B02c Adults’ medication guidance for staff · 5.4.1 If you are required to apply a medicated lotion, cream or ointment to a person’s skin, you will need to wear disposable gloves

Updated November 2018. To be implemented by February 2019. Review due November 2019. Carers Trust is a registered charity in England and Wales (1145181) and in

Scotland (SC042870). Registered as a company limited by guarantee in England and Wales No. 7697170. Registered office: 32-36 Loman Street, London SE1 0EH.

Crossroads Care trade mark is a collective mark. © Carers Trust 2018

B02c

Adults’ medication guidance for staff This document is provided to Carers Trust East Midlands (now referred to as ‘the organisation’) as a Network Partner of Carers Trust.

Table of Contents SCOPE ........................................................................................................................................ 1

INTRODUCTION.......................................................................................................................... 2

TYPES OF MEDICATION SUPPORT.......................................................................................... 2

STORAGE OF MEDICATION ...................................................................................................... 4

GENERAL RULES FOR HANDLING MEDICATION .................................................................... 4

RESPONSIBILITY FOR MEDICATION ........................................................................................ 5

RECORD KEEPING..................................................................................................................... 5

COLLECTION OF PRESCRIPTIONS .......................................................................................... 6

UNSUCCESSFUL ADMINISTRATION OF MEDICATION ........................................................... 7

MEDICATION ERRORS .............................................................................................................. 7

DISPOSAL OF PRESCRIBED MEDICATION ............................................................................. 8

CHANGES TO MEDICATION ...................................................................................................... 8

SIDE EFFECTS OF / ADVERSE REACTIONS TO MEDICATIONS. ........................................... 8

TAKING MEDICATION OUT OF THE HOME .............................................................................. 9

LEARNING AND DEVELOPMENT .............................................................................................. 9

APPENDIX 1 Types of medicatoin .......................................................................................... 10

APPENDIX 2 Administration of medication from compliance aids .......................................... 11

APPENDIX 3 Medication support flowchart .......................................................................... 12

APPENDIX 4 Paraffin-based creams, lotions and ointments ................................................. 13

1.0 SCOPE 1.1 This guidance is about adults with care needs, aged 18 and over. There is separate guidance (C03c) for children and young people aged 17 and under. 1.2 The aim of this document is to protect both staff and those with care needs by ensuring medication is managed and administered safely. 1.3 See Appendix 1 for examples of different types of medicine referred to in this document. 1.4 You also need to read the autonomy and independence policy (D08).

Carers Trust Adult’s medication guidance for staff

Updated November 2018 Review due November 2019 © Crossroads Care 2018

2 of 13

2.0 INTRODUCTION

2.1 We will encourage people wherever possible to manage and take their own medication to maintain their independence. If their condition means they can’t take it themselves, or they need help to take it, you may be asked to help. 2.2 You are not allowed to offer any kind of help or support with a person’s medication unless you have been trained to do so and it is written in their care and support / personal plan.

2.3 This applies to medicines that have been bought over the counter (such as common pain killers and cough remedies) as well as to those that have been prescribed by a doctor, because some over-the-counter medicines (for example Paracetamol, Ibuprofen) can cause adverse reactions if they are taken with other medication.

You must not help a person to take over-the-counter medicines unless it has been agreed by the care planner / assessor, and it is written in the care and support / personal plan.

You must not give advice about over-the counter medications or how to treat minor ailments such as common coughs and colds.

If you are unsure about what to do in any situation, contact your line manager. 3.0 TYPES OF MEDICATION SUPPORT 3.1 These are:

General support (assisted self-medication)

Administration of medication

Administration of medication by specialised technique. See Appendix 3 for medication support flowchart. 3.2 A care planner /assessor will assess the medication support, if any, each person needs and this will be written in their care and support / personal plan. Under no circumstances can you extend or change what you do or how you help a person with their medication (even slightly) without it first being agreed with the care planner / assessor and being written in the care and support / personal plan.

3.3 General support (assisted self-medication)

3.3.1 You can only offer general support with medication to a person who:

has the mental capacity to take responsibility for their own medication

can let you know what help they need you to give them. 3.3.2 When you are giving general support, you will always be working under the direction of the person with care needs and only doing what they ask you to do. You are not required to select the dose, the medication or the time it is to be given. 3.3.3 You can offer general support from a compliance aid1 filled by a pharmacist but also from one filled by someone other than a pharmacist (such as the person’s carer or family member), because the person with care needs is responsible for the medication they are taking from it, they just need your help to take it. 3.3.4 General support can include giving the person an occasional prompt or reminder to take their medication. However, if you are having to remind them frequently, or they appear confused

1 Also called a dossette box, monitored dosage system or blister pack.



3 of 13

or unclear about their medication, let your line manager know because it could mean they are no longer able to take responsibility for it. 3.4 Administration of medication

3.4.1 You are only allowed to administer medication from:

the original container (for example, bottle, package, foil strip) supplied and labelled by a pharmacist

a pharmacy-filled, sealed compliance aid – see Appendix 2 for details. 3.4.2 When you administer medication, always check you are giving:

the right dose

of the right medication

by the right route

to the right person

at the right time

The person also has the right to refuse their medication.

