Sam

Registered in England and Wales No: 7564579 Registered office: Peninsula Community Health CIC, Sedgemoor Centre, Priory Road, St Austell PL25 5AS

www.peninsulacommunityhealth.co.uk

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Peninsula Community Health is a not for profit Community Interest Company responsible for providing NHS adult community health services in Cornwall and the Isles of Scilly

Peninsula Community Health

GUIDELINES FOR

PATIENT SELF-ADMINISTRATION

OF MEDICATION (SAM)

Title: Guidelines for Patient Self-Administration of Medication (SAM)

Procedural Document Type: Guideline

Reference: CGP20

CQC Outcome: Outcome 1 and Outcome 9

Version: Version 3

Approved by: Matron Meeting 4/9/14

Ratified by: Clinical Quality and Safety Committee

Date ratified: 21/10/2014

Name of originator/author: Ros Palmer & Teresa Finnegan & Adrienne Darko - Admin

Name of responsible team: Pharmacy & Nursing Team

Review Frequency: 3 years

Review date: October 2017

Target audience: Community Hospital - Medical, Nursing and Pharmacy staff

Executive Signature (hard copy only):

Version 1 of 41 23 October 2014

Contents

1 Introduction........................................................................................................................ 4 2 Definitions.......................................................................................................................... 4 3 Equality Impact Assessment.............................................................................................. 5 4 Good Corporate Citizen..................................................................................................... 5 5 Duties ................................................................................................................................ 5 6 Patient Self-Administration of Medication while in Hospital ............................................... 5

6.1 Aims..............................................................................................................6 6.2 Patient Selection...........................................................................................6 6.3 Patient Assessment ......................................................................................7 6.4 Patient Consent ............................................................................................9 6.5 Patient Education .........................................................................................9 6. 6 Prescribing, Storage and Dispensing Medications for SAM.........................9 6.7 Administration and Documentation.............................................................13 6.8 Transfer of Patients ....................................................................................15 6.9 Discharge of Patients..................................................................................15

7 Risk Management Strategy Implementation.................................................................... 15 7.1 Implementation ...........................................................................................15 7.2 Training and Support ..................................................................................15 7.3 Dissemination .............................................................................................15 7.4 Storing the Procedural Document...............................................................16

8 Process for Monitoring Effective Implementation............................................................. 16 9 Associated Documentation .............................................................................................. 16 10 References ...................................................................................................................... 16 Appendices Appendix 1 Self Administration Assessment and Consent Form and variance form…….……19 Appendix 2 Self Administration Levels………………………………… …………………………..21 Appendix 3 SAM Quick Reference Guide………………… ……………………………………….21 Appendix 4 SAM Flow Chart …………………………………………………………………………22 Appendix 5 Variance Form……………………………………………………………………………23 Appendix 6 Patient Information Sheet……………………………………………………………….24 Appendix 7 Medicines Reminder Sheet……………………………………………………………..26 Appendix 8 Patient Tick Chart for Regular Medicines……………………………………………..28 Appendix 9 Patient Tick Chart for 'As Required' Medicines…………………………………..…..30 Appendix 10 Self Medication Compliance Checklist……………………………………………….32 Appendix 11 Quick Reference Guide on Essential Documentation……………………………...34 Appendix 12 Assessing Patient’s Own Medicines for Use on the Ward………………………...35 Appendix 13 The (Relevant) NMC Standards for Medicines Management (2008)………….... 36 Appendix 14 NMC Standard 9 - Standards for Practice of Administration of Medicines………38 Appendix 15 NMC Standard 10 – Self-Administration – Children and Young People …………40 Appendix 16 NMC Standard 16 - Aids to Support Compliance………………………….………. 41


Please Note the Intention of this Document

This Guideline sets out the process to be followed by Nursing Staff caring for inpatients in a Peninsula Community Health community hospital, who would like to self-medicate during their hospitalisation. It also gives guidance on how to support patients who may not be self-medicating on admission but who will be required to on discharge.

Review and Amendment Log

Version No Type of Change Date Description of change

1 Creation 2010 Documentation set up to support pilot scheme

2 Amendment 2011 Amendments following pilot scheme and comments from consultation process

3 Review June 2014 - Condensed Paperwork (appendix 1) to support ease of use

- Promotes the use of SAM Level 3, using Levels 1 and 2 as an introduction and to support assessment.

- Incorporates advice on assessment for 'rescue therapy' eg inhalers, insulin, GTN spray commonly self-administered by patients


1 Introduction These Self-Administration of Medication (SAM) Guidelines enable patients to administer their own medications whilst in hospital. The Audit Commission Briefing recommends that patients should be encouraged to self-administer their medications whilst in hospital as part of the medicine management strategy (Audit Commission, 2001). The Nursing and Midwifery Council (NMC) supports SAM and the administration of medication by carers/parents wherever it is appropriate, provided the essential safety, security and storage arrangements are available and agreed procedures are in place (see Appendix 15 and Appendix 16) (NMC 2008, Standard 9 and Standard 10). Self-Administration is also encouraged for children who are age appropriate and/or have a sufficient understanding of their treatment or whose parent/carer wishes to take part.

Objectives of Self- administration of Medication (SAM) at Peninsula Community Health (PCH). 1. Maintain patient independence in self-administration of medication where medication changes are minimal. 2. Improve patient knowledge and skills where gaps are identified, thereby increasing independence and concordance on discharge. 3. Possibly reduce re-admission due to treatment failure caused by non- compliance. 4. Highlight medication related problems prior to discharge e.g. poor eyesight or complex packaging/medication regimes, understanding of labelling. 5. Maintain independence and maximum therapeutic benefit for those patients who are on complex timed regimes that do not correspond with the timings of the traditional drug round e.g. Parkinson’s disease. The purpose of this guideline is to provide healthcare professionals with a framework for the safe and effective implementation of SAM at PCH. These guidelines can be applied on any ward within PCH provided that the necessary facilities and governance arrangements described in this document are in place to support SAM.

2 Definitions

Self-Administration of Medication (SAM) is the process where a patient, following assessment is able to administer their own medicines whilst in hospital. Patient - A service user being cared for in one of Peninsula Community Health Community Hospitals Nurse - A Healthcare professional registered as a Nurse with the Nursing and Midwifery Council. Pharmacist - A Healthcare Professional who is registered as a Practising Pharmacist with the General Pharmaceutical Council. Doctor- A Healthcare Professional who is registered as a Medical Practitioner with the General Medical Council


3 Equality Impact Assessment

Peninsula Community Health aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others.

