Care Homes for Older People
This policy and `Good Practice Guidelines for the safe administration of medicines' was agreed by the Directorate and forms part of the overall departmental "Stay Safe at Work" Health and Safety Policies and Procedures.
This Management of Medication Policy is the result of work carried out by the Medication Review Working Group and replaces the "Management of Medication", Residential Elderly and Day Care Services (February 2002).
The policy has been produced with the assistance of Social Services Managers, Practitioners, and staff from Prime Care Trusts.
Consultation process on the revised policy:
· Care Standards Inspectorate for Wales
· Representative from the Local Health Board
· Departmental - Legal Services, Health & Safety Advisor, Training Section
· Staff from Primary Care Trusts
· Commissioning Services and in House Provider Services
The County Council is committed to this policy which will be subject to a rigorous periodic and systematic review, the first review will be undertaken on: 1st September 2007.
With respect to the prescribing, supply, storage and administration of medicines, the department adheres fully to:
¬ Standard 17 of the National Care Standards Act 2000 - Minimum Standards for Older People.
¬ Care Homes Wales Regulations 2002
¬ The National Service Framework for Older People in Wales March 2006
¬ The Medicines Act 1968.
¬ The Misuse of Drugs Regulations 2001.
¬ The Misuse of Drugs (Safe Custody) Regulation 1973.
¬ The Data Protection Act 1998
¬ The Freedom of Information Act 2000
¬ Mental Health Act 1987
¬ The Health & Social Care Act 2001
¬ The Human Rights Act 1998
¬ To establish a culture in which safe working practices become a way of life for managers and care staff.
¬ Define the principals of good practice, which are to be applied to the administration of all medicines.
¬ To provide clear guidance and procedures to managers and staff on the management of medicines.
¬ Ensure consistency of practice across services ensuring the safety and protection of service users, managers and care staff.
¬ Ensure safe working practices in the ordering, storage, administration and disposal of all medicines.
3. The Guidelines
¬ Acknowledge that Social Care staff are not health professionals and therefore, must receive departmental training and undergo a competence-based assessment to ensure safe and good practice in the management of medicines.
¬ Are applicable to all care staff working with older people receiving care home services.
¬ A handbook "Good Practice Guidelines for the safe administration of medicines" will be provided for Managers and Senior Support Workers.
¬ A Management of Medication File will be available in every Carmarthenshire County Council Care Home for Older People.
4.1 Registered managers must establish safe working systems for all aspects of
management of medication, and will ensure that the policies and procedures are operationalised, and that practice is monitored on a regular basis.
4.2 Medicines and the arrangement for its management and administration should
4.3 Medicines will be administered in a way, which respects the individual rights, dignity, privacy, cultural and religious beliefs of the service user.
4.4 Information should only be shared on a need to know basis and, whenever
possible, with the informed consent of service users and their
4.5 The department believes that every service user has a right to manage and
administer their own medicines if they wish to, and will provide support and aids to enable self-administration wherever possible. However, to ensure their safety and that of others, all service users will be considered for self-administration when:
· They are assessed as safe to do so (this must be documented on an individual risk assessment).
· Signed form M11 - non compliance disclaimer form
4.5.1 Responsibility for the administration of medicines will only be taken with the full knowledge and consent of the service user wherever possible. Full consideration of an individual's ability to take their medicines will be determined by a comprehensive risk assessment.
4.5.2 The department also understands that despite the best effort of staff to sensitively obtain consent, there are circumstances where service users
because of their level of mental capacity or frailty, are unable to give it.
4.5.3. In such situations it is accepted that administration of medicines without consent may be necessary where the service users Registered Practitioner advises that the medicines are in their best interest for example: Mental Health Legislation.
4.6 Where Service Users can make a decision, refusal of treatment should be respected (See section 11 on Refusal and Covert Administration).
4.7 Medicines will only be managed in accordance with an individuals care plan, Medicines Administration Record (MAR) chart, medication profile and a comprehensive risk assessment, which must be reviewed and updated as required on an individual bases, or annual as a minimum.
