D68. Domestic (Homely or Non-prescribed) Medicines in Domiciliary Care

Policy Statement

This policy shows how {{org_field_name}} handles issues arising from the use of homely, non-prescribed or over the counter medicines by service users in situations where {{org_field_name}} has responsibilities for administering their prescribed medicines.

The medicines in this policy are those that can be bought over the counter to treat minor symptoms for short periods (eg headache, cough, indigestion).

{{org_field_name}} recognises that its service users might be taking over-the-counter medicines as well as prescribed medicines and in most instances they will be responsible for their buying, taking and checking with their medical advisers (GP or community nurses) on their safe use. However, it is always important to ensure that these medicines are safe to take and do not compromise the taking of other medicines, prescribed and in some instances non-prescribed.

This organisation is aware that in 2017 NHS England launched a consultation on “over-the-counter” (OTC) medicines, those non-prescription medicines available from pharmacies and supermarkets, etc. Guidance was subsequently produced to advise GPs and prescribers to reduce the prescription of OTC medicines for certain minor conditions and, instead, to advise patients of what product they should purchase over-the-counter and how to apply it.

The policy of this organisation is that implementing the OTC guidance should not restrict safe access to necessary medicines for vulnerable people, including adult social care service users. In addition, {{org_field_name}} recognises that some social care service users will be exempt from the requirement to purchase an OTC medicine because the medicine is being used for a long-term condition. Others may be exempt if the clinician considers that a service user lacks the ability to self-manage their medication.

Legislation and Guidance

The policy and procedures which {{org_field_name}} has developed are in line with the applicable national standards for health and social care, relevant legislation and best practice guidance relating to the management and administration of medication in adult social care, including:

The Medicines Act 1968
The Misuse of Drugs Act 1971
NG67 Managing medicines for adults receiving social care in the community (March 2017) National Institute for Health and Care Excellence (NICE) (NG67 contains specific guidance on the use of over-the-counter medicines.)
QS171 Medicines management for people receiving social care in the community (July 2018) National Institute for Health and Care Excellence (NICE)
NG21 Home Care: Delivering Personal Care and Practical Support to Older People Living in Their Own Homes (September 2015) National Institute for Health and Care Excellence (NICE)
The Safe and Secure Handling of Medicines (December 2018) Royal Pharmaceutical Society. (This is written primarily for healthcare settings. However, the RPS state that some of its content is applicable to adult social care settings and can be used to inform social care policies.)
Conditions for which Over the Counter Items Should Not Routinely be Prescribed in Primary Care: Guidance for CCGs (March 2018) NHS England
Over-the-counter Medicines Guidance (March 2019) British Medical Association

Over-the-counter Medicines Procedures

Where the domiciliary care service has a responsibility for any aspect of medication administration, it routinely checks if the service user is using over-the-counter medicines and asks the person if he or she could keep {{org_field_name}} informed if and when they are taking in new supplies. {{org_field_name}} will then check with the user’s GP or a pharmacist that the over-the-counter medication is compatible with the medication that {{org_field_name}} is responsible for administering. CQC guidance warns that care workers should not offer advice to people about over-the-counter medication or complementary treatments.

Care staff are also expected to check always that it is safe to proceed if a service user discusses, seeks advice or requests help with the taking of the domestic medicine irrespective of whether {{org_field_name}} is involved in the administration of any prescribed medicines. This can be done in some instances by checking the medicine’s Patient Information Leaflet (PIL).

This would apply if the request was even only to take a bottle from a cupboard or a tablet from its packaging. They should record all transactions and forms of help in their care notes/care plan. {{org_field_name}} would expect its staff to refuse to help if they thought it unsafe to proceed.

Whenever care staff from {{org_field_name}} are asked to administer or help administer prescribed medication in line with an individual’s care plan they are instructed to make basic checks with the service user on whether he or she has recently used or bought anything over the counter. If the answer is yes, then they are expected to check that it is safe to proceed with the administration of the medicines for which they are responsible. If they have any concerns they are required to check with their manager or a healthcare professional that it is safe to do so.

Staff should be aware of the possible side-effects of domestic medicines and their possible incompatibility with any other medication the service user might be taking and watch out for such side-effects, whereupon they should seek medical advice immediately.

Where a GP or other prescriber advises or recommends that a service user purchases and uses a specific OTC medicine or product, the clinician will be expected to provide verbal or written instructions on the use of the medicine. {{org_field_name}} will use this information to support the service user in taking the medicine or applying the product if required.

Records

In compliance with advice in NICE guideline NG67, care workers must record the medicines support given to a person for each individual medicine on every occasion. This includes details of all support for over-the-counter medicines. It includes actions such as:

reminding a person to take their medicine
giving the person their medicine
recording whether the person has taken or declined their medicine

All checks, observations and concerns about the safe use of over-the-counter medicines are recorded on the person’s care plan and regularly monitored and reviewed.

Training

All new staff will receive training as part of their induction covering basic information about common medicines and how to recognise and deal with medication problems, including issues relating to the taking of homely remedies.

Those with specific duties and responsibilities for the administration of medicines will be expected to attend additional training and subsequent updates.

Care staff should never undertake any duties or roles relating to the administration of any medicines that they have not been trained to do or for which they do not feel competent. Staff may at any time request clarification or information relating to controlled drugs from their line manager.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

D68. Domestic (Homely or Non-prescribed) Medicines in Domiciliary Care