Kent County Council Policy and Procedures For The ... · For The Management of Medication . In Kent...

Kent County Council Policy and Procedures For The Management of Medication In Kent Adult Placement Scheme (Shared Lives)

Issue Date: February 2013

Review Date: February 2015

Owner: Kent County Council Families and Social Care (Adults) Business Strategy and Support Brenchley House Maidstone Kent ME14 1RF

Working Title: Policy and Procedures for the Management of Medication in Kent Adult Placement Scheme (Shared Lives)

Status: Unrestricted

Version No: 2

Date Approved by DMT: 6 February 2013

Date Issued: February 2013

Review by: Heath and Safety (FSC Adults)

Review Date: February 2015

Lead Officer/s: Carol Cassin

Master Location: Heath and Safety (FSC Adults) Shared Drive

Publication: KNet (KCC Intranet) > FSC operational policies > Health and safety policies (FSC specific) > Health and Safety manual

Authorised to vary: Carol Cassin

Replaces: New Policy

RELATED LEGISLATION POLICIES/PROCEDURES/PROTOCOLS

Related Documentation

Health & Safety at Work Act (1974) HSE

Management of Health & Safety Regulations (1999) HSE

Health & Social Care Act 2008 (Registration Requirements) Regs 2009

Department of Health Medicines Act (1968) Dept of Health

The Handling of Medicines in Social Care (Oct 2007) Royal Pharmaceutical Society

The Safe Custody & Supervision of Medicines (Oct 2008) NASHICS

A Guide to Good Practice in the Management of controlled Drugs in Primary Care (England) (Dec 2009)

NHS

Domiciliary Care Agencies Regulations (2002)

Guidelines for the Use of the Incident Reporting System and related forms

NHS Eastern & Coastal

Mental Capacity Act 2005

Mental Capacity Assessment forms for decisions KCC / KNet

Contents: Page No

1. Introduction………………………………………….……………. 2. Scope…………………………………….……………………….. 3. Policy………………..……………………….……………………. 4. General Principles.……………………….……………………… 5. Procedures………………..……………………………………… 6. Controlled Drugs…………………………………………………. 7. Warfarin…………………………………………………………… 8. Over the Counter Medication…………………………………… 9. Oxygen……………………………………………………………. 10. Administration of Emergency Medication……………………... 11. Management of Medication Errors and Incident……………… 12. Training…………………………………………………………… 13. Monitoring………………………………………………………… 14. Confidentiality…………………………………………………….. 15. Queries/Problems………………………………………………...

1 1 1 1 2 4 4 5 6 6 7 8 9 9 9

Appendices Appendix 1 – Glossary of Terms Appendix 2 – AP Carer Tasks Appendix 3 – Medication Administration Procedure Flow Chart Appendix 4 – Service User Medication Risk Assessment Appendix 5 – Kent APS – Record of Medications Appendix 6 – Medication Administration Record (MAR) Appendix 7 – Guidance on Completion of MAR Appendix 8 – Administration of Emergency Medication Appendix 9 – Administration of Rectal Diazepam Appendix 10 – KCC Medication Error Report Form Appendix 11 – The Five Rights Appendix 12 – Assessment of Competence for the Administration of Medication Appendix 13 – Statutory duties under the Mental Capacity Act (MCA) 2005 (Guidance Briefing in respect of Medication Management) Appendix 14 – Routes of Administration Appendix 15 – In Use Shelf Lives

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1 INTRODUCTION This policy and related guidelines are intended to provide all those concerned

with the delivery of services under the Kent Adult Placement Scheme with a set of practise standards relating to the supply, administration and disposal of medication.

Underpinning the guidelines are the principles of promoting independence, choice

and control. 2 SCOPE This policy and guidelines are applicable to all those providing support within the

Kent Adult Placement Scheme (Shared Lives). 3 POLICY It is the policy of the Kent Adult Placement Scheme (Shared Lives), referred to as

the ‘Scheme’, to encourage and support Service Users to take responsibility for their own medication wherever possible. Where this is not possible, the AP Scheme will ensure that the AP Carer understands the principles behind the safe handling of medication and follows the procedures laid down by the Scheme for the control, administration, recording, safe keeping, handling and disposal of medicines.

4 GENERAL PRINCIPLES 4.1 People placed with AP Carers should, wherever possible be encouraged and

supported to take responsibility for their own medication if they are able to do so safely.

4.2 The Adult Placement Scheme must ensure that AP carers have the knowledge and

skills that they need to handle and administer medication safely. 4.3 Where AP Carers are asked to carry out specific medical procedures for the person

placed with them, they should only do so after having received training in that procedure and assessed as competent by a qualified Health professional.

4.4 AP Carers must not administer any externally applied dressings. The only

exception to this would be the application of emergency first aid for which the AP Carer has received appropriate training. Existing dressings can be made safe and a health professional notified who can attend to the dressing.

4.5 AP Carers should check the Service User Plan and, wherever possible, consult

with a Health Professional for information about any known allergies or

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contraindications before giving any non-prescribed remedies, also referred to as homely remedies to a Service User, e.g. medication for pain. A record should be kept of any remedies given.

4.6 All forms of medication are potentially harmful if misused and care needs to be

taken in obtaining, storing, administering, recording, disposing and controlling them.

4.7 Medication whether self administered or given with assistance should be stored in

a safe place. Where medicines need to be kept cool then they should be stored in a clearly marked box on the top shelf of the refrigerator.

