The Role of Home Carers in the Management of Medicines
Highland Council
&
NHS Highland
Warning – Document uncontrolled when printed
Policy Reference: / Date of Issue: July 2007
Prepared by:A. MacRobbie & B. Nott / Date of Review: July 2009
Lead Reviewer:A MacRobbie & B Nott / Version:3
Authorised by: Chief Officers Group / Date:
CONTENTS
Page
1. INTRODUCTION 2
2. FLOWCHART 3
3. ASSESSMENT OF CLIENT MEDICATION NEED 6
4. LEVEL 2 ASSISTANCE 6
5. LEVEL 3 ASSISTANCE 7
A. Responsibility/Liability 7
B. Consent 7
C. Medication Chart 8
D. Medication Administration Form 8
E Tasks Which May be Undertaken by Home Carers after Assessment 8
and with Appropriate Additional Training from Healthcare Workers
6. TASKS WHICH MUST NOT BE COMPLETED BY HOME CARERS 8
7. DESCRIPTION OF TASKS WHICH MAY BE UNDERTAKEN BY HOME
CARERS 9
8. SERVICE USERS WHO ARE UNABLE TO GIVE INFORMED CONSENT 12
9. GENERAL INFORMATION – HOW THE PHARMACIST CAN HELP 12
10. TRAINING 12
APPENDIX 1 Checklist for Assessing Client Medication Management Need
APPENDIX 2 Emergency Procedures & Form
APPENDIX 3 Medication Chart & Record of Medication Administration
APPENDIX 4 Medication Permission Form (for level 3 service user)
APPENDIX 5 Medicines Disposal Form
APPENDIX 6 Client Information Leaflet
APPENDIX 7 Information Leaflet for Health & Social Care Workers (Level 3)
APPENDIX 8 Information Leaflet for Medication Compliance and Monitored
Dosage Systems (Level 2)
1. INTRODUCTION
The aim of the Home Care Service is to enable service users to choose to continue to live in their own homes. The range of care tasks which Home Carers are required to undertake will be from household to personal care. These tasks supplement self care and the support available from informal carers.
The majority of service users are able to take responsibility for their own medicine management and it is important that people are supported to maintain as many self-care skills as possible. However service users may sometimes require assistance with medication. The assistance offered must be tailored to an individual’s needs and carried out in a professional manner by properly trained staff with the correct degree of competence.
These guidelines aim to ensure that any assistance given with medication is carried out in a safe professional manner, within the knowledge and competence of Home Carers. It is imperative that Home Carers observe the guidance set out in this document.
Home Care staff must feel confident to perform tasks correctly and safely.
Home Care staff should never be involved in any medicine management task unless authorised to do so by the Home Care Senior/Manager.
Home Care staff must not perform any activity out with the guidelines.
Medicines Administration by Home Carers in the Community
Flow Chart
NO
YESv YES YES
Hospital Admission/Discharge of Previously Identified Level 3 Medication Patients
Role and Responsibilities for team Members involved with a Level 3 medication patient
Role and Responsibilities for team Members involved with a Level 3 medication patient
3. ASSESSMENT OF SERVICE CLIENT NEED
Assessment of service client need is key to the whole process. This will identify what, if any, assistance is required. Assessment of need is the responsibility of a member of the GP Practice team and may not be carried out by the Home Carer Service.
Assessment of need must be carried out in a structured manner using for example the checklist (Appendix 1.)
The result of the assessment will be one of the following:
§ Able to manage their own medicines (Level 1 user) These service users will retain control of their medication, preserving their independence and choice. This should be encouraged wherever possible.
§ Able to manage their medicines with minimal assistance (Level 2 User) These service users will retain maximum control of their medicines and will require minimal input. The service user will retain overall responsibility for the management of their medicines.
§ Assistance required (Level 3 User) These service users are unable to manage their medicines themselves. They will not retain responsibility for the management of medicines. The service user or their carer must agree to assistance being given.
§ Assistance required beyond the knowledge and skills of Home Carers (Level 4 user) Any procedure other than those detailed for level 2 and level 3 users should only be performed by competent persons with medical knowledge and skill.
The results of this assessment must be recorded and made available to all who will be involved in the care of the service user.
