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Medication Administration in Care Homes (Wales) Policy

Policy Statement

With respect to the prescribing, supply, storage and administration of medicines, {{org_field_name}} adheres fully to the Medicines Act 1968, the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and Regulation 58: Medicines of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 and accompanying statutory guidance.

Regulation 58 states:

• the service provider must have arrangements in place to ensure that medicines are stored and administered safely
• these arrangements must include the arrangements for:
  • maintaining a sufficient supply of medicines
  • the effective ordering, re-ordering, recording, handling and disposal of medicines
  • regular auditing of the storage and administration of medicines
• the service provider must have a policy and procedures in place in relation to the safe storage and administration of medicines and must ensure that the service is provided in accordance with this policy and these procedures.

The statutory guidance emphasises the importance of adhering to national guidelines on the handling of medicines and updating policies and procedures in line with any changes. There must be systems for auditing and reviewing all medicines management and staff training.

The policy should be read and used as part of a suite of related policies and procedures that address specific matters involved in the management of medication, all of which reflect current best practice guidance. They include:

• Anticipatory Medicine in Care Homes
• Controlled Drugs in Care Homes
• Covert Medication
• Domestic (Homely or Non-prescribed) Medicines in Care Homes
• Drug/Medicines Errors (Identifying, Reporting and Reviewing Medicines-related Problems)
• Medicine Reconciliation and Review
• Medication to be “Taken as Required” in Care Homes
• Medication when the Person is Away from the Home
• Medication Non-compliance in Residential Care
• Oxygen Use in Care Homes
• Pain Management
• Requests for Service from GP, Other Healthcare Practitioners and/or Paramedic/Emergency Medical Services
• Record Keeping
• Information Governance Under the General Data Protection Regulation
• Confidentiality of People Receiving Care’s Information
• Sharing Information with Other Providers
• Transfer to, Stay In and Discharge from Hospital.

Procedures Regarding Medication

1. {{org_field_name}} considers that every person has the right to manage and administer their own medication if they wish to and will provide support to enable safe self-administration wherever possible. However, to ensure their safety, and the safety of other people who live in the home, their needs will be assessed on a regular basis and will only be considered for self-administration if considered safe to do so. Records will be kept of all medication prescribed to people who self-administer and a secure area will be provided in their room for the storage of self-administered medication, including non-prescription and alternative remedies.
2. The choices made by people — eg to administer and manage their own medication — will be respected by staff and recorded in their personal plan.
3. No assumption will be made that a person cannot self-administer their medication purely on the basis of their condition or mental capacity. People who are suspected to be lacking capacity will be assessed according to the “best interest” principles contained in the Mental Capacity Act. Where a person can be enabled to self-medicate with additional support, or where they can self-administer parts of their medication, this will be provided.
4. All medication within the home must be safely stored away, including non-prescription medication, alternative remedies and self-administered medication. A lockable metal drug cabinet and a lockable trolley are provided for this purpose. The keys to the cabinet and trolley should always be kept by the senior nurse in charge or by a manager. Neither the cabinet or trolley should ever be left unlocked or unattended at any time and when not in use the trolley should be secured to the wall. A lockable fridge is also provided for medication that needs to be kept cool. The temperature in this fridge should be regularly monitored. The normal foodstuff fridge should not be used to store medication.
5. All incoming medication should be recorded in the stock record. Controlled drugs should be recorded in the controlled drugs register. Incoming medication without a clear label stating name of patient, name of medication, expiry date, strength, dose, frequency of administration, start and finish times, should be referred to the community pharmacist. Stock should be checked weekly by the nurse in charge with particular attention paid to expiry dates. Medication should always be kept in its original packaging with the person’s name clearly visible.
6. Medication should be administered by a registered first level nurse or by a designated, appropriately trained member of staff.
7. Medication should only ever be administered to a person on the basis of their explicit consent or agreement to take the medication. The only exception would be on rare occasions when the giving of covert medication is appropriate.
8. A separate record should be kept for each person. Staff should carefully check the identity of each person to ensure that the correct record is being used and that the correct medication is being given to the correct person. Staff should also check the medication name, the strength of the medication, the dosage instructions and the expiry date. Controlled drugs should always be double-checked by a second suitably trained member of staff. Complex dosage calculations should also be double-checked.
9. Both paper-based or electronic medicines administration records must:
   – be legible
   – be signed by {{org_field_name}} staff or care workers
   – be clear and accurate
   – have the correct date and time (either the exact time or the time of day the medicine was taken)
   – be completed as soon as possible after the person has taken the medicine
   – avoid jargon and abbreviations.
10. All drug errors must be reported to the nurse in charge or to a responsible medical practitioner without delay.
11. Staff should always be aware of the medication being taken by the people they are caring for and should report any change in condition that may be due to medication or side effects immediately to the nurse in charge. The nurse in charge should then discuss the case with the prescriber, with another prescriber or with the community pharmacist.
12. All unwanted or surplus medication should be returned to the community pharmacist for disposal and a receipt obtained. When a person dies all their medicines should be retained for at least seven days before disposal.
13. All staff will be offered training covering basic information about common medicines and how to recognise and deal with medication problems. Additional training will be offered to those fulfilling the designated person role. 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).

Help for People 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:
  • reminder charts
  • winged bottle caps
  • large print labels
  • alarms (such as notifications on mobile phones)
  • tablet splitters
  • eye drop aids
  • inhaler aids
  • audible alarms
  • monitored dosage systems (MDS) or multi-compartment compliance aids (MCAs)
  • telehealth aids, etc.
• The best system for supplying medicines is one that meets the person’s health and care needs and maintains the person’s independence wherever possible.
• Monitored dosage systems (MDS) or multi-compartment compliance aids (MCAs) should only be used in line with current best practice 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 guideline (SC1) states that care home providers should determine the best system for supplying medicines for each resident based on the resident’s health and care needs and the aim of maintaining the resident’s independence.
• 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.
• 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.

 

Training

All staff receive training to implement the home’s policies and procedures on medication. The training is regularly updated and covers basic information about common medicines and how to recognise and deal with medication problems.

New staff are given training to achieve the relevant elements in the Social Care Wales: All Wales Induction Framework for Health and Social Care.

Staff responsible for the administration of medication are trained in line with national training standards so that they carry out their roles competently and safely.

Additional training is provided to those fulfilling the designated person role.

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