4.8 Medicines prescribed for the use of one service user must not be administered to anyone else; this also applies to wound dressing, nutritional supplements, surgical sundries etc.
4.9 As a source of reference, every home must have an up to date edition (not more than 18 months old) of the British National Formulary (BNF).
5. Service Users Medicines on admission to a Care Home setting
5.1.1 Consult with prospective service users to establish if medicines are currently being taken, and to discuss the arrangements for on-going management of medicines.
5.1.2 Gather as much relevant information as possible about their medication needs by obtaining permission to consult with appropriate others (GP, Carer, Family etc).
5.1.3 Provide a care plan and Form M1, which specifies clearly the support service users require with their medicines.
5.1.4 On admission the care staff at the home must be provided with:
a) A prescription for at least a 7 days supply of medicines.
b) For the medicines to have been dispensed by a community pharmacist prior to admission into a Sealed Monitored Dosage System (SMDS), accompanied by a printed MAR chart .
5.1.5 Following an emergency admission, either during the day or out of office hours into a care home, assessment staff/standby officers must establish what immediate action, if any, needs to be taken in respect of medicines e.g. Arrange a GP visit, collection of medicines from the service user's home.
5.1.6 Assessment staff/care coordinators are central to ensuring that service users on admission receive the appropriate level of assistance they require with administration of medicines.
5.1.7 The department reserves the right to postpone admission if medication or information received is insufficient.
5.2 Care Home Staff on admission must:
5.2.1 Ensure the appropriate documentation has been received from the assessment staff which includes Form M1 and Care Plan.
5.2.2 After consideration of the care assessment documentation, an initial risk assessment of the service users ability to self medicate must be undertaken and whatever the outcome a record must be made on the appropriate forms.
5.2.3 When the medicines are not received in a SMDS, arrangements must be made for the prescription to be sent to the local community pharmacist supplying the home to be dispensed if possible into a SMDS and ensure receipt of a printed MAR chart.
5.2.4 In an emergency, when deemed necessary, it is the responsibility of the Manager/Senior Support Worker (SSW) to confirm the service users current prescribed medicines with the Registered Practitioner (Form M2), and to organise the medicines to be administered from the service users own supply as directed on the container labels.
5.2.5 The current prescribed medicines must be entered onto Form M9 by the Manager/SSW clearly copying the exact prescription label, NO abbreviations to be used. The entries must be checked and signed immediately by a second competent person and must be printed in black ink for clarity.
5.2.6 Arrangements are then to be made within 72 hours by the Manager/SSW to
contact the Registered Practitioner for a prescription, and arrange delivery of the medicines in a sealed monitored dosage system (SMDS).
5.2.7 For evening admission after surgery hours, medicines should be withheld until confirmation can be obtained the following morning. If there are immediate concerns with the service users health, the out-of-hours GP service must be contacted.
5.2.8 Ensure that the service users medication regime is documented on the individual care plan, medication profile and daily report form.
6. Administration by Staff
Refer to handbook "Good Practice Guidelines for the Safe Administration of Medicines "for a more detailed guidance.
6.1 Where service users require assistance to manage their medicines, the
current good practice of administering from a sealed monitored dosage
system (SMDS), where medicines are compatible with this method, must
6.2 The medicines trolley should be taken to individual service users and all
medicines should be administered directly from the containers or SMDS,
which will bear the name of individual service user, name and dosage of drug,
directions for administration and dispensing date.
6.2.1 To ensure the hygienically handling of medicines, they should be placed
directly from the SMDS into a small medicine pot immediately before
6.3 It is essential that before administration, the person who administers the
medicine refers to the MAR chart and checks the details of all medicines due
against those contained in the SMDS and also any supplied separately. Any
discrepancies noted must be addressed and documented on Form M6 error of
medication administration form.
6.3.1 After the medication has been administered the MAR chart must be signed
immediately in black ink.