3.4.3 Also, before you give medication:

check the MAR2 chart and ask the person concerned to make sure it hasn’t already been given by someone else

check it has not gone past its use-by date (do not give out-of-date medicine)

ask the person if they are ready to take it. 3.4.4 ’As required’ (PRN) medication

The person’s care and support / personal plan and MAR chart will specify the precise reason each ‘as required’ medication is to be given (for example ‘for shoulder pain’, ‘for indigestion’). The care and support / personal plan will also state how the person will indicate they need the medication if they are unable to communicate verbally. Before you give PRN medication:

first establish that the reason the medication is being requested matches the reason given on the MAR chart and do not give it for any other reason than the one stated

make sure there has been enough time between doses by checking written records and asking the person and / or their carer when they last took it

check that the dose you give will not exceed the maximum dose permitted over 24 hours Once given, record the date and time you gave it on the MAR chart, using the 24-hour clock. 3.5 Administration of medication by specialised techniques

3.5.1 Administering medication by a specialised technique is referred to as a specialised task. See Appendix 1 for examples. 3.5.2 Before you can administer medication using a specialised task, you will need to be given client-specific training from a relevant professional. This will be updated at least once a year. 3.5.3 Once you have completed the training, you will be assessed to ensure that you are competent to carry out the task safely and that you feel confident and capable to do it.

2 Medication Administration Record



4 of 13

3.5.4 You can opt out of giving medication using a specialised technique if you prefer not to take on this level of responsibility. 4.0 STORAGE OF MEDICATION

4.1 It is important that a person’s medication is:

stored in a safe, secure place so that it isn’t misused or taken by accident

stored away from direct heat and as per manufacturers’ instructions

kept separate from medicine belonging to other people in the household. 4.2 The person’s care and support / personal plan will state where the medication is to be stored. If you become concerned it isn’t being stored safely, talk to the person with care needs or their carer, make a record on the client report form and if necessary, discuss it with your line manager. 5.0 GENERAL RULES FOR HANDLING MEDICATION The guidance below applies to all medication. 5.1 ALWAYS:

provide only the medication support detailed in the care and support / personal plan

wash your hands before and after helping with or administering medication.

5.2 NEVER:

give any help with any medication if it is not written in the person’s care and support / personal plan

give medication to a person against their wishes

try to disguise, crush or tamper with medication, (for example by hiding it in food or drink) unless it is written in the person’s care and support / personal plan

change the time or dose of medication or alter things in any way

give over-the-counter medication (such as Paracetamol or Ibuprofen) unless it is written in the care and support / personal plan

buy over-the-counter medication for a person with care needs

carry medication belonging to a person with care needs, except when authorised to do so on the care and support / personal plan, (for example when taking them on trips out, collecting prescriptions, or disposing of unwanted medication)

use a person’s medication for yourself

give your own or anyone else’s medication to a person with care needs

transfer medication from an original container to another

fill or assist a person with care needs (or their carer) to fill compliance aids

give support with or administer medication from a container if the label has come off or you can’t read it

change or re-attach labels to medication containers

put spoilt or unused medication back into its container (see 9.2 below)

leave medication out for a person to take later.

If in doubt, STOP – contact your line manager or the person on call and ask for advice.

5.3 Touching medication 5.3.1 Try to avoid directly handling medicines wherever you can. For example, push tablets out of the packaging directly into a pot / onto a spoon / into the person’s hand.



5 of 13

5.3.2 If the care planner / assessor has risk assessed that you have to handle the medication or if it would be harmful if you touched it, it will be written in the care and support / personal plan that you must wear disposable gloves. 5.4 Creams, lotions and ointments 5.4.1 If you are required to apply a medicated lotion, cream or ointment to a person’s skin, you will need to wear disposable gloves to protect both you and them. 5.4.2 You need to be aware that creams, lotions or ointments that contain paraffin are a potential fire risk. Examples include E45 cream and lotion, Zinc ointment, Sort White Paraffin. If you are aware that a person with care needs is using products containing paraffin and have any concerns, inform your line manager / the person on call straight away. See Appendix 4 for more details. 6.0 RESPONSIBILITY FOR MEDICATION 6.1 Person has capacity to take responsibility for own medication

Always work under their direction.

