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Medication in Care at Home (Scotland) Policy

This policy sets out the values, principles and procedures underpinning this care at home agency’s approach to administration of medication, where this has been agreed as an agency responsibility. It is written in line with the national health and social care standards, My Support, My Life, particularly Standard 2: “I am fully involved in all decisions about my care and support,” which includes as 2.23: “If I need help with medication, I am able to have as much control as possible.”

The standard states that where an agency helps a service user to take their medication, “it must be done safely, in accordance with the service user’s wishes, with detailed information properly recorded in the personal plan and known to the appropriate worker, planned and agreed arrangements for help with taking medication, and the relevant policies, procedures and records in place”.

The policy applies to the administration of medication by competent care staff or registered nurses according to their respective roles and responsibilities as delegated by their employing agency.

Legislation and Guidance

{{org_field_name}}’s policies and procedures are all in line with relevant legislation and best practice guidance relating to the management and administration of medication in adult social care, including:

Policy Statement

Most people receiving care in their own homes are prescribed some form of medication at some time as part of their treatment by their doctor or nurse. Many service users are able to administer their medication safely themselves and require no help.

However, others will require assistance, ranging from simple reminders and help with packaging through to actual administration of medication.

In some cases, this might include the administration of “controlled” drugs, which requires care workers to know how they are being safely stored and administered in the home setting.

{{org_field_name}} recognises that the correct and effective administration of medication is essential for the safety and wellbeing of its service users. Service users must, therefore, receive the help identified in their personal plan of care for the administration of medication only by trained and competent staff.

This policy should be read and used with other related policies and procedures that address specific matters involved in the management of medication in home care, as applicable, including:

Medication Management Procedures

  1. This agency works on the principle that every service user has the right to manage and administer their own medication if they wish to and provides support to enable safe self-administration wherever possible.
  2. The choices made by service users — eg to administer and manage their own medication — are always respected by staff and recorded in the personal plan.
  3. No assumption will be made that a service user cannot self-administer their medication purely on the basis of their condition or mental capacity.
  4. Service users who are suspected to be lacking capacity should be assessed in line with the requirements of the Adults with Incapacity (Scotland) Act 2000. Where a service user can be enabled to self-medicate with additional support, or where they can self-administer parts of their medication, such support is provided.
  5. Staff should provide appropriate support to any service user who wishes and is able to take all or some of their own medication.
  6. Medication is only ever administered to a service user on the basis of their explicit consent or agreement to take the medication except where “best interests” decisions have been taken as a result of a person’s mental incapacity.
  7. All new service users will have their health and social care needs fully assessed and any need for help with the collection or administration of medication identified.
  8. Any request for support from staff identified within a personal plan will be discussed with managers or nurse consultants before being implemented to ensure that the role being requested is appropriate and can be performed safely and competently.
  9. Full information about the details of a person’s medication will be obtained (medicines reconciliation), including the names of drugs, strength, dosages, timing and frequency, routes and methods of administration, indication (what the medicine is for), date and time the last dose of any “when required” medicine was taken, etc.
  10. No staff member should proceed with the administration of medication (tablets, liquids or creams) unless they have the explicit agreement of a nurse consultant or manager and this has been entered in the personal plan.
  11. Any staff member who is unsure of what to do regarding medication in any given situation should contact their nurse consultant or manager immediately. In all cases where help with medication is required, the explicit consent of the service user is required.

Kinds of Support with Medication

This service recognises that service users might need different kinds and levels of support as identified on their personal plan.

Providing general support

General support can include:

The policy is always to:

{{org_field_name}} understands that the Care Inspectorate document, Prompting, Assisting and Administration of Medication in a Care Setting: Guidance for Professionals, includes definitions of prompting and assisting with medication.

