / 06/06/2017 / 01/05/2021 / MHJHADS - JHS / 1 of 7
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register