6.3.2 There must be evidence to show that the MAR charts are checked weekly for
errors and compliance by the Manager/SSW. e.g. medicines that have been
administered are not signed for.
6.4 For the administration of topical medicines (creams, ointments and lotions). Follow the instructions carefully as directed on the medicine label and on the Service User's Form M12 body chart, and record and sign immediately in black ink on the MAR chart, that the treatment/medicine has been given.
6.5 If an emergency arises that requires the attention of the Manager/SSW whilst they are administering medicines, then the trolley must be locked and secured until they are able to return.
6.6 The home must retain a list of staff members authorised to administer medicines, which includes a record of their approved initials in the front of the Medicines Administration File, also to include date of recent competency and that staff have read, understood and will adhere to the policy.
6.7 All MAR charts must be retained in individual service users file for a minimum of three years from the date of last entry, and should be retrievable if needed.
7. New, discontinued or change in dosage of Medicines
7.1 The Registered Practitioner should ideally have the MAR chart, medication profile and the record of medicines taken, including homely remedies, accessible at the time of a visit, to enable changes to be made directly, to ease communication links and smooth the process of generating future prescriptions.
7.2 Although it is not part of the contract for the Registered Practitioner to sign the MAR chart or medication profile, it would be considered an element of good practice, particularly for changes to doses or discontinuation of medicines.
7.3 All changes must be authorised in writing by a Registered Practitioner. It may
be necessary in some instances to follow a verbal instruction, in these
circumstances the Manager/SSW must take the instruction by writing it down
as it is given on the Form M3 and then repeat it back. The form must then be
faxed as soon as practicable to the Registered Practitioner to confirm the
7.3.1 After notification of the change to the dosage of the medicine, the Manager or
SSW should amend the MAR chart, medication profile and record the
change in the clients daily report form. The amendments or new entries,
especially when a new prescription starts half way through the month must
be entered onto the MAR Chart or Form M9 by a Manager/SSW clearly
copying the exact prescription label, NO abbreviations to be used. The
entries must be checked and signed immediately by a second competent
person. All entries must be printed in black ink for clarity.
7.3.2 In addition, the community pharmacist should be immediately notified either by fax or telephone of any changes, in order that the service user's records remain up to date and that the next printed MAR chart supplied is correct.
7.3.3 If the relevant medicine is supplied in an SMDS, then this, together with the MAR chart, must be returned to the community pharmacist promptly for amendment.
7.4 At no time, accept a telephone instruction from a Registered Practitioner to give one service user another's medicine. Should a Registered Practitioner request this, explain that you are not allowed to do this and insist on a visit. In the event a visit is declined, inform him/her you will only continue to administer medicines as per MAR chart, and if service user's condition necessitates medical attention, then in the absence of a visit, emergency services will be summoned.
8.1 All forms of PRN medicines must be prescribed and administered as directed
on the container labels and recorded on the pre-printed MAR chart.
8.1.1 When a variable PRN dose is prescribed, then the number of doses (tablets,
or capsules) given should be recorded on the MAR chart each time.
8.1.2 The Registered Practitioner should be requested to indicate how often a PRN dose can be given, and the maximum number of times the dose can be given in 24 hours.
8.1.3 Staff must record in the service users daily record the circumstances that lead to the medicine being administered, dose and time given and whether the desired outcome was achieved. If the desired outcome was not achieved, then it must also be documented in the service user's daily record, and the registered practitioner contacted to review the medicine.
8.1.4. When "as required" (PRN) medicine is repeatedly requested, the service
user's Registered Practitioner must be contacted to initiate a medication
9. Authorised (NON-Prescribed) PRN Paracetamol
9.1 Care Home staff will only administer non-prescribed PRN paracetamol at the service users request if:
· Authorisation has been obtained in writing on either Form M1 or Form M4.
· PRN paracetamol will be administered from a bought, unnamed, stock bottle only.
· Form M5 and the back of the MAR chart must be completed for each administration, and totals checked by Manager/SSW on a monthly basis.