As part of its development, this strategy and its impact on equality have been reviewed in consultation with trade union and other employee representatives in line with the Equality and Diversity Policy. The purpose of the assessment is to minimise and if possible remove any disproportionate impact on employees on the grounds of race sex, disability, age, sexual orientation or religious belief. No detriment was identified.

The Equality Impact Assessment Tool has been used to help consider the needs and assess the impact of this policy and has been completed alongside this document.

4 Good Corporate Citizen

As part of its development, this policy was reviewed in line with the Peninsula Community Health Good Corporate Citizen Action Plan. The implementation of this strategy promotes good governance.

5 Duties Development Team, consisting of the Pharmaceutical Adviser, Sisters, Helston Community Hospital and Launceston General Hospital, and Administration support are responsible for the development of the procedural document in line with the guidelines

Consultation Team: responsible for reviewing the procedural document and providing feedback to the procedural document owner. Integrated Governance Committee responsible for the final review, ratification and approval of this document.

6 Patient Self-Administration of Medication while in Hospital

Patient assessment for SAM is performed by the registered nurse with the involvement of the clinical team as appropriate e.g. clinician, pharmacist. The NMC Standards state that the registered nurse is ‘responsible for the initial and continued assessment of patients who are self administering and have continuing responsibility for recognising and acting upon changes in a patient’s condition with regards to safety of the patient and others’ (NMC 2008, Standard 9). To maintain standards and safety the registered nurse will:

1) have undertaken education and be competent in SAM processes

2) have developed skills in patient assessment for SAM 3) be conversant with the contents of this guideline and the framework for SAM. (Please refer to section 7.2 for further information on education of staff)


6.1 Aims Self-Administration of Medications has two broad aims:

Allows an uninterrupted continuation of the patient’s pre-admission medication regime (where and when appropriate), using his or her own medications with familiar packaging, thereby promoting continued independence. Facilitates the development of an understanding of the actions of one’s own drugs and correct self-administration to ensure maximum independence upon discharge.

6.2 Patient Selection

It is anticipated that for many patients it may be suitable to maintain pre-admission medication regimes during their in-patient stay in a Community Hospital by allowing them to continue to self medicate. For other patients, training towards independence on discharge may require more Registered Nurse input and time for the educational aspects of SAM. The following criteria will need to be adhered to:- Inclusion criteria

Patients whom appropriate members of the multidisciplinary team (e.g. Consultant, GP and Team Leader) deem to be suitable Patients who are willing to assume responsibility for their medication Patients who will assume responsibility for taking their medication at home Patients who are on a stable medication regime Wards with suitable facilities for storage and security of medication.

Exclusion criteria

Patients at imminent risk of deliberate self-harm. Patient deemed unable to participate due to lack of capacity as defined under the Mental Capacity Act (2005). Patients who will not be self-medicating upon discharge.

Caution criteria

History of alcohol and detoxification. Physical disabilities which prevent SAM. Reduced cognitive capacity

Note: It is important not to automatically exclude patients who are confused if they are expected to manage their own medicines when they go home. It may be possible to establish a safe routine before they are discharged. For patients supported by the Mental Health Team, advice should be sought from a member of the team involved in their care before a decision is made to allow the patient to self-administer.


6.3 Patient Assessment 6.3.1 Initial Assessment A preliminary assessment can be made using the SAM section on page 2 of the prescription chart CHA2272 (Appendix 5). Prior to commencing self administration (Level 3), the assessor should observe the patient and consider implementing Level 1 and/or Level 2 for 24-48 hours to provide reassurance to the patient and nursing staff of the patient’s ability to manage their medications. If a patient is considered to have the potential to self-administer a full patient assessment is carried out (App 1). The assessment may be undertaken by the registered nurse alone; with the patient/carer; or jointly with the clinician and ward pharmacist. This will depend on individual patient needs. At this point the patient should be given the Self-Administration of Medicines, Patient Information Leaflet (Appendix 6) to read and be given the opportunity to discuss the SAM process. Completion of this assessment enables the healthcare professional to: Obtain a medication history. Assess the patient’s existing knowledge of his medications. Confirm the patient’s ability to identify packaging and read labels. Ensure the patient can open the containers. Ensure the patient can recognise which drug is which. Suitability of patients own medicines to be used in hospital. To support this assessment process the Self-Administration of Medicines Assessment and Consent Form (Appendix 1) must be completed by the Nurse and signed by the patient and hospital doctor. Some patients may wish to self-medicate with selected medication only eg asthma inhalers, insulin, GTN spray or emollient creams. Allowing patients to access and use such medication independently means that they can treat symptoms promptly (for ‘when required’ medication), and maintain their skills in using devices eg insulin injections. An assessment must be completed for the patient with particular reference to the medication(s) to be self-administered. For insulin:- Check the patient knows the correct name, dose and administration time Observe the patient drawing up and administering the correct dose For inhalers:- Check the patient knows the differences between ‘regular’ and ‘prn’ inhalers Observe the patient using the inhaler Document the particular medicines to be self-administered on the assessment form Appendix 1 The NMC provides guidance on the Levels at which a patient can self-medicate (see Table 1 below) (NMC 2008).


Table 1: Self Medication Levels – adapted from the NMC 2008

The Nurse administers medicines to the patient providing a full explanation of use.

Level 1

The nurse is responsible for medication storage and the supervision of the administration process ensuring the patient understands the medications being administered.

Complete Medicines Reminder Sheet (Appendix 7) with patient.

At the time of administration the nurse and patient discuss what drugs should be taken at that time and the effect they have on the body.

The nurse may prompt the patient to test his/her knowledge of the drugs. This does not need to be undertaken during the drug round.

Patient self-administers under nurse supervision Level 2

Whilst the nurse is responsible for safe storage of medications the patient self-administers the medications under supervision.

Complete the Medicines Reminder Sheet (Appendix 7) with the patient, if not already completed.

The patient dispenses the medications under the supervision of a nurse who unlocks the cabinet and checks that the dose and the drug selected are correct.

Patient completes the Patient tick charts for regular (Appendix 8) and “when required” (Appendix 9) medication

The nurse can still provide information to the patient but retains control over access to medications.

Patient self-administers medications independent

Level 3

The patient demonstrates sufficient knowledge of his drugs and self-medicates unsupervised, accessing medication from his bedside cabinet independently.

If the patient is training towards independence, a member of the Nursing Staff will check patient compliance and medications at regular intervals. Patient may use tick charts (Appendices 8 & 9) and Nurse will complete the Self-medication compliance checklist. (Appendix 10)

Check the Prescription Chart at every drug round to ensure all medicines have been taken and no “Nurse only administration” medicines need to be given.

Check the drugs are prescribed on the hospital prescription chart in the same dose, timing and method of administration as labelled on the packaging.