5 PROCEDURES (Appendix 3) 5.1 The Scheme will ensure that before any placement is made:

a) AP carers have training in safe handling of medication prior to managing medicines for service users. The training will be delivered by a competent and suitably qualified professional such as a pharmacist, nurse.

b) The AP carer is appropriately assessed to establish whether he/she is

competent to undertake the responsibility of medicine administration. (See Appendix 12).

c) The Mental Capacity of the Service Users will be assessed at the time the

decision is needed to be made and reviewed at Service User’s annual review.

5.2 The Scheme will, prior to a placement, and in consultation with the Service User

(and/or their advocate), the Service User’s GP, and the carer, undertake a risk assessment of the Service User’s competence to manage his/her own medication (see appendix 4).

5.3 The outcome of the assessment and/or details of the support that the Service

User requires to administer their own medication will be recorded in the health section of the individual Service User Plan. The Plan should include the signed agreement of the Service User or their advocate to whatever arrangement is made.

5.4 Where it has been agreed that the Service User can administer their own

medication, the Scheme will ensure that the Service User has a lockable place for storage of his/her medication; to which the AP Carer will be allowed access, with the Service User’s permission.

5.5 Where the AP Carer is asked to administer medication to or undertake a medical

procedure with the person placed with them, the Scheme will ensure that they receive training from a Health Professional in the administration of that

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medication or medical procedure and assessed as competent and that appropriate support continues to be provided by a Health Professional. The training provided should equip the AP Carer with current knowledge of the medical condition and the side effects of any medication. The detail of training and assessment of competence will be documented. (Appendix 2 for Carer Tasks).

5.6 Where the person placed administers their own medication, the AP Carer will

keep a record of all medication, together with the date and details of newly prescribed medication as described in (5.7). AP Carers should record and report to the AP team any concerns about the ability or willingness of the person placed with them to self medicate. The AP team should similarly record and if appropriate act on information provided by the AP Carer.

5.7 Where the AP Carer is asked to administer medication the AP Carer will keep a

detailed medication administration record for each Service User. (Appendices 5, 6 & 7). The record will include:

a) The date new medication is prescribed together with prescription details.

b) Each time medication is administered, with the time and dose. c) Any incident where medication has been refused.

d) Any period of illness which might affect absorption of medication (e.g. vomiting or diarrhoea).

e) The date when surplus or out of date medication was returned to the

community pharmacist for destruction. N.B. Only points a), d) and e) will apply in situations where the Service User self medicates.

5.8 Any refusal to take medication should be recorded and reported to the AP team

and GP or Community Nurse for advice as to appropriate action. 5.9 Errors in the administration or self-administration of medication should be

reported immediately to the GP for advice and appropriate remedial action. The carer should also advise the AP team of the incident as soon as possible. They will complete a medication incident report form (see appendix 10)

5.10 The AP Carer will monitor the condition of the person placed with them and will

report any unexpected change in condition that may be due to the side effects of the medication immediately to the GP.

5.11 The AP Carer will return all unwanted or out of date medication to the community

pharmacist for disposal and will obtain a receipt. The AP Carer will mark this on the medication record. If a person in the placement dies, the AP Carer will retain

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all their medicines for at least 7 days before disposal, as this may be required by the Coroner.

5.12 Administration of the Service User’s medication will be subject to regular review

by a medical professional at least on an annual basis and when a change of circumstances necessitates it.

5.13 Spoilt Medication If medication is accidently dropped or spilled it should be disposed of and a

replacement dose given. This should be recorded, giving date and time, on the Medication Record Sheet, advice sought from the GP or pharmacist and reported to the AP Team. Spoilt medication should be wrapped in tissue and placed in a clearly marked envelope stating “medication for disposal”, the name of the drug and dosage, and taken to the Pharmacist.

5.14 Monitored Dosage Systems Where medication is spoilt this should be disposed of as above. They should use

the next day’s medication and record this on the medication record. A separate note should be made and kept with the monitored dosage box which is signed and dated. The Health Care professional should be notified.

6 CONTROLLED DRUGS Controlled drugs are medicines that may be used to treat severe pain or drug

dependence. There are legal requirements for storage and record keeping that apply in residential settings but not in domiciliary care. They are a target for theft and even in domiciliary care, efforts should be made to keep them securely out of sight from those who do not need to know they are there. As with other medicines, these drugs should be securely stored in a locked cupboard within each Service User’s room.

If a controlled drug is to be administered within the AP setting then this should be

treated as any other drug to be administered and in accordance with the service user’s support plan.

For the collection and return of controlled drugs to the Pharmacy, on behalf of the

Service User, a form of identification and signature may be required. A receipt should also be obtained and inserted into the Service User’s file when returning these drugs.

7 WARFARIN People taking Warfarin must be regularly reviewed by healthcare professionals to

ensure that the dosage is correct. Support Workers should encourage and

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support Service Users to attend regular medication reviews with a maximum delay between tests of 12 weeks. Local procedures must be established based on the model of care for the individual. These must be clearly stated in the Support Plan before Warfarin can be administered. A ‘yellow book’ is provided to the Service User to record date of monitoring, blood level, medication dosage requirement and date of next test. The yellow book should be carried by the Service User at all times. The MAR and medication record should record that Warfarin is being administered together with any known interactions from foods or other drugs. However the ‘yellow book’ must always be referred to for the correct dosage unless otherwise agreed and documented.

8 OVER THE COUNTER MEDICATION These are non-prescribed medications which can be purchased from

pharmacists, supermarkets etc., and can also be referred to as Homely Remedies. OTC medication may include: tablets, liquids, creams, herbal remedies.

