Policy and Procedures on the Administration of Medication & Standards/Policies for Website... · Date printed 12-Jun-14 Version 11.0 Policy and Procedures on the Administration of

D a t e p r i n t e d 1 2 - J u n - 1 4 V e r s i o n 1 1 . 0

Policy and Procedures on the Administration of Medication

DOCUMENT CONTROL Developed by: Date Or ig ina t ion : Cope Founda t ion s ta f f

me mbers .

26 t h Ma rch 2001

Au thor is ed by:

Sean A bbo t t , Head o f Cl ien t Serv ic es

21 /09 /01

Approv ed by: Bernade t te O ’Su l l i v an Head o f Ho mes & Co mmun i t y 2 /Di rec to r o f Nurs ing

6 June 2014

DOCU MENT REVIEW HIS TOR Y Origina l C i rcu la t ion Date : 21 /09 /0 1

Issue Date

Review ed by Document Amended Y/N

Vers ion No:

Next Rev iew Date

25 /04 /02 Cope Founda t ion Y 2 .0 21 /05 /02 Cope Founda t ion Y 3 .0

11 /02 /03 Cope Founda t ion Y 4 .0 11 /04 /03 Cope Founda t ion Y 5 .0 . 01 /03 /04 Cope Founda t ion Y 6 .0 21 /10 /04 Cope Founda t ion Y 6 .1 05 /08 /05 Cope Founda t ion Y 7 .0 01 /05 /06 05 /09 /06 Cope Founda t ion Y 8 .0 01 /09 /07 24 /08 /07 Cope Founda t ion Y 9 .0 01 /09 /09 02 /08 /12 Cope Founda t ion Y 10 .0 01 /08 /14 06 /06 /14 Cope Founda t ion Y 11 .0 J une 2015

D a t e p r i n t e d 1 2 - J u n - 1 4 P a g e 2 o f 6 5 V e r s i o n 1 1 . 0

Tab le of Conten ts

Sect ion No . Page No . 1 . 0 I n t ro d u c t i on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 . 0 P u rp o se o f P o l i cy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

3 . 0 Te rmi n o l o g y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 . 0 A u d i t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

5 . 0 L i s t o f ab b re v i a t i o n s u se d b y Re g i s t e re d Me d i ca l P ra c t i t i o ne rs wh e n

p re sc r i b i n g m e di ca t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

6 . 0 De f i n i t i o n o f t e rms e mp l o ye d i n t h i s Po l i c y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 . 0 S co p e o f po l i cy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

8 . 0 A d mi n i s t ra t i o n o f Me d i c a t i o n b y De l e ga t e d S t a f f Me mb e rs . . . . . . . . . . . . . 1 0

9 . 0 S t a f f s e l f - a d min i s t ra t io n o f m e di ca t i on f ro m t h e se rv i ce s up p l i e s . . 1 1

1 0 . 0 P o l i cy f o r me d i c a t i o n p re s c r i p t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2

1 1 . 0 D i sp e n s in g o f Me d i ca t io n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6

1 2 . 0 P re sc r i p t i o n an d a d mi n i s t ra t i o n o f S t eso l id ® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7

1 3 . 0 P re sc r i p t i o n an d a d mi n i s t ra t i o n o f B u cc a l mi d a zo la m . . . . . . . . . . . . . . . . . . . . 1 8

1 4 . 0 S t o ra g e o f m e di ca t io n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9

1 5 . 0 A d mi n i s t ra t i o n o f Me d i c a t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1

1 6 . 0 A d mi n i s t ra t i o n o f med i c a t i o n s v i a e n tera l t u b e s . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

1 7 . 0 S e l f -A d m i n i s t ra t i on o f Me d i ca t io n s b y Cl i e n ts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5

1 8 . 0 A d mi n i s t ra t i o n o f P RN Me d i c a t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7

1 9 . 0 Co n t ro l l e d Me d i ca t i on s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 0

2 0 . 0 A d mi n i s t ra t i o n o f co n t ro l l e d me di ca t i on s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2

2 1 . 0 Th e p ro c e d u re t o f o l l o w wh e re a c l i e n t re f u se s t o ta ke th e i r

p re sc r i b e d m e d i ca t i o n s / m e di ca t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