Help for service users to take their medication

• Where it is identified that a person is potentially starting to experience difficulty managing or taking their own medicine the first step should be a comprehensive review of their medicines (medicines review). This review should be carried out by a pharmacist or by an appropriate health professional who is part of a multidisciplinary team. The review may lead to a rationalisation or optimisation of their medication.
• If the person is still experiencing difficulty with their medicines after the medicines review, consideration should be given to providing/recommending aids to support the person to take their medicines.
• This might include the use of aids such as:
a) reminder charts
b) winged bottle caps
c) large print labels
d) alarms (such as notifications on mobile phones)
e) tablet splitters
f) eye drop aids
g) inhaler aids
h) audible alarms
i) monitored dosage systems (MDS) or multi-compartment compliance aids (MCAs)
j) telehealth aids, etc.
• The best system for supplying medicines is one that meets the person’s health and care needs and maintains their independence wherever possible.
• Monitored dosage systems (MDS) or multi-compartment compliance aids (MCAs) should only be used in line with current guidance, such as that from NICE and the Royal Pharmaceutical Society.
• MDS or MCA systems may be of value for some people who have been assessed as having practical problems in managing their medicines. However, NICE guidance (NG67) states that the use of a monitored dosage system should be considered only when an assessment by a health professional (for example, a pharmacist) has been carried out, in line with the Equality Act 2010 and a specific need has been identified to support medicines adherence.
• NICE state that decisions must take account of the person’s needs and preferences and involve the person and/or their family members or carers and the social care provider in decision-making.
• If an MDS or MCA is to be used then care staff should only administer medicines from an aid that has been prepared by a pharmacy or dispensing practice. Care staff must never fill a dosette box or similar compliance aid for a supported person.

Assistance with administration of medication

Some service users might require active support with their medication.

Any need for medication to be actually administered by staff is identified at the care assessment stage and recorded in the personal plan. The service user must agree to have the care worker administer the medication and the consent is also documented. If the person is unable to communicate informed consent, the prescriber must indicate formally that the treatment is in the best interest of the individual and comply with the requirements of the Mental Capacity Act 2005.

Medication is only ever administered by a designated, appropriately trained member of staff.

When administering medication, staff always:

A care at home medication record is kept in the home of any service user receiving help with medication as part of their personal plan.

Home care workers should make a record each time they provide medicines support. This must be for each individual medicine on every occasion.

Both paper-based or electronic medicines administration records must:

Any mistake or error in administering drugs must be reported to a parent (in the case of a child), line manager, supervisor or responsible medical practitioner without delay.

Staff must never in any circumstances administer medication that has not been prescribed, give medication to a service user against their wishes, give medication that has been prescribed to another person, or alter in any way the timing or dosage of medications.

If a care worker does not feel competent to administer the medication, they should voice their concerns to their line manager. It is important that only staff who are appropriately trained and agree to perform the role administer medication.

Specialised administration

In exceptional circumstances and following an assessment by a healthcare professional, a domiciliary care worker may be asked to administer medication by a specialist technique including:

Any care worker asked to carry out any such procedure must agree to doing so and be properly trained in that procedure with specialist supervision also provided.

Monitoring of Medication

Staff should always be aware of the nature of the medication being taken by individual service users and should report any change in condition that might be due to medication or side-effects immediately to a child’s parent, their line manager or supervisor, or to the GP or community pharmacist.

Disposal of Unwanted Administration

Where the agency is responsible, unwanted or surplus medication is returned to the community pharmacist for disposal and a receipt obtained. Controlled drugs are disposed of in line with local procedures, which might involve contacting a licensed waste disposal service. The agency will seek pharmaceutical advice in order to follow the correct procedures.

Non-compliance with Medication

{{org_field_name}} accepts that there are circumstances whereby some service users will fail to comply with their prescribed treatments. This might include self-medicating service users failing to take their medication as directed or non-self-medicating service users refusing their prescribed medication, or failing to swallow it and then disposing of it.

In such cases, the service is clear that its staff have no right to force non-compliant service users to take their medication but that staff do have a duty to refer all such occurrences back to the original prescriber, to the service user’s GP and/or to the service user’s nurse or designated key worker.

Training

All new staff receive training as part of their induction covering basic information about common medicines and how to recognise and deal with medication problems.

Staff are trained to the level required by their roles and responsibilities, which is reflected in the certification issued from the training.

Additional training is provided by competent trainers to those fulfilling additional roles relating to the administration of medication.

Staff never undertake any duties or roles that they have not been trained to do or for which they do not feel competent.

Nursing staff are expected to keep themselves up to date as required in their revalidation process and as specified in their professional code of conduct (The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates, October 2018).

Training records are kept of all training accessed. These are periodically reviewed and staff are expected to attend any refresher training required.


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