Handling of Medication

Jane Hancock DipClinPharm BPharm MRPharmS

NEWS HEADLINES • Seven in ten care home residents is 'victim of drug error',

The Daily Telegraph, October 6 2009

• Fears over care home drug errors, BBC News, October 6 2009

• Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009

• More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009

• Elderly hit by muddles over drugs, Daily Express, October 6 2009

Medication errors affect three

quarters of care home residents

6 October, 2009

Care homes’ use of medicines study: prevalence, causes and potential harm of

medication errors in care homes for older people

The University of Surrey, in conjunction with the London School of

Pharmacy and Leeds School of Pharmacy Qual Saf Health Care 2009;18:341-346 doi:10.1136/qshc.2009.034231

Study Details

• 55 Care Homes

• 256 Service Users

• Average of 8 items of medication each

Findings

• 178 (69.5%) of Service Users had one or more errors

• 57 Service Users had 116 administration errors, including being given the wrong dose of medication or not being given their medication at all

Contributing Factors

• G.P.s not readily accessible

• Did not know the service user

• Lacked information in the homes when prescribing

Contributing Factors

• Home Staff had high workload• Lack of medicine training• Interruptions during medicine rounds• Lack of team work between Home,

Surgery and Pharmacy• Inefficient ordering systems• Inaccurate medication records• Verbal communication

Conclusion from the study

• "People in care homes are a frail and vulnerable population at particular risk from medication errors, and it is a cause for concern that two-thirds of care home residents in this study were exposed to one or more errors."

How can this be improved?

The five rights of administration

• Right service user • Right medicine• Right dose• Right time• Right route

Types of medicines

• Systemic

• Topical

Systemic medicines - One Oral medicines- Solid dose forms

- Tablets and capsules- Soluble/dispersible/effervescent tablets- Lozenges

- Enteric coated tablets - Sustained release tablets and capsules

- Liquid dose forms- Solutions- Syrups- Suspensions- Mixtures- Linctus

Systemic medicines - Two • Rectal medicines• Injections• Medication given via PEG tubes• Transdermal Patches

Topical medicines

• Eye, ear, nasal drops• Creams and ointments• Inhalers• Rectal medicines• Vaginal preparations

Applying topical medicines• Just as important as oral medicine• When opening new tubes or drops etc.

always record opening date• Unless labelled otherwise the general

guidance is: - Jars - discard one month after opening- Tubes - discard three months after

opening- Eye drops and eye ointment - discard

four weeks after opening

Giving the medicines - One • Be prepared

• Check the medicine record

• Find the medicine • Measure the dose*• Check the label *

Measure the dose - LiquidsRead at the bottom of the Meniscus

*

Giving the medicines - Two

• Take the medicine to service user

• Check service user is the correct person

• Make sure they are in an upright position

Giving the medicines - Three

• Give the medicine• Offer a drink• Record immediately what has

been given or declined

MARR sheet

Medication Administration Records and Request (MARR)TRACK MEDICATION – EVERY SERVICE USER – RECORD IMMEDIATELY

The Home is expected to carry out a minimum of five audits:

1. Quantity received audit2. Quantity disposed audit3. Administration audit4. Ordering audit5. Information audit

Therefore:Medication Containers & Labelling + Reminder Cards + MARR + Returns Book = FULL AUDIT TRAIL

Storage

• Locked cupboard or trolley• Cool, dry room• Key security• Self medicator’s medicine• Fridge temperature• Oxygen

Waste Medication

• Hazardous Waste Regulations 2005

• Care Homes classed as domestic waste record and return to Pharmacy

• Care Homes with Nursing classed as industrial waste collected from home by specialised waste contractor e.g. Cannon, PHS

Controlled Drugs

• Medicines Act 1968

• Misuse of Drugs Act 1971

Requirements of a Controlled Drug Prescription

• Service User’s name & address

• Age (if under 12)

• Name of Medicine

• Strength • Dose Form • Quantity (in

words and figures)

• Dose• Doctor’s

Signature• Prescribing Date

Storage of CDs

• Must comply with Misuse of Drugs (safe custody) regulations

• Made of steel• 5 lever or 6 pin lock• Fixed to a solid wall or a

wall that has a steel plate mounted behind it

• Fixed with rag or rawl bolts

Controlled drugs Register

The five rights of administration

• Right service user• Right medicine• Right dose• Right time• Right route

NEWS HEADLINES • Seven in ten care home residents is 'victim of drug error',

The Daily Telegraph, October 6 2009

• Fears over care home drug errors, BBC News, October 6 2009

• Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009

• More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009

• Elderly hit by muddles over drugs, Daily Express, October 6 2009