· The manager/SSW must ensure that authorisation is kept up to date by requesting the Registered Pracitioner re-authorises administration, following a change in the service users medicines regime on Form M4.
9.2 Stock levels must be checked and recorded by the Manager/SSW on a
10. Arrangements for Service Users who self medicate
10.1 Once a risk assessment has been completed Service users should be encouraged to be responsible for their own medicines in accordance with the MAR chart and medication profile.
10.2 This will preserve independence and prepare those in short term care for their
return to the community, where they will need to look after their own
10.3 Service Users must be provided with a personal lockable drawer or cupboard where medicines can be safely stored. Wherever appropriate, service users should be strongly encouraged to use a sealed monitored dosage system (SMDS).
10.4 Permission must be sought from service users to enable care staff to have access to monitor and review medicines.
10.5 The assessment of service user's capacity to self-medicate will be reviewed at least annually and any significant changes will necessitate a review sooner as identified on the risk assessment.
10.6 Where a service user is assessed as no longer having capacity, the registered manager will sensitively consult with the service user and, where appropriate, a family member in a multidisciplinary team meeting to discuss assuming responsibility for administering medicines.
10.7 All service users who insist upon self-medicating, despite the advice of the home and their GP, should be asked to sign a disclaimer (form M11). Their cases should be discussed with their GP/nurse/keyworker and a plan of regular reviews set in place.
10.8 The practice of carrying medicines in handbags or pockets should be actively discouraged, except where medical advice recommends they be available at all times e.g. In the case of angina tablets, or spray/inhalers for breathlessness. Where service users refuse to adhere to the advice, a note of this must be recorded on their individual care plans.
11. Refusal and Covert Administration
11.1 An adult who has mental capacity has the legal right to refuse treatments, even if a refusal will adversely affect their health or shorten their life.
11.2 When a service user has mental capacity, staff must respect a service user's refusal to take medicines. Failure to do so is unlawful in both civil and criminal law, and is a breach of the service user's human rights. The exception to this principal, concerns treatment under relevant mental health legislation.
11.3 If a service user refuses to take prescribed medicines then the reason for the refusal must be recorded on the back of the MAR chart and the service user's daily report form. Staff must then refer to the Doctor's Statement (form M1) and follow the GP's instructions.
11.4 Information recorded can then be discussed as part of a medication review with the service user's Registered Practitioner/community pharmacist.
11.5 Service users must be presumed to have the mental capacity to consent or, refuse to take medication unless they:
a) Are unable to take in and retain information.
b) Are unable to understand that information
c) Are unable to weigh up the information as part of a decision making process.
11.6 Where a service user is considered to lack the capacity to give consent or, their wishes appear to be contrary to their best interests, then the Registered Practitioner responsible for his/her treatment should be consulted.
11.7 The assessment of capacity is primarily the decision of the service users Registered Practitioner, but relatives and/or care staff should be involved in discussions about this assessment. No one, not even a spouse can consent for another adult, but the views of family and close friends may be helpful in clarifying a service users wishes and establishing their best interests.
11.8 Covert administration of medicines must only be used in the case of service users who actively refuse their medicines, but who are judged not to have the capacity to understand the consequences of their refusal.
11.9 Any decisions to administer medicines covertly, must take into account the following considerations based on the UKCC (NMC) Guidelines:
11.9.1The best interests of the service user must be considered at all times.
11.9.2 The medication must be considered essential for the service user's health and wellbeing, or for the safety of others.
11.9.3 The decision to administer medicines covertly should not be considered routine and must be reached only after an assessment of the service user's care needs and a multi-disciplinary meeting including carers, relatives, health professionals and advocates as appropriate.
11.9.4 It should be done on an individual basis in order to avoid routine administration of medicines in this way.
11.9.5 The method of administering medicines covertly should firstly be agreed with the community pharmacist, alternative formulations of the medicine that may be more acceptable should be considered e.g. liquid preparation. A medicine should only be crushed when it has been shown not to alter the pharmaceutical properties.