8.1 SERVICE USERS ‘WITH CAPACITY’ Where the Service User is assessed as having ‘capacity’ then advice should be

sought from the GP. If the AP Carer assists with /administers over-the-counter medicine as a one-off

dose, this MUST BE recorded in the Diary/Medication Record. Where the Service User with ‘capacity’ is regularly taking over-the-counter

medication, the AP Carer should report this to their AP Worker who will in turn advise Care/Case Management.

8.2 SERVICE USERS ‘WITHOUT CAPACITY’ Where the Service User is assessed as ‘not having capacity’ then AP Carers

SHOULD NOT purchase over-the-counter medication requested by the Service User. They should report to their AP Worker that these requests are being made and the Care Manager will be informed.

AP Carers SHOULD NOT assist with or administer any over-the-counter

medications which have not been approved by a Health Care professional and recorded in the Support Plan for the person who is ‘without capacity’.

AP Carers must alert the AP Worker if they become aware of OTC medications

being taken which have not been recorded in the Support Plan.

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9 OXYGEN Only authorised AP Carers who have undergone specific training (from a health

care professional) should be allowed to assist in the administration of oxygen to the Service User. AP Carers deemed competent are permitted to change cylinders.

The Oxygen Supplier as nationally agreed should be contacted to discuss the

safe storage of oxygen cylinders (including spare cylinders). The AP Team should make themselves aware of the contract between the supplier and the Service User regarding the domiciliary service of oxygen supply.

Where oxygen is being administered or stored smoking MUST NOT be allowed.

On occasions, if it is necessary to store spare cylinders of oxygen, they must be kept in dry, clean, secure and well-ventilated areas. Never lubricate cylinder valves or associated equipment and keep cylinders free from any oil or grease, etc.

In the event of a suspected leak from the cylinder or any other damage, the AP

Carer should IMMEDIATELY inform the Oxygen Supplier or the Police if no Oxygen Supplier is available. Where possible, move the defective cylinder outside to allow oxygen to escape into the air. Where moving the cylinder may create more danger it should be left where it is, people in the area should be evacuated and ventilation to that area increased.

10 ADMINISTRATION OF EMERGENCY MEDICATION Only AP Carers trained and competent in carrying out the procedures are

permitted to make the judgement as to whether it is an emergency. If the AP Carer is not trained to administer the medication the emergency

services must be called. Clear written instructions should be made available from the Health Professional

setting out when it should be used, how much should be given and any precautions necessary.

A risk assessment will serve to demonstrate which individuals are likely to require emergency treatment and under what circumstances. This will be recorded in the Support Plan. The administration of Emergency Medication form must be used (Appendix 8).

An emergency is defined as a life threatening situation where there is insufficient

time to wait for the emergency services to arrive. Emergency medication will be specified in the Support Plan.

Rectal Diazepam: See Appendix 9 for administration procedures.

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11 MANAGEMENT OF MEDICATION ERRORS AND INCIDENTS KCC recognises that, despite the high standards of good practice and care,

mistakes may occasionally happen for various reasons. Every AP Carer has a duty and responsibility to report any errors to his/her AP Scheme. If a mistake occurs, the AP Carer must IMMEDIATELY report this to the AP Scheme and seek medical advice from either of the following:-GP/District Nurse/NHS Direct/Out of Hours Service so as to prevent any harm to the Service User. The scheme should inform the Care/Case Manager where appropriate. The AP Carer will monitor the condition of the person and will report any unexpected change in condition that may be due to the side effects of the medication, to the GP. Action should be taken as soon as possible, with the Service User’s consent.

The Scheme must differentiate between those cases where there was a genuine

mistake or where reckless practice was undertaken and concealed. A thorough and careful investigation should be conducted in a timely manner to establish the facts and before any further action is taken. Any investigation must observe Adult Protection/Safe Guarding procedures.

AP Carers who make repeated medication errors will be expected to

undertake additional training and be re-assessed for competence. Where there is evidence of gross negligence, recklessness or flagrant

breaches of policy, AP Carers will be referred to the Scheme’s panel for review and may be removed from registration.

Note on completion of error form (Appendix 10) Only errors should be recorded on this form. Any spoilt medication, e.g. which the

Service User has spat out or any refusals to take should be recorded on the MAR sheet / daily log.

All forms should be copied to the Scheme. The Scheme will ensure these are

forwarded to the H&S Adviser and Case/Care Manager. Forms should be completed and forwarded within 2 days.

The Health & Safety section will collate data to monitor medication error reports

and analyse trends. Where an error has been made by either the Pharmacy of Prescriber then the Scheme will ensure the relevant PCT are supplied with a copy of the report with details of the Pharmacy/Prescriber and with details of the Service User removed.

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12 TRAINING All AP Carers administering medication are provided with approved training and

assessed as competent to manage the administration of medication as defined herein. Records must be kept of all training provided. (Appendix 12).

Training should be provided to all staff involved in the administration and control

of medication, including AP Staff and Care/Case Managers. Training should be included in induction and supervision and in addition must involve a certificated training programme operated by the community pharmacist or approved KCC training body.

The main elements of this training should be:

Induction training in the principles of the policies and procedures.

Familiarisation with their own responsibilities with regard to the procedures. A senior member of staff should supervise this familiarisation and record this on the Training and Assessment checklist. (Appendix 12).