Reassessment may be necessary at any time to take account of changes in the medication needs of the service user. Any change in medication needs should be notified to the Home Care Senior/Manager by the GP Practice Team.
4. LEVEL 2 ASSISTANCE
The level 2 service user is responsible for the management of his/her own medicines but may, after assessment by the Home Care Senior/Manager, including risk assessment, be offered help with the following tasks.
§ Ordering prescriptions from the medical practice at the request of the service user. The service user must indicate the medicines, dosages and quantities to be ordered.
§ Collecting prescriptions from the medical practice and delivering to the pharmacy.
§ Collecting medicines from the pharmacy.
§ Confirming the reading of medicine labels.
§ Opening containers such as medicine bottles, removing tablets/capsules from strip packaging. Assistance with opening compliance aids may only be given if these have been dispensed by a Pharmacist. Administration, where agreed by Senior Home Care Officer (SHCO), of short term temporary medications e.g. post surgical eye drops, where client is otherwise able to manage their own medication.
§ Returning unwanted medicines to the pharmacy at the request of the service user. The service user must indicate those medicines to be returned and the medicines disposal form (Appendix 5) be completed.
Home carers should ascertain which pharmacy is preferred by the service user and use this pharmacy at all times (see how the pharmacist can help).
The home carer must not fill compliance aids, e.g. dosette boxes.
All requests for assistance other than those listed above and agreed by Home Care Senior/Manager must be reported to the Home Care Senior/Manager.
GP Practices will be informed by the Home Care Senior/Manager of service users being supported at level 2
Mismanagement of Medicines
If the Home Carer suspects that a service user is not taking his/her medicines as prescribed they should discuss their concerns with the service user and try to support them to take their medicines appropriately. If this fails the Home Carer should inform the Home Care Senior/Manager who will in turn contact the appropriate GP Practice team member in writing to ask for a re-assessment.
5. LEVEL 3 ASSISTANCE
Before assistance can be given to a service user at level 3, a review of medicines must be undertaken by the GP Practice team or pharmacist. All medicines must be prescribed with specific directions – the use of the term ‘as directed’ must be avoided.
A. Responsibility/Liability
· Home Carers may only give medication to service users in their own homes after authorisation by the Home Care Senior/Manager as an agreed task on the Care Plan (see later). Procedures to be followed in emergency situations are set out in Appendix 2 to these guidelines e.g changes to medication, hospital discharge and verbal instructions.
· As a general rule, Home Care staff should be able to provide assistance with oral medication, some skin care and eye/ear/nasal preparations. Individual needs may also be provided following guidance and demonstration with the individual service user (see later).
· The Home Carer Service has the responsibility for ensuring that Home Carers assisting with medication have had proper training and receive appropriate support and that medication administration charts (Appendix 3) are completed.
· Home Carers will only assist with medication if a Medication Permission Form (appendix 4) has been signed.
· If the Home Carer has any concerns about any aspect of a service client’s medication regime, she/he must notify the Home Care Senior/Manager immediately.
· It is the responsibility of the service user to purchase any compliance aids or locked medicine cabinet necessary for the proper management of their medication.
B. Consent
Following an Assessment of Need, the Senior Home Care Officer/Manager will discuss medication issues with the service user and/or his/her representatives, agree the task to be undertaken and complete the Medication Permission Form. (See Appendix 4).
The Senior Home Care Officer/Manager will liaise with all others providing support to the service user (i.e. formal and informal carers, health care team) so that each party is aware of the input being provided. It will be emphasised that, in the interests of safety, any other carers involved in administration of medication must agree to use the medication administration form. This will be documented in the Care Plan. Any difficulties will be reported by the Home Care Senior/Manager to the GP Practice.
C. Medication Chart
Responsibility for assisting service users with medication at Level 3 will only be taken after the completion of a Medication Chart. (See Appendix 3). This responsibility will be undertaken by the pharmacist except in areas where dispensing practices are in place and the GP practice team will undertake this. A review of medication by a member of the GP Practice team, which could include the pharmacist, should take place to ensure that all medication continues to be indicated.
The Home Care Senior/Manager will be advised of any changes to the medication chart and it will be his/her responsibility to ensure that any new task is within the competency of the Home Carer.