11.9.6 The decision and the action taken, including the names of all parties concerned, should be documented in the service user's care plan/risk assessment and reviewed at agreed intervals.
11.9.7 Regular attempts should be made to encourage the service user to take their medicines; this should be documented in a daily report form. With some service users this might be helped by giving regular information, explanation and encouragement by a key worker, who has a good rapport with the service user.
11.9.8 Medicines should never be administered in a covert way merely for the
convenience of staff at the home. Any abuse of the procedure will be viewed
as a serious disciplinary matter.
11.10 Under no circumstances should service users be forced to take medicines
against their will, as this would constitute abuse under the Department's policy on the Protection of Vulnerable Adults.
12. Arrangements for Service Users away from the Care Home
12.1 Service users will at times need medicines away from their care home. Where possible the original dispensed supply should accompany the service user.
12.2 Where this is not practicable, and whenever possible two authorised staff must prepare the medicines for someone else to administer, and sign on the back of the MAR chart that they have done so.
12.3 The medicines must be placed in appropriate containers and must be labelled to show:
a) The service user's name.
b) Medicine name, strength, form.
c) Dosage instructions e.g. amount, time, swallow whole, take with
12.4 Upon return to the care home, staff who were responsible for administering
the medicines, must record the time of administration in the service
user's individual daily report form and MAR chart.
12.5 In the event of an emergency evacuation of the care home please refer to:
o Care Homes for Older People - Guidelines for the safe transfer of
Service users' medication, in the event of an emergency evacuation
of the care home.
13. Controlled Drugs
13.1 Two staff are required to record in a controlled drugs register when receiving, administering, and returning the controlled drugs to the pharmacy.
13.2 All entries should be dated, signed, timed and witnessed, and the balance should be checked at each administration.
13.3 There must be evidence to show that the controlled drugs balance is checked on a weekly basis by either the Manager/SSW.
13.4 Safe storage of controlled drugs - See section 18, Security & Storage of
14.1 Manager/SSW to ensure in conjunction with the Registered Practitioner agreement on the frequency of a medication review, but generally a minimum annual review is recommended.
14.2 Side effects from medicines need to be monitored, and Care Staff must alert Manager/SSW if a service users condition changes. There is a need to be especially alert when the Registered Practitioner prescribes new, or alters a service users medicine. The Manager/SSW will immediately consult the service users Registered Practitioner for advice if they have any concerns and notify the next of kin of all changes and any action taken.
15. Pharmaceutical Services
15.1 National Minimum Standards for Care Homes for Older People, Standard 17:
The registered person seeks information and advice from a community pharmacist regarding medicines dispensed for individuals in the home.
15.2 PATIENT INFORMATION LEAFLETS
Patient information leaflets are supplied with all new items. These should be made available to service-users, and care staff have a responsibility to read the contents of such information sheets, and assist the service-users with any queries if appropriate. The leaflets should be kept in an appropriate file or folder, and referred to for information on side effects, storage requirements, use etc.
15.3.1 Changes in legislation have prompted a review of the current practice guidance, with one aim being to develop a platform of joint working with Local Authorities and care homes.
15.3.2 Managers and care staff must continue to work closely together with the local community pharmacist to provide advice and help to the service users within our care homes.
16. Management of Medication errors and incidents.
16.1 The department recognises that, despite the high standards of good practice, mistakes may occasionally happen. It is important that an open culture exists in order to encourage their immediate reporting.
16.2 Every employee has a duty and responsibility to report any errors/incidents to his/her line manager, and refer to and complete Form M6.
16.3 Errors/incidents should be dealt with in a constructive manner that addresses the underlying reasons and procedures reviewed in order to prevent reoccurrence.
16.4 If error was found to be caused by reckless practice and concealed, a thorough and careful investigation will be undertaken in accordance with the County Council's Disciplinary Procedures.
