Social Care Workers’ Professional Responsibility in Respect ofAdministration of Medications - Northern Ireland Social Care Council Guidance

September 2013 (revised February 2016)

  1. Introduction
  2. Social care workers often find themselves in the position of having to assist individuals with taking medications. This may be because the person is not physically able to assist themselves through disability or he or she finds it difficult to remember to take medications. This guidance is to support care workers to develop best practice in assisting with medication, recording to ensure the care plan has been met and knowing what to do if a mistake occurs.
  1. Regulation by NISCC
  2. The Northern Ireland Social Care Council (NISCC) is a non-departmental public body, sponsored by the Department of Health and Social Services and Public Safety (DHSSPS). As the regulatory body for the social care workforce in Northern Ireland, it aims to increase protection for those using social care services, their carers and the public, by registering and regulating the social care workforce. It sets standards of conduct and practice to which the workforce must adhere. It also regulates training for social workers at qualifying and post qualifying levels and as the Northern Ireland partner of Skills for Care and Development, the Sector Skills Council for Social care, it approves training for the social care workforce.

2.2.The NISCC has issued Standards of Conduct and Practice (the Standards) which describe the behaviours, knowledge and skills a good social care worker should have. The Standards should be seen as a tool to drive up quality and enable workers to improve practice. They also form the regulatory framework against which a registrant’s practice will be judged if a complaint is made against them.

2.3.A number of referrals have been made to the NISCC regarding practice relating to the administration of medications. To enable all staff to work within Standards in relation to the administration of medications, the NISCC in partnership with employers has developed Guidance relating to administering medications to enable employees to safeguard service users and also themselves.

2.4.The NISCC maintains a compulsory register where designated staff groupings must register and it is within this regulation process that conduct issues are investigated by the NISCC. The NISCC also offers a facility for voluntary registration and those who register on a voluntary basis come under the same regulation as those whose registration is compulsory. However, the Standards are relevant to ALL social care staff and not just restricted to those staff who register with the NISCC as they give direction on the practice and attitudes which contribute to best practice.

  1. NISCC Guidance
  2. The NISCC guidance relating to the Administration of Medication does not replace the DHSSPS Minimum Standards or the RQIA Guidelines, but relates to expected conduct and behaviours from social care staff. As has been stated previously, the practice and behaviours expected from Social Care Workers are found in the NISCC Standards. For the purpose of the NISCC guidance in respect of administration of medications, the relevant components of the Standards will be cited and real examples given of scenarios where practice can be measured against them. Mistakes happen, and if they do, it is important that our responses are such that service users are kept safe and that their well-being remains our chief consideration.

3.2.Critically workers administering or supporting the administration of medications must receive the relevant training to do so. Also workers should always adhere to what they are permitted to do through the service user’s care plan and never deviate from what is on the plan. It is essential than everyone works to ensure that errors do not happen in administering or supporting the administration of medications. However in the pages which follow there are examples of medication errors which present the worker with guidance on what to do if mistakes are made and enable them to understand that they should always admit to the mistake and learn from it rather than cover up and risk harm to service users, to their own reputation and the reputation of their respective organisations. Each of the scenarios cited is aligned to specific relevant standards. This guidance demonstrates how standards can be used to support practice.

  1. Medication Guidance already Available to Agencies and Staff
  2. There are two areas of guidance relating to medication namely,the DHSSPS minimum standards referenced below and the Regulation and Quality Improvement Authority’s (RQIA) “Guidance for the Control and Administration of Medicines”. The latter document is specifically for Domiciliary Care Agencies and can be found on the RQIA website.

4.2.The main guidance in respect of medication is contained in the DHSSPS Minimum Standards for Adult Day Care, Domiciliary Care Agencies and Residential Care Homes. The relevant medication standards within these three documents are as follows;

  • Day Care Settings, Minimum Standards January 2012 – Standards, 29, 30, 31, 32
  • Residential Care Homes,Minimum Standards, updated August 2011, Standards 30, 31, 32, 33
  • Domiciliary Care Agencies, Minimum Standards, updated August 2011, Standard 7

(Day Care Settings - Minimum Standards DHSSPS January 2012)

(Domiciliary Care Agencies -Minimum Standards – DHSSPS Updated August 2011)

(Residential Care Homes - Minimum Standards - Updated August 2011)

These standards cover administration, storage, recording, training and reporting errors.