Formal Training will be provided with the objective of providing:- A basic knowledge about how medicines are used and recognition of known

interactions and side effects. An understanding of the legal position, dosage instructions, method of

administration for oral, inhalers, topical, ear nose and eye preparations. Safe storage, safe systems, order, receipt, use, destruction, information and support. An understanding of the principles behind all aspects of the relevant policies and procedures on medicines. Practical use of recording systems. The side effects of the main medications, their use and how to observe and report these observations. Information on specific drugs used within the Service.

Specific Training will be provided where invasive procedures are involved e.g.

rectal diazepam, PEG feed. Consent will be obtained from the Service User, parent or carer and specific training provided on an individual basis by a health professional. Refresher/retraining will also be provided on a 3 yearly basis by Health Care Professionals. AP Staff should provide refresher training on the policy.

See Appendix 11 for the Five Rights for Administration of Medication.

KCC will ensure that:

a. AP Carers have approved training in medication handling prior to managing medicines for Service Users;

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b. The training will comprise session(s) delivered by a professional with medication knowledge such as a pharmacist, nurse and certificated stating what has been covered;

c. The AP Carer is appropriately assessed to establish whether he/she is

competent to undertake the responsibility of medicine administration in respect of following KCC procedures and will be reassessed on a 2 yearly basis using Appendix 12 or more frequently if a medication error has occurred.

d. Managers will have Medicine appreciation training and assessed as

competent to assess Support Workers. 13 MONITORING

It is the Registered Manager’s responsibility to ensure that monitoring takes place to check that this policy and procedures are adhered to. To assist with this see the AP Monitoring form which should be completed by AP Staff on a quarterly basis.

14 CONFIDENTIALITY

AP Carers should ensure that the health details and arrangements relating to the administration of medicine should only be discussed with those who need to know i.e. AP worker, Health Professionals and relatives. Relatives should only be informed with the agreement of the Service User, care manager or the carer’s AP worker. Where the Service User is unable to give informed consent then consideration should be given to the use of an independent advocate.

15 QUERIES/PROBLEMS

If there are any queries or problems the AP Carer should contact the AP team. 12 POLICY REVIEW

Review of the policy and guidance should be carried out if for any reason it is considered insufficient or at a minimum of 2 yearly intervals.

Date of next review: February 2015 Master Location: Families & Social Care (Adults) Lead Officer: Carol Cassin

Appendix 1 Page 1 of 3

GLOSSARY OF TERMS

ADMINISTRATION OF MEDICATION vs. ASSISTANCE WITH MEDICATION The following descriptions define what assisting with medicines means and what administering medicines means: (Ref CQC Professional Advice)

When a care worker assists someone with their medicine, the person must indicate to the care worker what actions they are to take on each occasion.

If the person is not able to do this or if the care worker gives any medicines without being requested (by the person) to do so, this activity must be interpreted as administering medicine.

Within FSC both ‘Administration’ and ‘Assisting’ are carried out in accordance with the Support Worker Tasks provided. AP CARER A person who provides direct services to an individual under the Adult Placement Scheme. AP MANAGER The person who manages the Adult Placement Scheme. AP SCHEME The Service that provides support to Service Users requiring placement within people’s homes within the community. This is sometimes referred to as ‘Shared Lives.’ AP WORKER An employee of KCC working within the AP Scheme. APPROVED TRAINING This is a structured programme of training that has been agreed between Health and Families and Social Care. Staff involved in managing Service User’s medication will be assessed regarding their competency to undertake specific tasks and then judged whether competent to do so. AS REQUIRED MEDICATION Medicine to be given when required for defined problems, e.g. pain relief. Can also be referred to as PRN (Pro Re Nata).


CARE/CASE MANAGEMENT Is the process of tailoring services to meet individual needs following a holistic assessment and care planning by Care/Case Manager. CARE/CASE MANAGER Is a professional representative of Families and Social Care who assesses the needs of a Service User, plans and arranges delivery of services required to meet those needs. CARE PROGRAMME MONITORING/CONTACT BOOK This is any record of the Support provided to an individual and can also be referred to as Contact Notes. This may be referred to as Support Plan/Care Plan and Contact Book, Professional Notes etc. CONTROLLED DRUGS (CD) CDs are medicines that may be used to treat severe pain or drug dependence. There are legal requirements for storage and record keeping that apply in residential settings but not in domiciliary care. They are a target for theft and even in domiciliary care, efforts should be made to keep them securely out of sight from those who do not need to know they are there. HEALTH PROFESSIONAL These are people who are medically trained and assessed as competent in their field of work. They may all prescribe medication. These can include:- Doctors, Pharmacists, Nurse Practitioners, Ophthalmic Opticians, Physiotherapists. HOMELY REMEDIES A medicinal preparation used to treat minor ailments, which can be bought over the counter and does not require a prescription. MONITORED DOSAGE SYSTEMS They can also be referred to as:- dossett boxes, blister packs, nomads. These are systems for packing medicines to make use easier, e.g. by putting medicine for each time of day in separate blisters or compartments.