17.1 The Manager/SSW must record all medicines brought into the home from
whatever source, including:
· OTC (homely remedies)
· Discharge medicines from hospital
· Medicines prescribed in an acute situation.
· Medicines prescribed on a regular or ongoing basis
· Those brought from another home.
· Care should be taken to include medicines brought from the service users own home, or those brought in by friends/relatives.
The record should show:
a) Date of receipt
b) Name, strength and dosage of medicine.
c) Quantity received.
d) Name of Service user for whom medicines is prescribed or purchased.
e) Signature of the member of staff receiving the medicines.
17.2.1 Repeat Prescriptions
17.2.2 Stock to be checked for items required (remembering service user's who self medicate) to ensure adequate supplies are maintained.
17.2.3 Prescriptions are for a maximum of 28 days.
17.2.4 Using repeat prescription print out from Registered Practitioner, indicate required medicines by referring to service users individual profile and MAR chart.
17.2.5 Check for discontinued medicines and remove from list.
17.2.6 Check for new medicines and add to list if not shown.
17.2.7 Photocopy prescription requests before forwarding to surgeries.
17.2.8 It is also the responsibility of the Manager/SSW (prior to the prescription being submitted to the pharmacy for dispensing) to sign the exemption declaration on the back of the prescription form on behalf of the service user, if the service user is unable to do this themselves.
17.2.9 The Manager/SSW should photocopy prescription requests before forwarding them to the GP surgeries. These should be retained in the Service Users file to serve as:
· A record of requests.
· To check new supplies against.
17.2.10 When prescriptions are returned from the surgeries, they must be checked for accuracy, prior to forwarding to local community pharmacist. If discrepancies are found, prescriptions are to be returned to Registered Practitioner for amendments.
17.2.11 If items are required at other times, a written request must be sent to the Registered Practitioner using Form M7 and a copy to be kept on file.
17.3.1 The Manager/SSW has responsibility to check all medicines on receipt from
pharmacy, against record of ordered medicines and record on the
17.3.2 Discrepancies must be noted and local community pharmacist notified.
17.3.3 Where medicines for a service user differ unexpectedly from those received for the same service user in the past, the Manager/SSW should check with the community pharmacist or Registered Practitioner before administering the medicine.
17.3.4 Check and replace previous month's MAR chart, and retain in service users file.
17.3.5 Protocol for temporary managers:
It is the responsibility of the registered manager to document the Care Home's ordering and receiving procedure, including contact numbers for the GP's and pharmacies. The protocol must be easily accessible i.e. in the management of medication file.
18.1 Medicines must be stored in a dedicated locked medicines room which must have sufficient space to store nutritional supplements, prescribed dressings, surgical sundries etc.
18.2 Medicines, which are for internal use, should be separate from those for external use.
18.3. Care must be taken to ensure that medical items are stored off the floor at all
18.4 Medicines must be stored away from any source of heat, moisture or direct
18.5 Good practice recommends storage being kept below 25ºC. Daily temperature checks should be made and a record of these kept in the medication room. If a temperature check is found to be above 25ºC then it must be reported immediately via the Property Help Desk for immediate repair.
18.6 Stock levels of medicines for each service user are to be kept at an appropriate level, and dependant upon need. Expiry dates should be checked and monitored monthly. Any stock that has expired should immediately removed from use and disposed of as point 19.
18.7 Medicines requiring refrigeration should be stored in a locked drug fridge.
18.8 Daily monitoring and recording of the fridge temperature (normal range
should be between 2ºC and 8ºC) must be undertaken using a
maximum/minimum thermometer. The thermometer must be reset after each
daily reading to ensure that the temperature hasn't risen or fallen outside the
required range since the last reading. If the temperature reading is outside
the normal range it must be reported immediately to property maintenance
for service/repair. All affected medicines will have to be replaced
immediately. Spoilt stock must be returned to Pharmacy and a record of the
18.8.1 The drug fridge must be cleaned and defrosted regularly.
18.9 Medicines supplied in a SMDS are to be stored in a medicine trolley, and
when not in use, the trolley must be secured to a wall or kept in the medicine
18.10 Keys for the medicines room, controlled drugs cupboard and trolley must not
be part of the master system for the home.