2 2 . 0 Co v e r t A d m i n i s t ra t i on o f Me d i ca t io n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5

2 3 . 0 P ro ce d u re t o f o l l o w i n t h e e v e n t o f a n a cc i d e n t wi t h m e d i ca t i on s

(me d i ca t i o n e rro rs / n e a r mi ss e s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7

2 4 . 0 Me d i ca t i o n s t h a t mu s t be re t u rn e d t o th e Di sp e n si n g P h a rma cy . . . . . 3 8

2 5 . 0 A d ve rse re a c t i o n s t o m e di ca t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9

2 6 . 0 Re co rd i n g a nd a d m in i s t ra t io n o f m e di ca t i o n s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0

2 7 . 0 A l t e rn a t i v e me d i c a t i on s (V i ta mi n su p p l e men t s / h o m e o p a th i c

me d i c a t io n s a nd e ss e n t i a l o i l s ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0

2 8 . 0 Th e a d mi n i s t ra t io n o f ov e r t h e cou n t e r Me d i ca t i o n s ( i . e . i t e ms

p u rch a s e d wi t h o u t p re sc r i p t io n ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2

2 9 . 0 Ge n e ra l No t e s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2

3 0 . 0 Re f e re n c e s : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3


1.0 In troduction

1 .1 Cope Founda t ion is bas ed in ov er 60 loc a t ions w i th in Cork C i t y and Coun t y .

1 .2 Med ic a t ions fo r ind iv idua l c l ien ts a re p res c r ibed by h is /he r

pe rs ona l GP and d is pens ed by a Ph armac is t .

1 .3 On 1 s t Ma y 2007 , p r imary leg is la t ion was pu t in p lac e b y the Min is te r fo r Hea l th & Ch i ld ren to p r ov ide fo r p res c r ib ing by nurs e and mid w iv es in I r e la nd . Lega l regu la t i ons to s uppor t th is p rac t ic e inc lude :

§ Ir i s h Med ic ines Board (Mis c e l laneou s Prov is ions ) Ac t 2006 ,

(No . 3 o f 2006) (Co mme nc e ment Or der 2007) ,

§ Mis us e o f D rugs (Amend ment ) Regu la t ions 2007 , S ta tu to r y Ins t ru me nts No . 200 o f 20 07 ,

§ Med ic ina l Produc ts (Pres c r ip t ion and Con t ro l o f Supp ly )

(A men d me nt ) Regu la t ions , 2007 Sta tu to r y Ins tru ment No . 201 o f 2007 .

1 .4 Th is leg is la t ion , a long wi t h ne w ru le s , requ i re ments and

p ro fes s iona l gu ide l ines approv ed by An Bord A l t rana is p rov ides fo r the i mp le men ta t ion o f p res c r ip t iv e au thor i t y fo r s u i tab ly qua l i f ied nurs es /mid wiv es .

1 .5 Nurs e p resc r ib ing has been in t r oduc ed in to s o me a reas o f

Cope Founda t ion . Thes e a reas wi l l be l i s ted in the Cope Founda t ion “Po l ic y and Gu ide l ines t o Suppor t Nurs e Pres c r ib ing ” .


2.0 Purpose of Pol icy

The purpos e o f th is po l i c y i s to de ta i l “bes t p rac t ic e ” in the ad min is t ra t ion , s to rage , o rder ing , r e c e ip t and re tu rn o f med ic a t ion . Loc a l p ro toc o ls wi l l de ta i l ar rangem ents fo r the rec e ipt and re tu rn o f unus ed /ou t o f da te med ic a t ion an d the doc u menta t ion o f a l l s uc h ac t ions .

3.0 Terminology

3 .1 The te r m med ic a t ion (s ) i s us ed in th is po l i c y as the des c r ip tor fo r med ic a t ions o r med ic a l p repara t i ons u t i l i s ed b y reg is te red nurs es in the de l iv e ry o f nu rs ing in t e rv en t ions .

3 .2 An y re fe renc e to med ic a t ion (s ) fo r t he purpos e o f th is po l i c y

i mp l ies an y med ic a l l y p res c r ibed s ubs tanc e o r med ic a l p repara t ion .