6.3.2 Ongoing Assessment

Continuous assessment is required to ensure the patient maintains his/her level of competence. The Self Administration of Medicines Patient Assessment and Consent Form (Appendix 1) should be completed if the patient’s competence level changes.. If a patient’s condition worsens he/she may have to be temporarily removed from the programme of full SAM level 3. Patients may be competent to self-administer some of their prescribed medication but may require support in taking other medication. e.g. if they have new medications added which require education towards self-medication whilst they remain fully independent with their stable medications. Any changes to the patient’s Level of Self-Administration of medication must be recorded on the Variance Form (Appendix 1). This form should be used to document the progress of the patient through the different stages of SAM as well as record any problems the patient may encounter with the process.

6.4 Patient Consent The Safe and Secure Handling of Medicines: A Team Approach’ recommends written consent is required prior to SAM in hospital (Royal Pharmaceutical Society 2005). SAM is explained to the patient and a patient information sheet is provided (Appendix 6). Relatives and carers/parents should be included if appropriate. If the patient wishes to participate, he/she signs the consent section of the Patient Assessment Form (Appendix 1). The patient consents to: take part in SAM and the use and disposal of his/her own medications whilst in hospital The patient is informed that participation is voluntary and consent may be withdrawn at any time.

6.5 Patient Education

The initial assessment is discussed with the patient and the nurse ensures the patient fully understands the implications of self-administration..

For patients requiring additional support initially, education on the dose, timing and method of administration of medicines will be provided every time medications are administered (as per Level 1 or Level 2. Patients will also be given information on the actions of their medicines, their role in the administration process and the potential to achieve greater control over the administration of their drugs during their hospital stay.

6. 6 Prescribing, Storage and Dispensing Medications for SAM

6.6.1 Use of Patient’s Own Medications

Patient’s own medication can be used for SAM if the following criteria are met: These are the same criteria as those for assessing patients own medicines on a medicines management ward – (see Assessing Patients ~Own Medicines for Use on the Ward Appendix 12) The patient has consented to use his own medications whilst in hospital (See

Consent section of the Self Administration Assessment and Consent Form, Appendix 1).


The packaging is intact and the expiry date has not been passed. The label is clearly readable and contains the following information:

Name and strength of medication Dose and frequency Patient’s name Date dispensed (must be within the last 6 months) Name and address of dispensing chemist or doctor

The medicines are intact, dry and not broken, they appear to be of good quality and match up with the label.

Eye drops and creams have been opened less than 4 weeks ago. The packaging contains only those medicines identified on the label.

If the dosage on the label is not what the patient is currently taking (e.g. dose increased following verbal telephone discussion with GP), the patient cannot self medicate that medicine until it has been relabelled (see section 6.6 6 on prescribing which indicates action to follow if dosage is altered). In addition the NMC has provided guidance on the use of patient’s own medicinal products (see Appendix 13) (NMC 2008, Standard 5). The assessment of the suitability of the Patient’s Own Drugs must be documented on the Self Administration Assessment and Consent Form (Appendix 1). 6.6.2 Checking Patient’s Own Medications Patient’s own medications can be checked by the registered nurse responsible for drug administration at ward level, using the criteria outlined in section 6.6.1. If there is any doubt, pharmacy staff (Ward pharmacist or technician) can be asked to assess the suitability of the medications. 6.6.3 Refillable Compliance Aids/ Monitored Dose Systems/ Patients with Disabilities 6.6.3.1 Refillable Compliance Aids Certain patients, for example those with poor hand function, limited eye sight and/or those with disabilities who live alone and have to cope with SAM on discharge can achieve this by using refillable compliance aids. These allow a relative, carer or pharmacy to dispense into the box on a daily or weekly basis. The drug boxes are sectioned into days of the week. Each section has 4 compartments usually labelled for breakfast, lunch, tea and bedtime. For patients who are admitted with a refillable compliance aid, an individual patient assessment needs to be carried out to determine the suitability for continued use of this aid whilst in hospital. It is acknowledged that the independence of the patient, in the use of this aid, must not be compromised whilst they are in hospital; however the aid allows very limited checking of the medication contents against the aforementioned criteria for patients’ own medications. Only patients assessed at Level 3 SAM on admission may continue to use a refillable compliance aid on the ward, providing no changes have been made to the medication regime. In this case the patient is solely responsible for the contents of the device.


6.6.3.2 Monitored Dose Systems (commonly referred to as ‘blister packs’) In order to aid compliance and give visual indication of whether doses have been taken some patients in the community have their medications dispensed into tamper-evident packs, known as monitored dose systems (MDS). These packs contain the daily doses of the majority of the patient’s solid-dose medications. The MDS system can only be used for SAM where all medication remains unchanged as individual medicines cannot be identified for removal from the pack. Before patients are offered this system on discharge, (see Guidelines for the Use of Medicine Compliance Aids and Assessment Tool ), a full assessment and liaison with the patient’s community pharmacist needs to take place.

6.6.3.3 NMC Medicines Management Standard 16 The NMC and Guidelines for the Use of Medicine Compliance Aids and Assessment Tool provide recommendations on the use of aids to support compliance with suggestions for other possible solutions (see Appendix 16) (NMC 2008, Standard 16). 6.6.4 Ordering and Secure Storage of Medications

For those patients on a medicines management ward follow the usual procedure for ordering and replacing medicines as described in the procedure for medicines management in community hospitals. A 28 day supply of medicines will be dispensed for each patient. Nursing staff should encourage all patients participating in the SAM process to inform them of when their medicines need re-ordering. This will hopefully encourage the patient to develop a routine for ordering their medication on discharge. For patients on SAM, medications are stored in individual secure medication cabinets. These should only contain medications clearly labelled for that patient. Patients are provided with a key to the cabinet. Keys for cabinets of patients at Levels 1 and 2 are retained by nursing staff. The registered nurse holds a master key for each cabinet and a spare should be kept on the ward. It is the responsibility of the patient and the discharging nurse to ensure any keys are returned to the ward prior to discharge from hospital. Insulin pens/vials that are in use can be stored at room temperature for up to one month, so can be kept in the lockable cupboard. Insulin stock in use should be marked with the date of removal from the fridge and transfer to storage at room temperature. Additional stock/supplies should be stored in the ward medicines fridge. Rescue medication for emergency use (eg glyceryl trinitrate spray or inhalers) may be stored out of the locked cabinet, but out of sight of the other patients on the ward or visitors. Nursing staff should assess the risk to other patients on the ward (eg dementia patients who wander), before any medication is stored outside of the locked cabinet. Where Patients Own Drugs (PODs) are not used for SAM they must be stored away from the patient in a secure cupboard to ensure the patient does not become confused and take them in error. They can be returned to the patient at discharge or destroyed if no longer appropriate. Obtain and document the patients consent prior to destruction. 6.6.5 Medications omitted from inclusion in SAM The following medications or circumstances need special attention within SAM.