MULTI-AGENCY TEAM This consists of all FSC and Healthcare professionals involved in an individual’s care. NURSE PRESCRIBER Is a nurse who has undertaken additional training in order to enable him/her to prescribe medication. OVER THE COUNTER (OTC) These are non-prescribed medications which can be purchased from pharmacists, supermarkets, etc., and can also be referred to as Homely Remedies. OTC medication may include: tablets, liquids, creams, herbal remedies. PEG (Percutaneous Endoscopic Gastostomy) tube A flexible tube that goes through the abdominal wall directly into the stomach. Used for giving liquid food. PROVIDER A resource providing a service at an agreed cost. SECONDARY DISPENSING Re-packaging a medicine that has already been dispensed by a pharmacist or dispensing doctor. SERVICE DELIVERY ORDER An order for providing a support package, from the service purchaser to the service provider which is produced by translating an individual service plan via the Care Management Information System. SERVICE USER This term also means client, customer or resident and describes anyone who makes use of the services provided by Families and Social Care or its contractors. SUPPORT PLANNING Means negotiating most appropriate ways of achieving the objectives identified via an assessment of need and incorporating them into an individual support plan.


AP Carer Tasks

Adult Placement Scheme

RED (tasks NOT to be undertaken by AP Workers): Change wound dressings Filling or altering syringe drivers Filling a compliance aid (dosette box or similar) Give pessaries and enemas Advising on any medication including OTC

AMBER (tasks which MAY BE undertaken by named AP Carers who have received specific accredited training for an individual Service User). They must be assessed as competent and monitoring arrangements to be provided by appropriately qualified health professionals. Training and assessment must be documented and included in AP Carer files: Assisting with administration of nebulisers Administration of PEG feed Administration of and assistance with oxygen in liaison with the oxygen

supplier. Administering of Rectal Diazepam/Buccal Change dressings after having specific training from a healthcare

professional in respect of the Service User Give injections Give suppositories (with the exception of administering emergency

diazepam, subject to competence) Monitoring of blood glucose levels Assist with Stoma Management GREEN (tasks which may be undertaken by all AP Carers who have received accredited training and assessed as competent): Remind Service Users to take their prescribed medication Give tablets, capsules or liquids to be swallowed Give medication to dissolve in the mouth or suck Application of creams and ointments to skin Instill eye, ear or nose drops Changing ordinary support stockings Assisting with administration of inhalers and sprays Replacement of a simple dressing, e.g. temporary first aid measure Leaving drugs out for Service User’s own administration where the

Service User has capacity or as agreed in the Support Plan. Assist with putting on post-operative stockings (e.g. TED) Application of patches e.g. GTN (Glyceryl Trinitrate), Fentanyl, HRT

(Hormone Replacement Therapy)


MEDICATION ADMINISTRATION PROCEDURE & DOCUMENTATION

ADULT PLACEMENT SCHEME

Carer’s Annual Review

SELF MEDICATION

ASSISTED MEDICATION

Adult Placement Carer Administers Drugs & Completes

form Daily

AP Worker + AP Carer Completes

Medication Administration record

Adult Placement Carer to Monitor & Advise as Necessary

(Review at service users annual review with case

manager)

QUERIES a) Consult with GP/Pharmacy/Care Manager

b) Request any Clarification in Writing c) Record Changes on administration record Sheet

Provide Secure Storage (For Service user)

Monitor – Complete Incident Forms

Support Plan Provided by Case Manager. AP Team conduct Risk Assessment to include whether Service User can Self Medicate

Referral from Case Manager

Service user medication risk assessment and consent form to be completed with Adult Placement Scheme

Record of medications form Completed by Adult Placement Carer


Service User Medication Risk Assessment and Consent Form

Name ………………….……………………………………………………………..…………

Address………………………………………………………………………………...…

GP………………………..……Community Pharmacist………………………...………. Care/Case Management Assessment: Has the Service User been assessed as: ‘With Mental Capacity’ [please tick as appropriate] ‘Without Mental Capacity’

‘With Capacity’ (Responsible for own medication)

‘Without Capacity’ (can not take responsibility for own medication)

(please tick as appropriate) (please tick as appropriate) Yes Yes Needs prompting to

take medication No Needs physical help to

take medication No Yes Yes Needs physical assistance

to take medication No Needs prescriptions to be collected

No Yes Yes Needs prescriptions to

collected No Needs medication to be collected

No Yes Yes Needs medication to

collected No Does the Care/Case Manager’s assessment clearly state if the Service User is to be

denied access to their medication?

No

Who is responsible for safe disposal of surplus medication?

Who is responsible for safe disposal of surplus medication?

How will medication be stored?

How will medication be stored?

Yes Yes Can the Service User access the storage area? No

Can the Service User access the storage area? No

Comments (please include details of any staff support). Please state if self medicating):

P.T.O.


Notes You may need to support the Service User to understand the questions overleaf. Wherever possible we should support individuals to self-administer medication. From the questions asked and any other relevant information, ensure you are satisfied that the individual is competent and used to self medicating. It is always wise to double check any details you are not confident about with another professional/carer involved in working with the individual. If there is a history of self-harm, drug or alcohol abuse, self-administration of medication may only proceed if current risk is assessed as very low. If it is decided that the individual is not able to self-administer medication, you must clearly state the reasons for this decision in the comments box. Prompting to take medication can take many forms including verbal, visual, electronic.

3. Administration of Medication I understand that only formally trained staff will administer medication and that the medication must be supplied in a suitably labelled bottle as dispensed by the pharmacist. I give consent for medication to be administered to me as outlined in my support programme.

Signed (Service User)

………………………………… Date……………………………

Signed (KCC representative)

…………………………….….… Name (in block capitals) Date…………………….………

2. Some Assistance Required I need some assistance with the management of my medication.


………………………………… Date……………………………


……………………………….…… Name (in block capitals) Date………………………………

1. No Assistance I agree that I do not need any support with the administration of my medication.


………………………………… Date……………………………


…………………………..……….. Name (in block capitals) Date…………………………..…


Kent Adult Placement Scheme Record of Medications

Name:

Address: Telephone:

Allergies/condition GP name: ……………………………………………………………………………………………… Telephone contact:……………………………………………………………………………………..