3 .3 In th is po l i c y, the te r m “MP Char t /C R 21 ” re fe rs on l y to the

C l ien t Med ic a t ion Pres c r ip t ion ( MP) Char t (CR 21) .

4.0 Aud it

4 .1 The aud i t o f “bes t p rac t ic e ” in the a d min is t ra t ion , s to rage , o rder ing rec e ipt and re tu rn o f med ic a t ion is r equ i red and s hou ld be c a r r ied ou t a t leas t quar te r l y o r more f requen t l y where ind ic a ted .

4 .2 Aud i ts s hou ld be c a r r ied ou t r ou t ine l y and s hou ld de ta i l bo th f ind ings and ac t ions .

4 .3 In add i t ion to in t e rna l aud i t s , the d i s pens ing pharmac y c a r r ies ou t audi t s in a reas the y s upp l y.


5.0 Lis t o f abbre via tions used by Registered Medica l Pract i t ioners when p rescrib in g medicat ions.

Abb re via t ions Mean ing B.D. Bis ( In ) D ie

Twic e da i l y. Th is us ua l l y means morn ing and ev en ing . A l wa ys c hec k t i mes wi th Pres c r ib ing Med ic a l Prac t i t ioner and as k h i m/her to wr i t e t i mes on the c l ien t ’s Med ic a t ion Pres c r ip t ion Char t (MP Char t /CR 21)

T .D .S. Tere D ie Su mendu m T . I .D. Ter ( In ) D ie

Three t i mes da i l y. A l wa ys c hec k t i mes wi th Pres c r ib ing Med ic a l Prac t i t ioner and as k h i m/her to wr i t e t i mes on the c l ien t ’s Char t

Q.D.S. Q. I .D . Quate r ( In) D ie

Four t i mes da i l y. A l wa ys c hec k t i mes wi th Pres c r ib ing Med ic a l Prac t i t ioner and as k h i m/her to wr i t e t i mes on the c l ien t ’s Char t

S.O. S. Si Opus S i t

I f n ec ess ary (onc e on l y) .

P.R.N . Pro Re Nata

“PRN ” means as nec ess ary /requ i red . PRN med ic a t ion mus t be ad min is te red s t r i c t l y in ac c ordanc e wi th the wr i t ten ins t ruc t ion o f the med ic al p rac t i t ion er who has p res c r ibed i t . Th is ins t ruc t ion mus t inc lude the pu rpos e o f the PRN med ic a t ion and the c i r c ums tan c es when i t mus t be us ed . The dos age to be ad min is te red in i t ia l l y, the f r equenc y o f the repea t dos age ( i . e . 10 minu t es ) and the max i mu m dos age in 24 hours and the ac t ion tha t mus t be ta ken i f t he s y mp toms pers is t a f te r the med ic a t i on has been ad min is te red .

Stat . Sta tu m

Immed ia te l y.

Nocte At n igh t . A l wa ys c hec k ac tua l t i me (2000 h rs o r 2200 h rs ) wi th Pres c r ib ing Med ic a l Prac t i t ioner and as k h i m/her to wr i te t i me on t he c l ien t ’s c har t

Mane In t he morn ing .


Abb re via t ions Mean ing A l wa ys c hec k ac tua l t i me wi th Pres c r ib ing Med ic al Prac t i t ioner and as k h i m/ he r to wr i te t i me on the c l ien t ’s c har t

P.R. Per Rec tum

B y the rec tu m.

P.V. Per v ag ina

B y the v ag ina .

I .M. In t r amus c u la r l y.

I .V . In t r av enous ly .


6.0 Defini t ion of terms e mployed in th is Pol icy . The fo l lo w ing te r ms a re us ed th roug hou t th is doc u ment in r e la t io n to med ic a t ion p repara t ion ma nagem ent .

T erm Def in it ion Admin is t ra t ion To giv e an ind iv idua l dos e o f med ic i na l p roduc t

( tab le t , c aps u le , l iqu i d , in jec t ion ) e i the r to ones e l f o r to a c l ien t v ia the appropr ia te r o ute (o ra l , r ec ta l , in t ra mus c ula r ) .