Controlled drugs will continue to be kept in the controlled drugs cupboard and administered by nursing staff in accordance with the Trust policy for administration of controlled drugs.

Medications which have been recently introduced where the dose needs to be stabilized, e.g. warfarin, may not initially be kept with the patient.

Low molecular weight heparins and any injections that will not be continued on discharge.

Any drugs that are prescribed as a once only dose. Any drugs that require special storage conditions or refrigeration may not be stored

within the individual secure medication cabinets but may still be administered by the patient if appropriate i.e. insulin.

6.6.6 Prescribing 6.6.6.1 Prescription Chart All medications are prescribed on the hospital prescription chart (CHA 2272) in the same dose, timing and method of administration as labelled on the packaging. If using the patient’s own medications, medical/pharmacy staff need to be satisfied that the details and drugs match up with the prescription chart. An entry should be made in the patient’s medical notes that the patient is self medicating and the level at which they have been assessed. Any change in self-administration status must be documented. 6.6.6.2 Newly prescribed medication When a patient is prescribed a new drug the prescriber will complete an emergency Patient Medication Label detailing the drug strength, dose and frequency. This medicine, if in stock, can then be placed in the individual secure medication cabinet for the patient to self-administer until a labelled supply is received from Pharmacy.

6.6.6.3 Discontinued drugs/altered dosage When a drug is discontinued, or the dosage altered, the doctor will cancel or amend the prescription in the usual way and must also alert the nurse so that she can remove the item from the individual secure medication cabinet and advise the patient accordingly.

6.6.6.4 Documentation/communication of alterations and additions

For all alterations and/or additions, the following documents, if being used by the patient, will need to be updated by the nurse. A full explanation of the changes must be given to the patient and any other relevant person, such as primary carer.

Patient’s Medicine Reminder Sheet (Appendix 7),

Patient Tick Charts (Appendix 8 and Appendix 9).

Self Medication Compliance Checklist (Appendix 10).

Upon receipt of the new drug/further supplies of a drug, the nursing staff must check it against the Prescription. The nurse must then explain the drug to the patient and ensure it is placed in the locked cabinet


6.7 Administration and Documentation

6.7.1 Administration

When patient’s own medications are administered by nursing staff, the administering nurse must sign the prescription chart as usual. For patients independently self-administering (Level 3), the prescription chart must be checked by the nurse at each drug round in case any other items need to be administered. For self-administered items, the nurses must indicate ‘3’ down the recording panels and verbally check with the patient if they have taken their ‘self medicated’ items. For Levels 1 and 2 and for other items administered by the nurse, he/she must document in the usual way.

6.7.2 Medication Checks Frequency and appropriateness of medication checks need to be decided on an individual patient basis and in conjunction with the patient and the clinical team. The decision and rationale must be documented within the nursing record. This may be more appropriate for patients training towards independence. These checks are documented on the Self Medication Compliance Checklist (Appendix 10), which will be kept inside the individual secure medication cabinets. As required drugs will be checked to ensure the recommended dose over 24 hours has not been exceeded. A drug error, when the patient takes the wrong number of tablets is recognised when a discrepancy exists between the number of tablets remaining at the check and the number that should have remained had the drug been administered correctly. Discrepancies must be reported to medical staff and the nurse-in-charge immediately. All drug errors which could potentially cause harm to a patient or where a significant difference in the number of medications exists must be treated as major drug errors. Minor discrepancies must be discussed with the patient and medical staff and the patient must be reassessed to ensure it is safe for him/her to continue self-medicating. All discrepancies and action taken must be documented in the nursing and medical records and on the Trust’s Incident Reporting System 6.7.3 Essential Documents

To ensure good communication and maintain patient safety throughout each patient admission to hospital, clear and careful documentation of the whole self-administration process is paramount. The documentation required will be dependent on the reason self medication is being undertaken for each patient and will be decided on an individual patient basis by the appropriate team member (e.g. admitting nurse) following a full patient assessment. A quick reference guide on essential documents is provided in Appendix 11.

Documentation for Self-Administration of medications

For all Patients

Once the decision has been taken to try self administration of medicines with a patient the following process should be followed:-


Give the patient the Self Administration of Medicines patient information leaflet (Appendix 6) to read, allowing them time to ask questions if needed

Complete the Self Administration of Medicines Assessment and consent Form (Appendix 1) Patient, Doctor and Nurse must sign.

Assess patients own medicines for suitability of use while in hospital. Follow the same process used for assessing patients own medicines as detailed in the procedure for medicines management in community hospitals. All medicines must be labelled with full instructions as prescribed on the prescription chart. Until this has been checked and all medicines labelled correctly the patient may not self-medicate.

When a patient is initiated on a new medicine during their hospital stay or the dose is changed a new supply of that medicine with correct label must be ordered from pharmacy to allow the patient to continue to self medicate.

It is acceptable for the prescriber to complete a label for medication taken from ward stock to allow patients to commence treatment urgently and to continue to self-medicate. A supply of blank labels can be obtained from pharmacy. The label should meet the labelling requirements (see 6.6.1)

Determine if the patient can commence Level 3 Self Administration, or if they require induction at Level 1 and/or Level 2 prior to Level 3.

Level 3 Patient will need the following documentation CHS Prescription sheet CHA 2272 Completed Medicines Reminder Sheet (Appendix 7) Patient Tick Chart for Regular (Appendix 8) and ‘when required’ medicines

(Appendix 9) (may be used for patients working towards independence) Self Medication compliance checklist (Appendix 10) Key for bedside locker. On the Prescription chart , tick Self-Administration assessment completed and date commenced. List all the regular medicines (Appendix 8) and ‘when required’ medicines (Appendix 9) the patient will be self administering on the Self Administration tick charts. Although the patient is self-medicating independently the prescription chart must be checked by the nurse at each drug round to make sure that all items prescribed for the patient may be self administered. Certain drugs must be administered and signed for by the nurse e.g.:- Controlled drugs, Low molecular weight heparin injections or other injections that the patient will not

continue once discharged from hospital Newly prescribed medicines for which a named patient supply has yet to be obtained Once only medicines If the patient is using the patient tick charts (Appendices 8 & 9), the charts must be completed for all medication taken recording the date and time administered. These charts must be checked by the nursing staff on a daily basis to ensure compliance. The Self Medication Compliance Checklist (Appendix 10) must be completed by the nurse before the patient commences on Level 3 self-medication.