Medication Name Dosage Why prescribed Route Special instructions

Additional information if required

Signature service user/Carer:______________________________________________________________________________

Date Reviewed Comments/signature

Appendix 6 Page 1 of 2 KCC, Kent Adult Social Services Adult Placement Services

Medication Administration Record (MAR) (Always check dosage against GP instructions on packaging) Month/Year……………….20……..

Service User’s Name and Address:

Date of Birth: GP:

ALLERGIES:

DRUG – Medication, Strengths, Cautions TIME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

DOSE EXP SIG ROUTE RECD. QUAN. BY RETURNED:DESTROYED



WHEN MEDICATION IS SEEN TAKEN, INITIAL THE APPROPRIATE BOX. WHEN MEDICATION IS NOT SEEN TAKEN PLEASE ENTER THE APPROPRIATE LETTER

A = REFUSED B = NOT GIVEN C = PREPARED BUT NOT SEEN TAKEN D – PLANNED HOSPITAL STAY. WHENEVER IT IS NECESSARY TO RRCORD A, B OR C – IT IS REQUIRED THAT YOU MAKE AN ENTRY ON THE MEDICATION RECORD SHEET.


Medication Record Sheet Service User’s Name………………………………….…… Page No………………. Please use this sheet for recording any untoward occurrence involving medication including any occasion when you do not observe the service user taking the medication.

Also for recording collection/disposal of medication and ‘spoiled’ medication.

Recording of unplanned hospital admissions (ILS only).

Date Time Details Initials


Guidance on Completion of Medication Administration Record (MAR) Form 1. The MAR has been designed to enable administration of different types

of medication to be recorded for a period of up to 31 days (1 month). 2. As and when required, medication must state the signs/symptoms

present to identify when to administer the medication. 3. On commencing use of the form, enter the following information across

the top of the form :-

Name of service user Date of birth GP – name Allergies – enter details of any known allergies. Month & Year – a new sheet will be required at start of each new

calendar month. 4. Enter following information down the left-hand side of the form for each

medication prescribed for the client.

Name of medication/drug, strength and any cautions included on label.

Dose (e.g. 1 x 20 mg tablet, 10 ml) Expiry Date – enter expiry date of medication if included on

container. Signature – of administrator entering information on the sheet. Route – enter route by which medication is taken (e.g. Oral) Time – enter the time/s that the medication is taken.

5. The small boxes should be initialled by the administrator to indicate that

the medication has been administered on the day and times indicated. If dose is variable, insert actual amount administered.

6. Where medication is not administered on a specific day or time, one of

the letters at the bottom of the sheet is entered in the box and, if necessary, comments are made on the Medication Record Sheet.

7. The horizontal line beneath each drug type must also be completed as

follows:-

‘Recd’ (Received) – enter date new supplies of medication are received.

‘Quan’ (Quantity) – enter quantity received. ‘By – enter initials Returned/Destroyed – enter date medication returned to

pharmacist. Note – spoilt medication should be wrapped in tissue, placed in a clearly marked envelope and taken to the pharmacist.

Appendix 8Page 1 of 2ADMINISTRATION OF EMERGENCY MEDICATION

(ONLY FOR ADULT SERVICE USERS, AGE 18 AND ABOVE)

Adult Placement Scheme

To be completed by the appropriate healthcare professional and then countersigned by the Service User

(In block capitals please)

Service User’s Name _____________________________________ Date of birth _________________ Medical Condition requiring emergency medication __________________________________________

Drug, strength of dose and identification of when the medication is needed (one drug per form):-

Trigger Points Action Guidance where necessary Recognition of when

medication is needed.

At what point should emergency services be called?

When should the first dose be given?

How should the patient be cared for?

Observations to be made. When should a repeat dose be

given?

Aftercare required?

e.g. recovery position. i.e. pulse taking etc + expectations/side effects.

Can this medication be administered by a member of the community without further training:

YES/NO

If no, what level of additional training is required: _____________________________________ Additional comments: _________________________________________________________________

Signature of Healthcare professional: _____________________________ Date: ___________________ Name of Healthcare professional: ________________________________________________________ Address: ___________________________________________________________________________ Telephone Number: ___________________________________________________________________


It is the duty of the Service User to supply Kent Adult Social Service with emergency medication in properly labelled containers. It is also the duty of the Service User to advise KCC if any medication or the instructions change in any way. I consent to administration of medicine in this defined emergency situation by a member of KCC staff as set out in this protocol. I express a preference for a male/female* member of staff to undertake this procedure or I have no preference* *delete as appropriate I give consent for this information to be shared among KCC staff who are involved in my care. Signature: ____________________________________________ Date: _________________ Service User name: ____________________________________________________________ Address: ____________________________________________________________________ Telephone Number: ___________________________________________________________ 2nd Emergency Contact: ________________________________________________________ Telephone Number: ____________________________________________________________ If the Service User lacks mental capacity it is the responsibility of the Healthcare Professional to make the “best interest” decision to administer the medication following consultation with relevant individuals. Review of form and medication required at least annually. Date of Review Reviewed By (Block Capitals) Signature