D. Medication Administration Form
Senior Home Care Officers/Managers will be responsible for ensuring Home Carers complete the Medication Administration Forms (See appendix 4), for monitoring record-keeping and supporting and supervising staff. Home Carers will be responsible for following instructions from the Medication Chart and for recording actions showing date and time of actions in the Medication Administration Form. Any problems encountered with the administration of medication must be recorded on the reverse of the Administration Record under the headings “Date”, “Problem”, “Actions Taken” and “Outcome” Medication Administration forms will be removed from the service user’s home on a monthly basis by the Home Care Senior/Manager and a new sheet supplied. Old medication charts will be stored in the service users file.
E. Tasks Which May be Undertaken by Home Carers after Assessment and with Appropriate Additional Training from Healthcare Workers (Level 3)
§ Changing catheter leg bag, where this does not disturb the catheter
§ Changing colostomy bags
§ Changing dressings, simple dry dressings, covering a minor wound with sticking plaster or as a first-aid measure until medical advice is sought
§ Application of creams, ointments or lotions
§ Eye drops, eye ointments
§ Ear drops, ear ointments
§ Nasal drops, nasal ointments
§ PEG feeding
§ Inhalation devices, nebulisers, oxygen.
§ Insertion of pessaries if agreed appropriate by the health care team.
§ Insertion of suppositories or microenemas if agreed appropriate by the health care team.
§ Mouthwashes
6. TASKS WHICH MUST NOT BE UNDERTAKEN BY HOME CARER (Level 4)
§ Filling compliance aids
§ Any invasive procedures, for example
Injections
Removal of stitches
Insertion of catheters
Changing of dressings, unless simple dry dressings
Stoma care in post-operative phase
Testing for diabetes
Eye drops/ointments/creams/lotions when medical or nursing assessment indicates trained health staff should be involved
Administration of medicines which need skilled observations either before or after administration (e.g. taking pulse) which have been so designated by the health care team.
7 DESCRIPTION OF TASKS WHICH MAY BE UNDERTAKEN BY HOME CARERS
LEVELS 2&3
§ Ordering Prescriptions
This will involve ordering prescriptions from the medical practice. At level 3 only those medicines which are listed as regular medicines on the Medication Chart should be ordered. The chart will also indicate the frequency of ordering and the amount to order. Requests for repeat prescriptions are usually made to the medical practice 48 hours in advance of collection, although this interval may be longer if a weekend or public holiday intervenes.
§ Collecting Prescriptions
This will involve collecting prescriptions from the medical practice and delivering to the pharmacy. Many pharmacies collect prescriptions directly from the medical practice.
§ Collecting Medicines
This will involve collecting medicines from the pharmacy. Many pharmacies have collection/delivery services. The Home Care Senior/Manager should ascertain if one is in operation locally and use this if possible. She/he will also ascertain whether family or friends can undertake this task. Collection of medicines will only be undertaken after an assessment of risk to the Home Carer by the Home Care Senior/Manager.
Home carers should be provided with a means of identification (badge or letter of introduction) for use at the surgery/pharmacy when ordering/collecting prescriptions or medicines.
Requests for purchasing over the counter (OTC) medicines - Home carers may purchase OTC medicines for Level 2 clients where agreement has been sought from the community pharmacist or GP. Purchase should ideally be made from the pharmacy supplying the clients prescribed medication. The client must be able to manage these medicines themselves.
Returning medicines which are no longer required for disposal - this is the responsibility of the client or family. In exceptional circumstances, following risk assessment by the SHCO, the carer may be given permission to return medicines for disposal.
LEVEL 3
§ Storage of Medicines
Medicines should be stored in a cool dry place or refrigerator as appropriate (i.e. preferably not in bathrooms or kitchens) and out of direct sunlight.
Medicines must be stored so as to ensure that they cannot be taken inappropriately by the service
user or any visitors to the house, particularly children.
Medicines should be stored in their original containers as dispensed from the pharmacy; they should
not be decanted into other containers.
When the administration of medicines is the responsibility of the Home Carer they should be stored
in a sealed container labelled in a manner to inform relatives/friends not to administer medicines