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Medicines Management

Band 3 Training

Medicines Management

Nigel Buck Learning and Development Facilitator

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Aim

Within your role you will play your part in the safe supply, administration, handling and storage of medicines.

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ObjectivesAt the end of the session you will be able to -

say what a medicine isunderstand some of the legal aspects relating to medicines

state who can prescribe medicinesunderstand the principles of safe transport and storage of medicines

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Objectives (continued)

Understand how to administer medications safely (including record keeping)

Understand how to support patients in their use of medicines

Know what to do if something goes wrong

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What medicines do

Can you name any medicines?

Do you know what they do?

How can you find out – BNF

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BNFBritish National Formulary for all medicines (current / childrens)

http://bnf.org/bnf/bnf/current/Contraindications CautionsSide EffectsInteractions

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BNFUse the BNF find CalpolCautions – What are the cautions when taking Calpol?

Side Effects?Interactions?

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BNFUse the BNF find NurofenCautions – What are the cautions when taking Nurofen?

Side Effects?Interactions?

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What is a medicine?“Any substance or combination of substances...........(a) presented as having properties for treating or preventing disease in human beings;

(b) ……to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis

Medicines and Healthcare products Regulatory Agency

MHRA Guidance Note No. 8 Revised June 2007

A GUIDE TO WHAT IS A MEDICINAL PRODUCT

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Legal aspectsMedicines Act 1968 & Human Medicines Regs. 2012Marketing Licence (MHRA)The Safe and Secure Handling of Medicines 2005 (revision to the Duthie Report 1988 CD’s)

Health and Safety Regulations

Policy for the supply, administration, safe handling and storage of medicines CPPG/MM01

*Registering bodies guidelines*

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Legal aspects

There are 3 classifications of medicines GSL – (general sales list) Medicines sold in general shops as well as pharmaciesP – (pharmacy medicine) Medicines sold in pharmacies by or under the supervision of a pharmacist

POM – (prescription only medicine)Medicines only obtained on a prescription through a pharmacy

Can you name some?

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Controlled Drugs (CD’s)Misuse of Drugs Act 1971Drugs liable to abuseControlled drugsE.g..Controlled Drugs Regulations 2006 – “all significant events involving CD’s should be reported to Chief Pharmacist.

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Prescription

P.O.M. must be given as instructed by the authorised prescriber.

Changing dose or giving medicines to a different person without the prescribers permission is against the law.

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Who can prescribe?Doctors – GMC Registered, (& Dentists GDC)Suitably trained, experienced, qualified…………………………… Independent Prescriber – Suitably trained and competent

Nurses & Pharmacist- licensed medicines only (CD’s limited) Supplementary Prescriber- needs a clinical management plan

(CMP) & be a…. ……….nurses, pharmacists, physiotherapists, chiropodists/ podiatrists, radiographers or optometrists

Extended Nurse Prescriber Limited Nurse Prescriber Specific List Prescribers (RN prescribers)

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What information must a prescription have?

Clearly written black ink or computer generatedPatients-

full name &

address Age (by law for the under 12’s), DatePrescribers signature

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What information must a prescription have? (continued)

Medicine

Name (Generic)

Form (tablet / capsule)

Strength (note liquids)

Dose (best to avoid abbreviations)

Frequency

Route

NB CD’s

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Who can give medicines?Section 6.2 “The law states who can prescribe medicines it allows anyone to administer them………………... provided they follow the authorised prescriber’s instruction”

Section 6.3 Non- registered healthcare professionals may only administer medicines after receiving appropriate training & assessment at local level in accordance with local guidance to a named patient only.

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Get it Right -ChecksRight Patient (Name & D.O.B.) & prescriptionRight Medication (name form strength)Right DoseRight RouteRight Date & Time (Last dose given?)Right Duration (over what time)Appropriate member of staffExpiry DateDrug sensitivity

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Patients at high risk Taking 4 or more medicationsPost discharge from hospitalIn care homesMedicine- related problems identifiedChildren & Special Needs & over 75’s Following adverse change in healthNote side effects of medicationGP Medicines review may be needed

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Medicines & Children Children & Special NeedsChildren’s metabolism – reduce drug clearance – report adverse drug reactions

Many children require medicines not specifically licensed for paediatric use or for unlicensed applications (‘Off Label’).

Writing of prescriptions –Age, Strength of capsulesDoses in children – Body Weight (Overweight / Ideal weighted dose) or Body Surface area

Children’s BNF

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Medicines & Children

Oral SyringesOut of reach?Rare ConditionsSugar Free?

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Help with medicationsLarge print labelsClic-loc topsReminder chartsPrompt sheetsVolumatic devicesMedicines Information

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Side EffectsCan you name some side effects of medications?

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Side EffectsOver SedationMedication interactionD&VDehydrationConstipation

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SedationKeep to regular bedtimes - don't sleep or doze during the day.

Hidden CaffeineHave a set time for getting up in the morning. Make sure your bed and bedroom are comfortable; not too cold or too warm.

Sleeping problems are common.

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FallsWhat medicines could contribute to the risk of falls?

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Analgesics - Painkillers

• Constipation• Many stronger painkillers such as co-codamol (eg Solpadol, co-dydramol, and morphine (eg MST) cause constipation as a side effect, so a laxative may also be needed.

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Analgesics continued

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) -ibuprofen (eg Brufen, Nurofen), naproxen (eg Naprosyn, Synflex) & others can cause bleeding from the stomach or bowel.

More than one NSAID should not be taken at the same time. (note cold & flu remedies)

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Storage of MedicinesFollow manufacturers instructionsE.g.

Vaccines and the cold chain +2 to +8 degrees C

Keep in original containers, do not mix batches

Expiry dates do not over order

Lockable cupboards

Check them in and store them

Patients medication is the patients property

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Documentation

Record at the time of administrationSign to say it has been given“R” refused“O” omittedNote CD’sWhen things go wrong..

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Disposal of Medication

P.29 section 21.In general return to pharmacist

Not the domestic sewage system

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AdministrationP22 section 11.2.1Only Following training & Assessment- HCA working with an individualized planned package of care…naming both the patient & the HCA.

Routes of administration

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The Gut A&P

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Bristol Stool Chart

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Eye Drop administration

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Eye infections

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P.E.G. TubePercutaneous Endoscopic Gastrostomy TubeP.26 & separate policy

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When things go wrongPrevention- follow the policyPrevention- are you competent?Prevention- Get it right checksTrust’s Incident Reporting Policy and ProcedureNotify supervising staff / line managerCommunity PharmacistGP - prescriberMedicines manufacturer e.g. loss of refrigeration