4.3.It is the responsibility of individual workers to keep themselves up to date with changes to policies and standards issued from DHSSPS, the RQIA and the NISCC

4.4.The RQIA has issued “Guidelines for the Control and Administration of Medicines” for Domiciliary Care Agencies and they reflect the minimum standards issued by the DHSSPS. The Minimum Standards define expected practice and the RQIA guidelines outline detailed steps that should be taken by domiciliary care providers to meet the standards.Medication errors have been defined by RQIA as; medication being wrongly administered, doses omitted, duplicated doses, administration of discontinued medicines and medication being lost or stolen. Errors by staff must be reported immediately to line managers who must notify RQIA. The RQIA Guidelines go on to say “Errors by care workers must be reported immediately to their line manager who will notify the RQIA and all relevant parties.” The Guidelines stress that the safety of the service user must be of paramount importance and where necessary, advice should be sought from the prescriber or emergency services without delay. It is then the responsibility of the registered manager of the agency to investigate errors and incidents, to determine if the cause is poor practice, non-compliance with policies and procedures and to determine if there are training or competency issues to be addressed. The DHSSPS Minimum Standards and the RQIA Guidelinesoutlined above will continue to be the standards for administering medications.

Practice Examples

Standard 2 / As a social care worker, you must strive to establish and maintain the trust and confidence of service users and carers
2.1.
Being honest and trustworthy / Scenario
Two domiciliary care workerscome to do a morning call with Mr Henry who lives with his wife. He has had a stroke and cannot physically take his medication by himself. His wife has a significant visual impairment and needs assistance with her own medication and is thus unable to assist her husband. The call is to assist Mr Henry to get up, washed and dressed and also to assist both Mr and Mrs Henry with their medications from the blister packs.
One worker is assisting Mr Henry to his chair in the living room while the worker who is assisting with the medications realises that she has given Mr Henry his wife’s medication and given Mrs Henry her husband’s medication. Since her colleague is too busy to notice she decides that no-one will ever be the wiser and records that she has given each the correct medication.
The Right thing to do
  • The social care worker should explain the mistake to the service users involved and advise them of the steps they will take to remedy the matter
  • The social care worker should contact her line manager without delay and tell him or her that she has made a mistake and given the wrong medication. The line manager will contact the prescriber to establish what the adverse effects may be
  • The social care worker must not leave the service users unattended until the risks of having given the wrong medication have been assessed
  • The social care worker should always record truthfully what has occurred
  • The social care worker should not write false statements in the service users record
Honesty and Trustworthiness allows people to learn from their mistakes. Genuine mistakes can usually be managed. Training can be provided if required. Techniques for differentiating between both sets of medicines can be identified to avoid making the same mistake again.
Dishonesty puts service user’s lives at risk as the wrong medications may have different effects on different users. Also it puts your own integrity as a worker and the integrity of the agency at risk. It may also affect your registration with NISCC. It is better to own up and learn from it.
Standard 3 / As a social care worker, you must promote the autonomy of service users while safeguarding them as far as possible from danger or harm
3.2.
Using established processes and procedures to challenge and report dangerous, abusive, discriminatory or exploitative behaviour and practice
3.5
Informing your employer or an appropriate authority, without delay, where the practice of colleagues may be unsafe or adversely affecting the standards of care / Scenario
You are carrying out an evening call with a colleague to Mrs Smith. Mrs Smith is forgetful and often forgets if she has eaten or who called with her that day. You read on the client-held record that she has already had her tablets for the day. She complains about a sore head and pleads with you and your colleague to give her pain relief from a box of tablets which her daughter got at the chemist. The administration of these tablets is not on her care plan. You tell your colleague that you should not do this as you don’t know if she has already had pain relief that day or how much she has had. Your organisational policy on Administration of Medication states that you can only assist with administering the medications that are on the care plan and which are in the blister pack. Also you feel that you should not make a judgement about the origins of her headache and ought to take advice. Your colleague tells you not to be silly that it is only a couple of tablets and she proceeds to give her two tablets. When you have left your shift, you feel very uneasy and wrestle with whether you should speak to your line manager as it will look like you are telling tales about your colleague.
The right thing to do
Mrs Smith is the most important person in this situation and you need to do the best thing for her sake. To achieve;
  • The social care worker should adhere to what it says in the organisation’s medication policy