Administration of Rectal Diazepam The administration of emergency medication such as rectal diazepam may only be undertaken by trained and approved staff, and as detailed in the individual’s support plan. The prescriber or overseeing consultant is responsible for defining the circumstances under which such medications can be given. Written consent must be sought from the Service User likely to require rectal diazepam to control convulsions setting out their agreement for KCC staff to undertake the procedure as necessary. Rectal diazepam must only be administered in emergency situations when it is evident that the emergency services will not reach the individual within the specified period of intervention as determined by the Health Professionals. Only those employees who are willing and have undergone relevant training should undertake the administration of rectal diazepam. The staff supervision process should be used to discuss and record the employee’s preference in respect of this task. It is unlikely to be possible to definitely determine competence, as staff will be unable to practice in “safe surroundings”. It would normally be preferable for two staff to be present when emergency administration is being carried out. The absence of a second member of staff however, should not delay administration. Whenever feasible, the individual’s preference concerning the gender of administration staff should be respected. For those not able to express a preference, male should administer to male and female to female. In an emergency, the absence of the appropriate staff gender should not delay administration. If the administration of rectal diazepam is required the staff should calmly request others present to move to another area or different part of the room so as to maintain the dignity and privacy of the individual. In a public place, the emergency services (ambulance) should be called out. If due to unforeseen circumstances, the situation becomes potentially life threatening, administration of rectal diazepam may be conducted within the criteria set by the GP while providing the maximum privacy possible.


Med 13 Form No: ..…M………..….

Families and Social Care (APS) (Adult) Medication Error Report Form

Name of Service User: …………………………………...………. Unit/Service: ………………...……….…... SWIFT / NHS No: ……………………………….……………….

Error or Incident identified by: Name: ……………………………………………………………. Job Title: …………………..………………... Date: …………………………………… Time: ……………………..…...……………...

TYPE OF MEDICATION ERROR (please tick)

1. Drug given to wrong person.

2. Drug given at wrong dose (over or under) to correct person.

3. Drug given by wrong route.

4. Drug given at wrong time of day including error in respect of cautions on mealtimes.

5. Missed medication.

6. Drugs administered out of date.

7. Missed initials. Incomplete entry on MAR sheet.

8. Drugs mislaid.

9. Drug wrongly prescribed. (state name & address of prescriber)

10. Wrongly dispensed from pharmacy (state name & address of pharmacy)

10a. Drugs supplied in error.

10b. Dosage information – not current dose on label.

11. Stray medication found (not community services)

12. Other (please state reason)

* Note: The pharmacy / GP must be referred to immediately if incorrect medication is provided by them. The relevant PCT Medicines Management Team must also be informed.

For Pharmacy / GP errors All CD incidents report to [email protected] Other medicine incidents report to [email protected] Describe error and drugs identified: (use separate sheet as necessary)

…………………………………………………………………………………………..........................................

.................................................................................................................................................................... Did the Service User become unwell because of this incident? YES/NO If yes, please give details:

…………………………………………… …………………………………………….........................................

.................................................................................................................................................................... Action taken (in as much detail as possible):

…………………………………………………………………………..…………………………………….………

………………………………………………………………………………..……………………………….………

…………………………………………………………………………………………..……..………….………….

Signature of AP Carer completing form: …………………………...……………………………………... Date: …………………………………………..

If at any time there is doubt about the person’s wellbeing the GP must be contacted immediately. If GP unavailable contact A&E, Pharmacist, District Nurse or NHS Direct on 0845 46 47.

mailto:[email protected]



AP Scheme’s Investigation Please detail any factors that you feel contributed to this incident:

………………………………………………………………………………………………………..…………

…………………………………………………………………………………………..………………………

…………………………………………………………………………………………………………..………

…………………………………………………………………………………………..………………………

……………………………………………………………………………………………………..……………

………………………………………………………………………………………………..…………………

……………………………………………………………………………………………..……………………

………………………………………………………………………………………………..………………… What measures have been taken to prevent a repeat of this incident in the future?

………………………………………………………………………………………………………..…………

…………………………………………………………………………………………..………………………

…………………………………………………………………………………………………………..………

…………………………………………………………………………………………..………………………

……………………………………………………………………………………………………..……………

………………………………………………………………………………………………..…………………

……………………………………………………………………………………………..……………………

………………………………………………………………………………………………..………………… Signature of AP Worker: ……………………………………………….……. Date: ……………………. Circulate to:- Care/Case Manager / Registered Manager / CQC (for serious or significant errors only) / Head of Service / H&S Adviser


THE FIVE RIGHTS

FOR ADMINISTERING MEDICATION

When assisting with/administering medication KCC staff should always remember the five rights.

1. Is this the RIGHT PERSON for whom the medication has been

prescribed with their name on the label 2. Is this the RIGHT MEDICINE and within the use by date 3. Am I assisting with/administering the RIGHT DOSE 4. Am I giving this help at the RIGHT TIME of day 5. Am I using the RIGHT ROUTE for this medicine

o Is it to be swallowed?

o Is it to be inhaled?

o Is it to be applied to the skin?

o Is it to be put in the eyes?

o Is it to be put in the ears?

ALWAYS CAREFULLY CHECK THE LABEL ON MEDICINES –

To get it ALL RIGHT !


KENT ADULT PLACEMENT SCHEME

Assessment of Competence for the administration of medication Name of Carer:

Criteria Discussed/Comments Date Collecting medication prescribed and repeat prescriptions

Recording the collection and delivery of medication. Ensure controlled drugs are checked and signed for

Disposal of medication including controlled drugs, make sure receipt is received for these

Preparation made for the administration of medication cleanliness care and safety

Correctly identifies the Service User receiving the medication

Checks are made on the correct time, dosage, route of administration. Checking for expiry date.