Do not automatically assume they will consent to the help you are offering.

If you suspect the person is having difficulties managing their medication (for example, forgetting to take it, getting confused, frequently mislaying it) or if you have any concerns, report the matter to your line manager.

6.2 Person does not have capacity to take responsibility for own medication 6.2.1 Even though you are taking responsibility for a person’s medication, it is important to maintain their dignity and independence wherever possible. Before helping with medication:

give the person an explanation of what you are intending to do and why

encourage them to do as much as they can for themselves.

6.2.2 When giving medication to a person who lacks capacity, any action you take must be in their best interests - see the autonomy and independence policy (D08) for details. If you have any concerns about their medication, contact your line manager / person on call to discuss it. See examples of possible concerns below.

The person gets upset about taking their medication.

They are excessively drowsy.

You suspect that their level of capacity is changing or fluctuating.

You recognise side effects of the medication that the person is unable to express (for example they are becoming more confused).

6.3 Safeguarding concerns

6.3.1 Medication can be misused in various ways, including for example:

being given excessively or inappropriately to control a person’s behaviour

deliberately giving or withholding it as a form of punishment or to cause harm. 6.3.2 If you suspect this is happening or you have any concerns, get in touch immediately with your line manager / person on call to discuss it.

7.0 RECORD KEEPING 7.1 Poor record keeping can put people receiving medicines support and care workers at risk and result in preventable mistakes.



6 of 13

7.2 General support 7.2.1 Record exactly what help you gave on the client report form. For example:

if you opened a container, record what you did, including details of which container you opened

if you reminded a person to take their medication, record it (but remember, if this is happening frequently, inform your line manager).

7.2.2 If it is written on a person’s care and support / personal plan that you can help them with non-medicated products (such as hand lotions, sun cream or cosmetic moisturisers), make a record on their client report form whenever you do it. 7.3 Administering medication (including by specialised techniques)

7.3.1 A care planner /assessor will record on the MAR chart:

the name and date of birth of the person taking the medication

the name of their GP practice and pharmacy

the name of the medication

the dose of the medication

the route it is to be given by

the time it is to be administered

further special instructions (for example ‘to be taken with food’)

any stop or review dates. 7.3.2 You need to sign or initial the appropriate section on the MAR chart:

against each medication given

each time you give it

when you give it. Do not rely on your memory to sign the MAR chart later – you might forget to do it or get the details wrong. Remember, this is a legal record of the medication administered to the person with care needs. See also Appendix 2 regarding administration of medication from a pharmacy-filled sealed compliance aid. 7.3.3 You are not allowed to copy details of medication onto a MAR chart unless you have been trained to do so. 7.3.4 As well as completing the MAR chart, also record on the client report form that you administered medication as directed.

7.4 Records need to be kept of:

all unsuccessful administrations of medication (see 9.0 below)

all suspected adverse reactions to medication (see 13.0 below). 7.5 Client report forms and MAR charts need to be transferred to the office as directed by your line manager. 8.0 COLLECTION OF PRESCRIPTIONS 8.1 You will not normally be expected to collect a service user’s prescription from the pharmacy.



7 of 13

However, in some circumstances, where a family member is not able to collect it, the care planner / assessor may agree that you can do it on their behalf. Details of what you have to do will be written in the care and support / personal plan. 8.2 Once you have collected the medication:

keep it out of sight while transporting it (for example in a bag or in the boot of your car)

take it immediately to the person’s home

check the medication with the person with care needs and / or carer to make sure it’s correct

place the medication in a safe place as agreed with the family and as detailed on the care and support / personal plan (see 4.0 above)

record what you have done on the client report form. 8.3 If you have any questions about a prescription you have been asked to collect, discuss the matter with the person with care needs and / or their carer, and if necessary get in touch with your line manager or the person on call for advice. 8.4 If you are asked to collect a prescription in an emergency and it is not written into the care and support / personal plan, contact your line manager or the person on call and ask them what to do. 9.0 UNSUCCESSFUL ADMINISTRATION OF MEDICATION 9.1 If you are supposed to be giving medication to a person with care needs but are not able to do so (for example because it is missing / not available or the person refuses to take it):

record what happened on both the client report form and the MAR chart using the key provided at the top of the form – do not leave an unsigned ‘gap’ on the chart