The quantity of each medicine must be recorded on the checklist. Initially this checklist should be completed daily to establish an accurate picture of the level of compliance of the patient. Once results are consistent for 3 consecutive days, the frequency of carrying out the checks can be reduced. This must be clearly documented on the Variance Form (Appendix 1).and in the Patient Care Plan. Stock balances of all medicines in the patient’s locker must be checked at least once every 7 days. It is important to inform the patient that they must give at least 5 days notice to a member of staff to obtain further supplies of their medicines from pharmacy.

6.8 Transfer of Patients

When patients are transferred to another ward any named medications in the individual secure medication cabinets should be sent with them. However, before the patient can continue SAM, a reassessment by staff on the receiving ward must be carried out.

6.9 Discharge of Patients

When a patient is to be discharged from hospital a Patient Discharge Summary Form CHA 2592 (TTO form) must be written for him/her. The medications stored in his/her individual secure medication cabinet may be suitable to be sent home as a TTO although this must be confirmed by the prescriber and/or ward pharmacist. All medications need to be itemised on the TTO form for the purposes of clear communication with the patient’s GP. The patient must be discharged with at least 14 days supply of all their regular medicines plus a rewritten Appendix 7 together with Appendices 8 & 9 to aid compliance with their self medication.

7 Risk Management Strategy Implementation

7.1 Implementation

The process can be implemented in Community Hospitals running a medicines management system.Education and training will be provided to each unit at roll out.

7.2 Training and Support For patients to self administer medications on a ward constitutes a major change in Nursing practice across the whole of Peninsula Community Health services and will require the following support and educational input: Theoretical education on the SAM process and underpinning knowledge Competency assessment of staff who will be undertaking patient assessments Access to relevant documentation Relevant equipment in place (individual secure medication cabinets) The change process will need to be led by the ward manager with support and educational input from the relevant pharmacist.

7.3 Dissemination

Once ratified this policy will be loaded to the intranet (read only).


Staff will be made aware of its existence through the weekly briefing email and the Team Briefing.

Confirmation of receipt is not required for this procedural document.

7.4 Storing the Procedural Document

The signed procedural document will be stored centrally, Hard copies will be provided for each ward, and the digital version will be available via the intranet.

8 Process for Monitoring Effective Implementation

SAM processes will be audited on a yearly basis on selected wards to ensure practice is in line with these guidelines. The audit tool will include: 1) information provision processes 2) consent processes 3) documentation processes 4) storage facilities and safe practices 5) medication incident reports relating to SAM Audit results will be reported to the Quality and Patient Safety Committee.

9 Associated Documentation

This document references the following supporting documents which should be referred to in conjunction with the document being developed. NMC Standards for Medicines Management 2008

CIOS-CHS Records Management Policy - 1.6.2009 (adopted by PCH October 2011)

CIOS-CHS Policy for the Safe Ordering, Prescribing and Administration of Drugs in Community Hospitals and Minor Injury Units, 2010 (adopted by PCH October 2011

10 References

Policy for the Development and management of procedural documents.

Altman IL, Wheeler R, Avery J (2002) Self-Administration of Medicines in Brighton Hospital Pharmacist Vol 9, p305-307 Audit Commission (2001) A Spoonful of Sugar: Medicines Management in NHS Hospitals London: Audit Commission Department of Health (2000) Pharmacy in the Future – Implementing the NHS Plan London: Department of Health Hospital Pharmacists Group (2002) One-stop dispensing, use of patients’ own drugs and self-administration schemes Hospital Pharmacist Vol 9, p81-86


Lowe CJ, Raynor DK, Courtney EA, Purvis J, Teale C (1995) Effects of self- medication programme on knowledge of drugs and compliance with treatment in elderly patients British Medical Journal vol 310, p1229-1231

Nursing and Midwifery Council (NMC) (2008) Standards for Medicines Management London: NMC Royal Pharmaceutical Society of Great Britain (2005) The Safe and Secure Handling of Medicines: A Team approach Department of Health Mental Capacity Act 2005 (c.9)


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Appendix 1 Self-Administration Assessment and Consent Form

Patient Details Patient Consent for self medication Self-administration of medicines has been explained to me. I have read and understood the information sheet ‘Self-administration of Medicines’ and am willing to take part in the self administration programme on the ward or clinical area. I understand that I may withdraw from the programme at any time by informing the nursing staff. I consent to the use or disposal of my own medications as required. (Please circle) YES NO

Name: CR No: Consultant: D.O.B: Ward: (or use patient ID Sticker)

Signed : Date:

PATIENT ASSESSMENT Based on the questions below, please assess and indicate whether you consider the patient fully competent to self-administer their medicines (see also overleaf and 6.2 Guidelines for Self-Administration of Medicines Policy). Patients requiring additional support initially, may commence at Level 1 or Level 2 self-administration (refer to Assessment section 6 in Guidelines for Self-Administration of Medicines Policy). Only record again if competence changes Date Questions (answer Y/N) 1. Does the patient usually take

responsibility for their own medications?

2. Has SAM been explained to the patient and the patient information leaflet been given?

3. Has the patient read and understood the leaflet explaining self-medication?

4. Has patient consent been obtained?

5. Is the patient competent to make decisions?

6. Can he/she read the labels and open the containers?

7. Does he/she understand the dosage, timing and any special instructions?

8. Does the patient understand the purpose of his/her medications?

YES for each of the above indicates the patient is assessed as competent to self-medicate unsupervised, assessing medication from the bedside cabinet independently using key (Level 3).

Name of nurse completing assessment Signature Date Doctor signature

Please indicate if assessment covers particular medicines only:-

Insulin Yes/No

Inhalers Yes/No

Other medicines – please name


Patient selection (see section 6.2 Guidelines for Self-Administration of Medicines Policy ) Inclusion Criteria Exclusion criteria Cautions

Patients whom appropriate members of the multidisciplinary team deem to be suitable

Patients who are willing to assume responsibility for their medication

Patients who will assume responsibility for taking their medication at home

Patients who are on a stable medication regime

Patients at imminent risk of deliberate self-harm.

Patient deemed unable to participate due to lack of capacity as defined under the Mental Capacity Act (2005).

Patients who will not be self-medicating upon discharge.

History of alcohol and detoxification.

Physical disabilities which prevent SAM.