18.11 Key security is integral to security of the medicines. Therefore, access must
be restricted to authorised members of staff only (Manager/SSW). Keys
must be kept on the person in charge and handed over to the authorised
person in charge at each shift change.
In the event of an emergency a duplicate set of keys must be kept in the
Care Homes Office Safe. An incident form should be submitted for each
occasion that the drug keys are lost and the situation requires the duplicate
set to be used.
18.12 A metal cupboard must be secured to the wall in the medicines room for the
safe storage of controlled drugs, that complies with the Misuse of Drugs (Safe
Custody) Regulation 1973.
18.13 The medicines room and trolley must be kept clean and tidy at all times.
18.14 Hand washing facilities must be provided in the room.
19.1 To provide a full audit trail of all medicines through a care home, a record is required, to identify the removal from the home of a service user's medicines. This record should detail the following:
a) Date of disposal/return to pharmacy.
b) Name and strength of medicine.
c) Quantity removed.
d) Name of Service user for whom medicines were prescribed or
e) Signature of the member of staff who arranges disposal of the medicines and receiving community pharmacist.
19.2 This record is also necessary when medicines are transferred to another care provider, including an NHS hospital.
19.3 Medicines should be disposed of when:
a) A course of treatment is completed or discontinued
b) Expiry date is reached
c) Medicines are refused or have become soiled
d) A service user dies (medicines must be retained on the premises for a period of 7 days in case there is a coroners inquest).
19.4 Where service users are self-administering insulin, or any other medicines with a syringe, a "sharps box" must be provided by the Community Nurse and stored safely in the locked medication room.
20. Over the Counter (OTC) Medicines (Homely Remedies)
20.1 OTC/Homely remedies can be purchased for the individual service user on their request, after consultation and authorisation is received, from the Registered Practitioner.
20.2 Manager/SSW must ensure that Form M8 is completed and signed by the service users Registered Practitioner, authorising administration.
20.3 All Homely remedies must be recorded and signed for on administration in the MAR chart (Form M9).
20.4 If homely remedies are to be used by a service user, because of the risk of interactions between prescribed medicines and medicines purchased OTC, a service user or relative who purchases a medicine for self-administration, should be encouraged to inform the home's staff that the service user is taking a particular remedy.
20.5 The Care Home need only keep a record when they have an involvement in obtaining the medicines on behalf of the service user.
20.6 There may be different levels of monitoring required of the care staff in respect of service users. This would be part of the ongoing risk assessment.
21. Health Related Procedures
The guidelines for the following procedures can be found in section 2 of the Management of Medication file:
· Care of a stoma
· Care of an urinary catheter.
· Administration of oxygen
· Management of continence
(This list is not exhaustive, and will be added to as new procedures and guidelines are developed.)
The Registered Manager has the following responsibilities:
· To ensure that all staff responsible for administering medication have received the appropriate minimum training. i.e. NVQ Level 2 and Departmental training.
· To ensure that all staff responsible for administering medication have been assessed as competent of undertake these procedures on an annual basis by an appropriate person (see section 23).
· To ensure that all staff responsible for administering medication have been updated in the administration of medication at least annually.
· That comprehensive training records and assessment of competence are maintained for each staff member.
· That all staff caring for service users should posses a basic knowledge and an understanding of infectious diseases, and have received training in the use of universal precaution to prevent the spread of infection.
· That all staff are aware of, and use, the Management of Medication Policy and Procedures within their day-to-day work.
· That all staff must adhere to the policy and procedural areas, which relate to them and are assured of the full support of the department when working within these procedures. Failure to follow the policy, will lead to a thorough and careful investigation of circumstances, and may lead to disciplinary action being taken.
23. Assessment of Competence
23.1 All staff involved in the Management of Medication will undergo an annual assessment of their competence to practice.