report it to the person’s carer and / or to your line manager / the person on call. 9.2 If the medication is taken out of its packaging, then refused or not taken, or if it is spoilt in any way, do not place it back in the container. Contact your line manager / the person on call who will find out from the person’s pharmacist how you are to dispose of it. 10.0 MEDICATION ERRORS 10.1 Examples of errors include:

giving the wrong medication

giving the wrong dose (too little or too much)

failing to give medication

giving medication at the wrong time

failing to sign for medication given

medication given to the wrong person

missed doses. 10.2 If you make a mistake with medication or notice someone else (such as a colleague, professionals or staff from another agency) doing so, you have a duty to:

let your line manager / the person on call know straight away

discuss with your line manager / the person on call what the person with care needs and / or their carer need to be told and who is going to tell them

record the mistake on the MAR chart as appropriate and the client report form.



8 of 13

10.3 Your line manager / the person on call will check with a healthcare professional (such as the person’s doctor) what action needs to be taken and may ask you to complete an incident report form (DT03). 10.4 If you make a mistake and don’t report it, or if you try to cover it up or make false entries on records, this may be dealt with under the disciplinary policy. 11.0 DISPOSAL OF PRESCRIBED MEDICATION 11.1 You will not usually be expected to dispose of a person’s unused medication. If you are required to do so, it will be documented in the care and support / personal plan. This will involve for example:

making a list of the medication (name, quantity, dose)

taking it directly to the pharmacy from the person’s home

asking the pharmacy for a receipt which you then need to pass on to your line manager

recording what you did on the client report form. 12.0 CHANGES TO MEDICATION 12.1 Where you are giving any medication support, the person with care needs or their carer has to let the organisation’s office know if their medication gets changed in any way so that the care planner / assessor can record the changes. 12.2 If you notice that a person’s medication has been changed, politely remind either them or their carer that they need to tell the office and if necessary check with your line manager that they have done so. 12.3 A person with care needs or their carer may tell you about short notice changes to their medication when you arrive at their home and there may not have been time for the changes to be written up in their care and support / personal plan or on the MAR chart. This could include for example:

a dose of existing medication being increased or reduced

medication being stopped

new medication being prescribed

short-term medication being prescribed, such as a course of antibiotics. If this happens:

do not act solely on the verbal instructions of the person with care needs or their carer

contact your line manager / the person on call so that they check out the changes and get back to you to tell you what to do.

13.0 SIDE EFFECTS OF / ADVERSE REACTIONS TO MEDICATIONS. 13.1 If you think that medication is causing side effects or an adverse reaction, do not ignore it – see below for what action to take. 13.2 Examples of an emergency side effect or adverse reaction include:

difficulty in breathing

swelling of the eyes, tongue or face

unresponsiveness or drowsiness

increased confusion / agitation (especially if the person with care needs lacks capacity).

http://www.xrds.org.uk/dsweb/Get/Document-4951/DT03%20Incident%20report%20form.doc



9 of 13

If this happens:

immediately begin emergency first aid as required

call 999 or 112 for an ambulance

contact your line manager / the person on call for further advice and support

record the incident on the client report form. 13.3 Examples of common side effects are:

sudden changes in mood

feelings of nausea

pains in the abdominal region

unusual rashes

a dry mouth

blurred vision

difficulty passing urine

diarrhoea and vomiting

unsteady on their feet when before there was no problem

blood in the faeces. If you suspect a person with care needs is experiencing any of the above:

immediately inform your line manager or the person on call who will contact the carer to discuss what action to take

record the incident on the client report form. 14.0 TAKING MEDICATION OUT OF THE HOME

14.1 If you are taking a person with care needs out of their home and they need to take medication with them (either for routine use or in an emergency, such as to treat an epileptic seizure), the care planner /assessor will have made all the necessary arrangements, and details will be written in the care and support / personal plan.

If the person is able to carry and take their own medication, they will be asked to do so.

If the person is not able to take responsibility for their medication, then you will be authorised to carry and administer it on their behalf.

14.2 The care and support / personal plan will include:

details of the medication to be taken outside of the home

the circumstances in which you are required to give it

details of the medication support needed

who will carry the medicine/s

the container to carry it in.