Reduced cognitive capacity

VARIANCE – please record reasons for change of level Date Time Reason for variance Name & Signature

ASSESSMENT OF PATIENTS’ OWN MEDICATIONS Patient’s own medication can be used during their stay in hospital if the following applies:-

The packaging is intact and expiry date has not been passed

The label is clearly readable and contains the following information: Name and strength of medication Dose and frequency Patient’s name Date dispensed (must be within the last 6 months) Name and address of dispensing chemist or doctor

The medicines appear to be in good condition and match up with the label. Eye drops and creams have been opened less than 4 weeks ago. The packaging contains only those medicines identified on the label

If in doubt, pharmacy staff can be asked to assess the suitability of the medications The following must also apply:-

The drugs are prescribed on the hospital prescription chart in the same dose, timing and method of administration as labelled on the packaging.

The patient has consented to use his own medications whilst in hospital. Each item for self-administration must be endorsed SAM in the ‘Other instructions/Indication’ box on the

prescription chart, and the SAM assessment box completed on the front of the chart

Assessment of patient’s own medications Please circle yes or no Date & Signature Has patient consented to the use of his/her own medications?

Yes No

Has patient brought his/her own drugs into hospital?

Yes No

Are patient’s own medications suitable for SAM?

Yes No

Comments


SAM Quick Reference Guide

SELF ADMINISTRATION LEVELS Level 1: *For Ref only

The nurse administers medicines to the patient providing a full explanation of the useof all medicines. Medications will be kept in the patient’s individual secure medication cabinet. Medicines will be fully labelled with all dosage instructions.

Level 2: *For Ref Only

Patient self-administers under nurse supervision. Medications will be kept in the patient’s individual secure medication cabinet. The patient is responsible for dispensing them under the supervision of a nurse who unlocks the individual secure medication cabinet and checks that the dose and the drugs selected are correct.

Level 3: Patient self-administers medications independently. The patient is assessed as competent to self-medicate unsupervised, accessing medication from the individual secure medication cabinet independently using the key. Informs nursing staff when further supplies of medicines are required.

*See NMC Guidelines Appendix 14

SAM Quick Reference Guide

Ordering, Prescribing, Administration & Documentation Ordering :

All medication in the patient’s medication locker must be fully labelled, ensuring that the dosage instructions for each medicine are the same as those on the prescription chart.

A 28 day supply of all medicines will be supplied. Prescribing:

All medication for the patient must be prescribed on the prescription sheet. Any changes to medication must be communicated to the nursing staff and patient to ensure that all relevant SAM paperwork is updated.

Administration: Where a patient is self-administering the prescription chart should be checked by the nurse on

each drug round in case any items need to be administered by a nurse, or any new items have been prescribed.

Documentation: For self-administered items, the nurses will write ‘SAM in ‘Indication and Other Instructions’

Book on the drug chart. Administration of other items will be documented in the usual way.

APPENDIX 2

APPENDIX 3


SAM Flow Chart

Obtain consent and carry out patient assessment (Self Administration Assessment & Consent Form - Appendix 1)

Daily Reassessment to determine current or changing Level (Record variance on Appendix 4)

If

YesNo

Obtain Medications from pharmacy suitable for SAM (With full details and

instructions) (See Section 6.6.6 – Prescribing)

Check Prescription sheet at each drug round for non-SAM items

Provide Medicine Information Card and Patient Tick Charts.

Compliance checklist is optional (Assessor or patient dependent)

Educate patient on the implications of SAM and provide access to the bedside locker if Level 3

Assess Patient’s Own Medications for suitability

(POD Flowchart- Appendix 12)

Has patient consented to use his/her own drugs?(Self Administration Assessment & Consent Form - Appendix 1 )

undeliverable

Patient is suitable for SAM

Documentation: Consent to SAM & use of own medicines Level of supervision required Daily reassessment Assessment of Patients Own

Medications Compliance checklist

APPENDIX 4


Appendix 5

Registered in England and Wales No: 7564579 Registered office: Peninsula Community Health CIC, Sedgemoor Centre, Priory Road, St Austell PL25 5AS

www.peninsulacommunityhealth.co.uk

Quality care, closer to you

Peninsula Community Health is a not for profit Community Interest Company responsible for providing NHS adult community health services in Cornwall and the Isles of Scilly

SELF-ADMINISTRATION OF MEDICINES

PATIENT INFORMATION SHEET

A self-medication facility is available on this ward to enable patients, where possible, to be responsible for taking some or all of their own medicines. Self-medication is NOT COMPULSORY and you need not feel that you have to administer your own medicines. If you decide you would like to take part, a member of staff will discuss exactly what self medication involves and the possible benefits for you. You will be asked about all your current medicines and these will be checked by the nurse or pharmacist. Your medicines will be kept in a locked cabinet in your room. You may be able to keep certain ‘rescue’ medicines (eg angina sprays or inhalers for asthma) outside of the locked cabinet if appropriate. The nurse will discuss this with you. If you usually administer your own medicines at home, you should be able to fully self-medicate before you leave the hospital. Your own medicines from home may be used if suitable. Any other medicines you require will be obtained for you from the hospital pharmacy. All your medicines will be clearly marked with your name, the name of the medicine and instructions on how to take them. If at any time you have any questions concerning self-medication please contact the nursing staff who will be happy to help.

APPENDIX 6


PLEASE REMEMBER

It is your responsibility to keep your medications safely locked in the cabinet and keep the key in a safe place.

Do not exceed the stated dose. If you forget the number of tablets or when to take them, or if you

have any questions please ask one of the nursing staff. Remember that, if not used properly, medicines can be

dangerous. If anyone tries to take your medicines please contact the nursing

staff immediately. Before you go home your medicines will need to be checked.

Please allow the staff time to do this. Please remember to return your key to nursing staff before you go

home.


MEDICINES REMINDER SHEET - Times to Take your Medication This is not a Prescription – For Patient Guidance Only Please take this sheet with you when you visit your Doctor, Nurse or Pharmacist

Name

NHS No DOB

Name of Medicine Dose Times to be taken What I take this medicine for

Notes How to take the medicine (Eg with food, take only when needed, when to stop taking etc) Side effects (eg constipation)

Written by (Print Name) Signature: Checked by (Print Name) Signature: Date:

Yellow booklet with latest INR results to be supplied for patients on warfarin. Record cards, instructions and information leaflets to be supplied for patients on methotrexate or lithium. Total no. medicines (including any listed on the back of this form)

APPENDIX 7


MEDICINES REMINDER SHEET - Times to Take your Medication (continuation sheet)

This is not a Prescription – For Patient Guidance Only Please take this sheet with you when you visit your Doctor, Nurse or Pharmacist Name

NHS No DOB

Name of Medicine Dose Times to be taken What I take this medicine for

Notes How to take the medicine (Eg with food, take only when needed, when to stop taking etc) Side effects (eg constipation)

Special Notes


SELF ADMINISTRATION TICK CHART – Regular medicines

PATIENT NAME: NHS/CR NUMBER:

WARD:

DRUG, DOSE & FREQUENCY DATE 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 Written by: Signature: Checked by: Signature:

APPENDIX 8


PATIENT TICK CHART FOR REGULAR MEDICINES

SELF ADMINISTRATION TICK CHART – Regular medicines

PATIENT NAME: NHS NUMBER:

CR NUMBER: WARD:


22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00


PATIENT TICK CHART FOR ‘AS REQUIRED’ MEDICINES SELF ADMINISTRATION TICK CHART – ‘As Required’ Medicines


CR NUMBER WARD:


22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00

APPENDIX 9


PATIENT TICK CHART FOR ‘AS REQUIRED’ MEDICINES SELF ADMINISTRATION TICK CHART – ‘As Required’ Medicines


CR NUMBER WARD:


22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00 08.00 10.00 12.00 14.00 18.00

22.00


SELF-MEDICATION COMPLIANCE CHECKLIST

Sheet No….. of……

PATIENT NAME:

NHS / CR NO: WARD:

Date Drug Name & Quantity Supplied

Time REGULAR PRESCRIPTIONS

Predicted Amount

1

Actual Amount

Predicted Amount

2

Actual Amount

Predicted Amount

3

Actual Amount

Predicted Amount

4

Actual Amount

Predicted Amount

5

Actual Amount

Predicted Amount

6

Actual Amount

Predicted Amount

7

Actual Amount

Predicted Amount

8

Actual Amount

Predicted Amount

9

Actual Amount

Predicted Amount

10 Actual Amount

APPENDIX 10


SELF-MEDICATION COMPLIANCE CHECKLIST

Sheet No….. of……

PATIENT NAME:

NHS / CR NO: WARD:

Date Drug Name & Quantity Supplied

Time REGULAR PRESCRIPTIONS

Predicted Amount

11

Actual Amount

Predicted Amount

12

Actual Amount

Predicted Amount

13

Actual Amount

Predicted Amount

14

Actual Amount

Predicted Amount

15

Actual Amount

AS REQUIRED PRESCRIPTIONS Number Issued

1

Actual Amount

Number Issued

2

Actual Amount

Number Issued

3

Actual Amount

Number Issued

4

Actual Amount

Number Issued

5

Actual Amount


Quick Reference Guide on Essential Documentation

To ensure good communication and maintain patient safety throughout each patient admission to hospital, clear and careful documentation of the whole self-administration process is paramount. The documentation required will be dependent on the reason self medication is being undertaken for each patient and will be decided on an individual patient basis by the appropriate team member (e.g. admitting nurse) following a full patient assessment. Read the following for guidance.

Minimal Documentation Required for Patient who is assessed for SAM

(Already self medicating at home – minimal medication changes, short stay, maintain uninterrupted continuation of pre-admission medication regime)

Self Administration Assessment and Consent Form – Appendix 1

Additional Documentation Required for Patient who is assessed as SAM Level 1 or 2 (Some patients who will be self administering following discharge may need additional educational and practice input to enable this to occur – new complex regimes, those assessed as requiring medication checks)

Medicine Reminder Sheet – Appendix 7

Patient Tick Charts – Appendices 8 & 9

Self Medication Compliance Checklist – Appendix 10

Bedside Reference Required by Staff

SAM Quick Reference Guide – Appendix 3

Quick Reference Guide on Essential Documentation – Appendix 11

Information Required by Patient

SAM Patient Information Sheet – Appendix 6

APPENDIX 11


Appendix 12

Assessing Patient’s Own Medicines for use on the Ward.

Tablets Liquids

Mixed or loose tablets should not be used Must be in original bottle

Mixed batches should not be used

Must be in foil strips or original containers Creams/Ointments

Must be opened less than 4 weeks ago

Eye Drops

Must be opened less than 4 weeks ago Fridge items

Must have been stored correctly

Dosette boxes Store excess stock in fridge

Do not use. (impossible to verify contents)

Blister packs

Controlled Drugs If possible check with pharmacist before using.

Use only if above conditions met

Enter in “Patients Own” CD register Inhalers

Use a separate page for each item Must be reasonably full (if not, re-order)

If you have ANY doubts about a patient’s own medication, DO NOT USE THEM!

The following conditions must be met for Patients Own Drugs to be used on the wards

All medicines must be: Labelled with the patients name Labelled with Instructions that correspond with the prescription chart Dispensed within the last 6 months In good condition In date


Appendix 13

The (Relevant) NMC Standards for Medicines Management (2008)

The NMC Standards for Medicines Management relevant to SAM Standard 5 - Dispensing Registrants may use patient’s’ own medicines in accordance with the guidance in this booklet Standards for medicines management. The NMC welcomes and supports the self-administration of medicinal products and the administration of medication by carers wherever it is appropriate. The use of patient’s’ own medicinal products in any setting Where patients have their own supply of medicinal products, whether prescribed, over the counter (from a pharmacy or supermarket/shop), complementary therapy, herbal preparation or homely remedy such as paracetamol, the registrant has a responsibility to: ask to see the medicinal products check for suitability of use explain how and why they will or won’t be used establish if they are prescribed ascertain if they meet the criteria for use.

These medicinal products including Controlled Drugs remain the patient’s property and must not be removed from the patient without their permission and must only be used for that named individual. The registrant has a responsibility to document in the patient’s notes when a patient refuses consent: to use their own medicines. to dispose of their own medicinal products no longer required. to dispose of their own medicinal products not suitable for use. when in the hospital or care home setting to send their own medicinal products home

with a relative or carer. Storage of patients’ own medicinal products As a registrant you have the following responsibilities: to ensure that suitable facilities are provided to store patients’ own medicinal products

for their safe storage to assess patients on a regular basis using local polices to ensure that the individual

patient is still able to self-administer to document issues relating to storage in their records. the medicines cabinet/locker is kept locked and that the master key is kept secure. if the patient is self-administering, consent is obtained from the patient to keep the

individual medicines cabinet/locker locked and the key secure with the patient.


if a patient moves to another bed, to another ward/room or is discharged the patient’s medicinal products are transferred with the patient.

in a hospital setting, best practice indicates that stock medicines should not be placed in the patient’s locked cabinet/locker as they are not labelled for that individual patient.