Administers and records the taking of the medication in line with APS Medication Policy and Procedures

Discuss action taken to secure medication if called away from administration

Discuss how to find out common side effects of medicines including current

Explain the policy and procedures on self-administration

Discuss action to be taken if anyone is non-compliant, incident, loss or damage Reporting errors

Carer’s Signature

APS Officer’s Signature

Date

Review Date Comment/signature


Statutory duties under the Mental Capacity Act (MCA) 2005

(Guidance Briefing in respect of Medication Management)

1. The 5 statutory principles of MCA must be followed at all times:

A person must be assumed to have capacity unless it is established that they lack capacity.

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his/her best interests.

Any such actions or decisions must be achieved, wherever possible, in a way that is least restrictive of the person’s rights.

2. If the person is assessed to have mental capacity for the specific decision at

the time the decision needs to be made, the person signs consent for this decision. Assessment of capacity must be undertaken under the framework of MCA.

3. If the person is assessed to lack mental capacity for the specific decision at

the time the decision needs to be made, then the statutory best interests’ decision process follows. Under MCA, the decision maker needs to be identified and the decision maker consults all relevant individuals (other professionals, family, an independent advocate if appropriate), taking into account past and present wishes and feelings of the person, and the decision maker then makes the final decision in the best interests of the person. No one in this consultation process should sign consent on behalf of the incapacitated person, but the decision maker should show in their recording that consultation has been fully undertaken. Others can sign to say they have been consulted, and the decision maker can sign to state this is the final decision they have reached.

4. Assessment of capacity must be decision specific and time specific. A

person could be assessed as having capacity for one medication decision and lacking in capacity for a different medication decision. Where a person’s capacity fluctuates over time, the determination of capacity is based on the balance of probability after all practicable steps have been taken to do so.

5. If the person has a registered Personal Welfare Lasting Power of Attorney

(LPA) with relevant health decision making authority, then the LPA makes the final decision. Enduring Powers of Attorney (EPA) and Property and


Affairs (LPA) are not the decision makers for healthcare decisions, but they should be consulted under the best interests’ decision process of MCA.

6. If a person has made a valid and applicable Advance Decision whilst they

have capacity, stating specific treatment they would refuse when they lose capacity, the Advance Decision must be followed.


ROUTES OF ADMINISTRATION Oral – by mouth Buccal - the pouch between the cheek and the top gums Sublingual – under the tongue Intra-nasal – into the nose Intra-aural – into the ears Intra-ocular – into the eyes Inhalation – breathed in via nose/mouth into the lungs Topical – applied to the outer surface of the body e.g. skin Transdermal – introduced onto/into the skin, usually in a patch which the resident wears as prescribed Percutaneous Endoscopic Gastrostomy (PEG) – medicines given directly into a PEG tube inserted directly into the resident’s stomach Intra-muscular – injected into a large muscle in the arm leg or buttock Subcutaneous – injected into the subcutaneous layer (below the skin but above the muscle layer) Intra-venous – injected directly into the vein or via a cannulae, or given over a period of time as an intravenous infusion (drip) Intradermal – very small amounts of injection given just under the skin Rectal – into the rectum Vaginal – into the vagina


IN-USE SHELF-LIVES

The following information is a guide to expiry dates for products in patients own homes or residential care however some products may have shorter expiry dates.

The manufacturer's expiry, if shorter or the manufacturer's specified in-use shelf-life takes precedence over the following guidelines. The guidance given here should be used as aid

to a pharmacist's own professional judgment on matters of stability and in-use expiry.

If in doubt check with the dispensing pharmacist

TABLETS AND CAPSULES Blister packed in manufactures original pack As Manufacturer's Expiry Date

Single Unit Dose As Manufacturer's Expiry Date

Bulk packs of loose tablets 1-year from date of opening

Medicines dispensed in monitored dose systems (MDS)

Expiry dates should be discussed with the dispensing pharmacy.

Exceptions: Products susceptible to atmospheric moisture, GTN

LIQUIDS

Preserved Internal and External 3-Months

Extemporaneously Prepared to a BP monograph or EDS Formula

4-Weeks from date of manufacture

Diluted Preserved liquids

2-Weeks

Preserved with Chloroform

2-Weeks

CREAMS

Packed in Tubes 3-Months (1- Month for Unpreserved creams)

Packed in Pump action tubs

3-Months

Packed in Jars/Pots

1-Month

Diluted Commercial Preparations

2-Weeks

Extemporaneously Prepared in a suitable base


OINTMENTS

Packed in Tubes 6-Months

Packed in Jars/Pots

3-Months

Diluted Commercial Preparations

4-Weeks

Extemporaneously Prepared in a suitable base


References

1. Quality Assurance Service, Pharmacy Department, and Guy’s Hospital. In-Use Shelf Lives of Medicines, London, Eastern and South East Specialist Pharmacy Services. 2001.

2. Storage, Stability and In-use Shelf-life Guidelines for Non-sterile Medicines, Including Cream and Ointments in Residential Settings. NHS Eastern and Coastal Kent Dec 2010

Contact Details:

Accountable Officer: Sheila Brown

NHS Eastern and Coastal Kent, Kent House, 81 Station Road. Ashford TN23 1PP

Tel: +441233618158 Fax: +441233 618195

Email [email protected] Web: www.easternandcoastalkent.nhs.uk Issue: Date: April 2011


http://www.easternandcoastalkent.nhs.uk/

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