14.3 Your line manager will let you know what records need to be made, for example:

how you register taking the medicine from and returning it to the person’s home

whether the medicine was used or returned unused to the home. 14.4 If you need extra training your line manager will make sure you have received it and are competent to do the task before you provide the service. 15.0 LEARNING AND DEVELOPMENT 15.1 See learning and development guidance (E13c).

http://www.xrds.org.uk/dsweb/View/Collection-2090



10 of 13

16.0 ACCEPTANCE

16.1 You are required to sign to indicate that you have received, read and understood the content of this guidance as directed by your line manager and on completion of training, it is your personal responsibility to follow it. Failure to do so may result in disciplinary proceedings. APPENDIX 1 TYPES OF MEDICATION General medication This includes:

oral preparations (medications taken by mouth), including controlled drugs: tablets, capsules, mixtures, lozenges, liquids, sub-lingual medication

topical applications (applied to the skin): medicated liquids / lotions / creams / ointments, transdermal patches

drops and ointments to ears, nose and eyes

inhaled medication (via inhalers and spacers). Medication administered by specialised techniques This includes:

suppositories and micro-enemas (inserted into the rectum)

pessaries (inserted into the vagina)

buccal medication (inserted between the gum and cheek)

injections.



11 of 13

APPENDIX 2 ADMINISTRATION OF MEDICATION FROM COMPLIANCE AIDS These are also called ‘monitored dosage systems’, blister packs’ and dossette boxes’. The only compliance aid you are allowed to administer medication out of is one that is filled and sealed by a pharmacist. You are not allowed to administer medication from an unsealed container filled by the person’s carer, family member or anyone else.

If you are administering medication from a pharmacist-filled, sealed compliance aid, the following information about the contents will be documented on the MAR chart:

precise details of the compartment within the compliance aid that tablets are to be taken out of (for example “lunchtime” dose)

the name of the medication

the dose of the medication

the time the medication is to be given

any further special instructions.

Your manager has to make sure that you are trained how to identify tablets taken from a compliance aid before you give them.

The pharmacist will provide a picture or description of each tablet, (including for example its size, shape, colour, dose and any inscription on it), so that you can match the tablet to the description.

You are required to:

identify each tablet within a pharmacist-filled compliance aid before you give it

check to make sure the contents match the medication recorded on the MAR chart

sign or initial the MAR chart for each individual tablet given

inform your line manager / the person on call immediately if the contents don’t match or you can’t identify the tablets

record that you have / have not administered medication on the client report form.

Do not administer medication if:

you are not able to positively identify it

there is a discrepancy between the contents of a particular compartment and the medication listed on the MAR chart.



12 of 13

APPENDIX 3 MEDICATION SUPPORT FLOWCHART

Does person have mental capacity to take responsibility for their own medication?

Yes

Is person able to tell you what they need and to take their own medication with

your help?

Yes

General Support

EXAMPLES

Person asks you to:

- remove cap from bottle / open packaging

- pop tablets from blister / foil

- pour out liquid

- pass medication to person with care needs to take / apply

- pass inhaler / spacer.

An occasional reminder to take medication.

No

Administration

EXAMPLES


- select, prepare, measure medication

- place medication in person’s mouth

- apply medicated cream, lotion, ointment, patch

- insert ear, nose, eye drops

- administer inhaled drugs via inhaler / spacer

No

Any assistance given to a person who lacks

capacity is classed as administration

EXAMPLES


- select, prepare, measure medication

- help person to access their medication (for example open packaging, pop tablets from blister / foil)

- give medication to person to take

- regularly prompt person to take medication

- place medication in person’s mouth

- apply medicated cream, lotion, ointment, patch; insert ear, nose, eye drops

- administer inhaled drugs



13 of 13

APPENDIX 4 Paraffin-based creams, lotions and ointments Examples include such products as E45 cream and lotion, Zinc Ointment BP, White Soft Paraffin. These may be prescribed but are also readily available to buy as over-the-counter products. They are used extensively to treat a wide range of common skin conditions such as dry, itchy skin, eczema and dermatitis. The paraffin ingredients contained in such preparations present a fire risk when the product or materials that have absorbed it come into contact with a naked flame or source of ignition, such as a cigarette. The risk is therefore increased when:

such products are used extensively or on large areas of the body causing clothing, bedding and bandages to become soaked in it

the person using the product or other members of the household smoke. Anyone using paraffin-containing preparations must:

keep away from open / gas fires, hobs and naked flames (such as candles)

not smoke

keep away from others who are smoking or using naked flames

regularly change / wash clothing and bedding that comes into contact with paraffin-containing preparations.

Care planners / assessors will risk assess each person individually in relation to the above and enter details of their assessment into their care and support / personal plan.

Ian Turnbull, Chairman

Documents

B02c Adults’ medication guidance for staff · 5.4.1 If you are required to apply a medicated lotion, cream or ointment to a person’s skin, you will need to wear disposable gloves