Administering medicines using the patient’s own supply in the hospital/care home setting. When administering medicines from the patient’s own supply the registrant must check the medicines in the locked cabinet/locker with the prescription chart and use only those medicines belonging to that named patient. If a supply is not available medicines belonging to another patient must not be used. For further guidance on the use of patients’ own medicinal products including discharge and checking medications ‘to take home’ (TTO’s) see Annexe 3. For self-administration of medicines see Standard 9 of this document Self-Administration of medicines. One Stop Dispensing In some hospitals a system of One Stop Dispensing is in operation and local policies should be developed for this using the guidance for patients’ own medicinal products as stated under Standard 5 of this document. Guidance One-stop dispensing is a system of administering and dispensing medicinal products adopted in hospitals throughout the UK (Audit Commission Report: A Spoonful of Sugar 2002 – The Right Medicine (Scottish Executive 2002). It involves using the patient’s own medicinal products during their stay in hospital, either those dispensed by a community pharmacy or by the hospital pharmacy or both, providing they contain a patient information leaflet and are labelled with full instructions for use. Supplies are replenished should the supply run out whilst in hospital or when any new items are prescribed. Patients are discharged with a supply of medicinal products as agreed locally. In one-stop dispensing medicinal products are dispensed once only on or during admission ready for discharge. Registrants should check that the medication handed to the patient on discharge is as per the discharge prescription, as medicines may be altered / stopped during hospital admission. If a particular medicine has been stopped during admission and is not to be restarted on discharge, the patient must be informed. The ward pharmacist is a useful resource for advice.


NMC Standard 9 - Standards for Practice of Administration of Medicines As a registrant you are responsible for the initial and continued assessment of patients who are self-administering and have continuing responsibility for recognising and acting upon changes in a patient’s condition with regards to safety of the patient and others. The NMC welcomes and supports the self-administration of medicinal products and the administration of medication by carers wherever it is appropriate. Registrants may assess the patients as suitable to self-administer medicinal products both in the hospital and primary care settings. Duty of care relating to using patients’ own medicinal products. Guidance At all times the registrant jointly with other health care professionals has a duty of care to the patient to ensure that only medicinal products which are prescribed and meet the required criteria are used by the patient. Where self-administration of medicinal products is taking place, you should ensure that records are maintained appropriate to the environment in which the patient is being cared for. The Mental Capacity Act 2005 requires all those working with potentially incapacitated people to assess the individual's capacity at a particular moment about a particular decision/issue. All patients should be assessed on a regular basis using local policies to ensure that the individual patient is still able to self-administer and this should be documented in their records. Patients can be assessed for suitability at the following Levels: Level 1 The registrant is responsible for the safe storage of the medicinal products and the supervision of the administration process ensuring the patient understands the medicinal product being administered. Level 2 The registrant is responsible for the safe storage of the medicinal products. At administration time the patient will ask the registrant to open the cabinet/locker. The patient will then self-administer the medication under the supervision of the registrant. Level 3 The patient accepts full responsibility for the storage and administration of the medicinal products. The registrant checks the patient’s suitability and compliance verbally. The Level should be documented in the patient’s notes.

APPENDIX 14


Guidance Where patients consent to self-administration of their medicines the following points should be considered: 1. Patients share the responsibility for their actions relating to self-administration of their medicines. 2. Patients can withdraw consent at any time. 3. The pharmacy will supply medicines fully labelled, with directions for use, to every patient who is involved in self-administration. Information given and supervision should be tailored to individual patient need. The following information should be provided to a patient before commencing self-administration:

- the name of the medicine - why they are taking it - dose and frequency - common side effects and what to do if they occur - any special instructions - duration of the course or how to obtain further supplies

The registrant must ensure that the patient is able to open the medicine containers or is offered assistance e.g. compliance aid. Whilst the registrant has a duty of care towards all patients the registrant is not liable if a patient makes a mistake self-administering as long as the assessment was completed as the local policy describes and appropriate actions were taken to prevent re-occurrence of the incident. Guidance on exclusion criteria for self-administration of medicines can be found in 6.2 Patient Selection.


Standard 10 - Self-Administration – Children and Young People Environments In the case of children, when arrangements have been made for parents/carers or patients to administer their own medicines prior to discharge or rehabilitation, the registrant should ascertain that the medicinal products have been taken as prescribed. Guidance This should preferably be done by direct observation but when appropriate also by questioning the patient/parent/carer. The administration record should be initialled and ‘patient self-administration’ documented. The administration of medicinal products by parents/carers to their children must be carefully controlled. There is the potential for inadvertent omission of doses or administration of extra doses unless there is clear communication and documentation. Parents/carers can be encouraged to administer to their children in whatever setting when this is appropriate to the clinical condition of the child and when the registrant has assessed that the parent/carer is competent to do so. In a hospital setting the registrant should provide the medicinal product from the appropriate storage and supervise administration. Unsupervised administration to children Some parents/carers may administer to their children unsupervised if this has been agreed with the Registrant in Charge and if the medicinal products are stored in an appropriate secure locker. Responsibilities of the registrant and parent/carer must be specifically agreed and approved by the Registrant in Charge and agreed under local policies. Arrangements must be made for holding keys to the locker and for ensuring their return on discharge and that any medicinal products remaining are supplied for discharge (if appropriately labelled and checked) or returned to the pharmacy. The employing organisation should ensure appropriate clinical governance structures are in place.

APPENDIX 15


NMC Standard 16 - Aids to Support Compliance Registrants must assess the patient’s suitability and understanding of how to use an appropriate compliance aid safely. Guidance Before considering the use of compliance aids the registrant should explore with the patient other possible solutions, for example reminder charts, large print labels, non-childproof tops. Self-Administration from the dispensed containers may not always be possible for some patients. If an aid to compliance is considered necessary, careful attention should be given to the assessment of the patient’s suitability and understanding of how to use an appropriate aid safely. Ideally a locally recognised assessment tool should be used. However, all patients will need to be regularly assessed for continued appropriateness of the aid. Ideally, any compliance aid, such as a monitored dose container or a daily/weekly dosing aid, should be dispensed, labelled and sealed by a pharmacist. The sealed compliance aids are generally referred to as monitored dosage systems. Where it is not possible to get a compliance aid filled by a pharmacist, you should ensure that you are able to account for its use. The patient has a right to expect that the same standard of skill and care will be applied by you in dispensing into a compliance aid as would be applied if the patient were receiving the medication from a pharmacist. This includes the same standard of labelling and record keeping. Compliance aids, which can be purchased by patients for their own use, are aids that are filled from containers of dispensed medicines. If you choose to repackage dispensed medicinal products into compliance aids, you should be aware that their use carries a risk of error. You should also be aware the properties of the drug might also change when repackaged and so may not be covered by their product licence. Your employer needs to be aware of this activity and it should be covered by a SOP (Standard Operating Procedure) The NMC would recommend that you confirm the appropriateness of re-packaging dispensed medicinal products with the community pharmacist who dispensed the medicines. You also need to consider how the patient will cope with medicines that cannot be included in compliance aids.

APPENDIX 16

Sam

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