23.2 This will ensure that all staff have the ongoing knowledge and skills required to maintain high standards of practice, and that CSIW standards are achieved.
23.3 The Manager will have responsibility to maintain all records relating to the care staff competency assessments. A copy must be forwarded to the Training Section.
Care Home Manager
Care Home Manager/Nurse Advisor
Senior Support Worker (Lead for Medicines)
SSW (Lead for Medicines)
Senior Support Workers
24.1 The processes in use within the Department will be subject to an annual programme of internal and external audit, as follows:
Nurse Advisor/Care Home Manager
Senior Support Worker
Community pharmacist inspector
On request of CSIW
Local community pharmacist who supplies the care home
Administration - This term describes staff responsibility for
directly giving of medicines subject to the procedures and guidance set out in this policy.
Approved Training - Trainings that is accredited
Assessment Staff - Include Social Workers, Care Co-ordinator
Assessor Care Managers,
Welfare Assistants and staff
from other agencies in multi-disciplinary
teams - e.g. Physiotherapists, Occupational
Therapists, District Nurses etc.
Audit - Official examination of management of
BNF - British National Formulary. A list of
medicines published jointly by the BMA and the Royal Pharmaceutical Society of Great Britain.
Care Home - An establishment providing accommodation
with personal care.
Care Home Staff - Include Resource Manager, Registered
Manager, Senior Support Workers and Care Assistants.
Care Plan Objectives identified by an assessment of
Competence based Assessment - Assessed as having adequate knowledge,
skills and ability.
Controlled Drugs - Drugs controlled under the provision of the
Misuse of Drugs Act 1971 and listed in the Misuse of Drugs Regulations 1973.
Controlled Drugs Register - Bound book with numbered pages, which
will include the balance remaining for each
product with a separate record page being
maintained for each Service user.
Covert Administration - The practice of disguising medicines in a
Service User's food or drink.
Day Care - Centre that provides care for the service
users only during the day.
Dispensed - To make up and give out medicines etc
according to prescriptions.
MAR - Medication Administration Record
Medicines/Medication - Substances with healing properties used in
Monitoring - Maintain regular supervision
NMC - Nursing Midwifery Council
Nutritional Supplement - Provide additional nourishment.
OTC/Homely Remedies - OTC/Homely remedies are non-
prescribed medicines for minor complaints.
Community pharmacist - Person who dispenses medicines
PRN Medicines - PRN is medication that is prescribed or
(as required) authorised by a Registered Practitioner for
use as and when necessary such as
Registered Manager - Person registered by the Care Standards
Inspectorate for Wales (CSIW) to manage
the Care Home.
Registered Practitioner - This term covers General Practitioners,
dentists, Chiropodists, opticians, registered
nurse and nurse prescribes.
Reviewing - Re-assessment of Needs and the service
outcomes with a view to revising the care plan at specified intervals.
Risk Assessment - A systematic examination of all aspects of
the work undertaken which includes
individuals and environment to consider
what could cause injury, harm or loss,
whether the hazards could be eliminated
and if not, what preventative or protective
measures are, or need to be in place, to
control the risks to acceptable levels.
Self Administration - This term is limited to making medication
available for the client's own use.
Service Users - The term also means client, customer and
describes anyone who may make use of the
service provided by Carmarthenshire
SMDS - Sealed Monitored Dosage System
SSW - Senior Support Worker
Surgical Sundries - Products used to manage a range of
physical conditions e.g. Catheters,
dressings, stoma applications etc.
UKCC - United Kingdom Central Council
· National Care Standards Act 2000 - Standard 17, National Minimum Standards for Older People & Standard 20 for Younger Adults.
· National Service Framework for Older People in Wales March 2006.
· The Administration and Control of Medicines in Care Homes and Children's Services - Royal Pharmaceutical Society of Great Britain Publication (June 2003).
· UKCC (NMC) - Position statement on the covert administration of medicines.
· Crooner's Care Standards - A Management Guide.