  • The social care worker should only dowhat it says on the care plan and not deviate from it
  • The social care worker should explain to Mrs Smith why they cannot give the medication
  • The social care worker who wants to work within the policy guidelines should strongly advise his/her colleague not to act outside the care plan
  • The social care worker shouldadvise his/herline manager, or the manager who is on call about Mrs Smith’s distress and request for medication
  • The manager/social care workerwill contact family and explain the situation and gain assurance from them that they will deal with the situation
  • The social care worker should report unsafe practice tothe line manager
Unsafe Practice puts service users in danger and needs to be challenged. It is importantnot to collude with unsafe practice and to report it when it happens to assist others improve their practice.
Standard 3 / As a social care worker, you must promote the autonomy of service users while safeguarding them as far as possible from danger or harm
3.7
Recognising and using responsibly the power that comes from your work with service users and carers / Scenario
Mr Murphy is in residential care. His case notes state that there have been a few occasions in the last month where he has refused to take his tablets. He is fully able to make decisions for himself, but sometimes decides that he is not taking his medication and that he can do without it.
On one occasion one of his residential care workers gets frustrated and has an argument with him over refusing his medication. At first she tries to force the medication into his mouth and when he refuses to open his mouth, shethen tries to cajole him by saying that if he does not take his medication, she will not give him his tea and bun before he goes to bed that evening.
The right thing to do
  • The social care worker should treat Mr Murphy as an adult and acknowledge that he has the right to make the decisionto refuse his medication
  • The social care worker should tell Mr Murphy that she does not agree with his course of action as his tablets are an important part of his well-being but that he cannot be forced to take them.
  • The social care worker should point out to Mr Murphy that in following his care plan, one of the duties is to ensure that he has assistance with his medications and she needs to record that he was offered assistance but declined.
  • The social care worker should explain to Mr Murphy that in order to ensure that she has fulfilled her responsibilities, she will discuss this with her line manager within the care home
  • The social care worker should report the refusal to take medicines to her line manager
  • The social care worker should record in the service user notes that Mr Murphy has refused his medication
Abuse of power –The fact that an individual needsresidential care does not take away from his or her ability to decide for themselves, where they have the capacityto do so.To force medication into the service user’s mouth is abuse. Also the withdrawal of services is abusive. The social care worker has a responsibility to protect the service user. However it is important that the social care worker also protects herself and this can be achieved through writing accurate records and reporting to her line manager to agree further action.
Where a service user is unable to make decisions for him or herself and refusal of medication is an issue, reporting to the line manager is essential and he or she will involve the GP and the family.
Standard 5 / As a social care worker, you must uphold public trust and confidence in social care services
5.1
You must not abuse, neglect or harm service users, carers or colleagues / Scenario
Mr Henry lives in a supported living facility for older people.You visit to support him to get washed and dressed in the morning. Once he is up and dressed you assist him with his medication. Once you have completed this you realise that you have given him his night medication by accident. You decide to say nothing as you will be the person calling again to assist him to bedwhere you will give him his morning medication to balance the day out so no-one will notice. You go ahead and record that he has received his morning medication. You intend to give the missed medication in the evening. Mr Henry’s night-time medication contains a tablet which causes drowsiness. In the course of the morning Mr Henry falls and fractures his femur due to being unsteady on his feet.
The right thing to do
  • The social care worker must always double check the blister pack to ensure that he or she givesthe right tablets for the right time of the day
  • The social care worker must tell Mr Henry once it is realisedthat an error has been made and explain that he or she needs to take advice to ensure his safety
  • The social care worker must phone the line manager immediately and take advice to ensure the safety of the individual. The manager, in accordance with the RQIA guidelines, will have to contact the prescriber or if required the emergency services without delay to assess and manage potential risk to Mr Henry. The line manager will also have to inform the family where appropriate
  • The social care worker must stay with the service user while the manager assesses the risks
  • The social care worker must record the incident accurately in Mr Henry’s record
Causing abuse, neglect or harm – in this instance, the harm was caused because the social care worker tried to cover up the error and hence put his or her own desire to avoid criticism before the safety of the service user. This social care worker’s practice,through covering up the mistake, failed to protect the service user.