Chart In th is po l i c y the te r m “M P Char t / CR 21 ” re fe r s on l y to the Cl ien t Med ic a t ion Pres c rip t ion (MP) Char t .

Cove rt Admin is t ra t ion

Cov er t admin is t r a t ion of med ic ines i nv o lv es the ad min is t ra t ion o f a med ic ine d is gu is ed in food o r d r in k to a res iden t who res is ts i t wh en g iv en open l y

Cont ro l led Drug

For the purpos e o f th is po l i c y , c on t ro l led med ic a t ions re fe r to MDA Sc hedu le 2 and MDA Sc hedule 3 med ic a t ions on ly ( fo r a l i s t o f the more c ommon MDA Sc hedu le 2 and MDA Sc hedu le 3 med ic a t ions s ee Append ix 3 ) .

Delegated Sta f f Membe r

A Cope Founda t ion emp loyee work i ng in a s pec i f ied s e t t ing who has been d i r e c ted to ad min is te r med ic a t ions to c l ien ts under h is /he r s uperv is ion .

Medica l Prepa rat ion

A s ubs tanc e wh ic h is s o ld under p ropr ie t y des igna t ion and wh ic h ma y b e us ed fo r the p rev en t ion o r t r ea tmen t o f an y hu man a i l men t , in f i rmi t y , in j u r y o r de fec t . An y o the r p rophy lac t ic , d iagnos t ic o r the rapeu t ic s ubs tanc e, wh ic h ma y be us ed fo r the p rev en t ion o r t rea t ment of an y hu man a i l men t , in f i rm i t y , in ju r y or de fec t . An y d rug o r p repara t ion in tend ed to p rev en t p regnanc y. O ther p repara t ion us ed fo r r es to r ing , c o r rec t ing o r mod i f y ing phys io logic a l func t ion in hu man be ings (Hea l th Ac t , 1947 , No . 28 , Sec t ion 6 5) Fa mi l y P lann i ng (Amend ment ) Ac t 1992 (No . 20 , Sec t ion 7 ) . (See Sec t ion 3 .0 Ter mino lo gy ) .

Medicat ion A s ubs tanc e wh ic h when ta ken in to a t i s s ue , o rgan o r body s ys te m mod i f ies i t s s t r uc tu re and func t ion . (See Sec t ion 3 .0 Ter mino l ogy ) .

Medicat ion erro rs

Any p rev en tab le ev en t tha t ma y c aus e o r lead to inappropr ia te med ic a t ion us e o r pa t i en t / c l ien t ha rm wh i le the med ic a t ion is in the c on tro l o f the hea l th c a re p ro fes s iona l , pa t ien t / c l i en t enc oun te r o r c ons umer . Thes e ev en ts ma y b e as s oc ia ted wi th p rofes s iona l p rac t ic e, hea l th c a re p roduc ts ,


T erm Def in it ion proc edures and s ys te ms . Th is inc ludes p res c r ib ing ; o rder c o mmun ic a t ion ; p roduc t labe l l ing , pac kag ing , a nd no menc la t u re ; c ompound ing ; d is pens ing ; d is t r ibu t i on ; ad min is t ra t ion ; educ a t ion ; mon i to r in g and us e (Na t iona l Coord ina t ing Co unc i l f o r med ic a t ion Er ro r Repor t ing and Prev en t ion , 1998) . 1

Near Miss Is an ev en t o r s i tua t ion where the e r ro r does no t r eac h the pa t ien t / s e rv ic e us er and no in ju r y r es u l ts ( e .g . , inc o r rec t dos e is p resc r ibed but i s r ec ogn is ed and ad jus ted be fo re the med ic a t ion is ad min is te red) . An Bord Al t r ana is , 2007 , p . 27 )

Regis tered Nurse

A wo man o r man whos e na me is c u r ren t l y en te red in the An Bord A l t rana is Reg is te r (N urs es Ac t , 1985)

Regis tered Nurse Presc r ibe r

A Nurs e who is r eg is te red wi th An B ord A l t rana is as a Reg is te red Nurs e Pres c r ibe r (RNP) and has the au thor i t y f r o m the Hea lth Serv ice p rov ide r who e mp lo ys the m to p res c r ibe a range o f med ic a t ions wi th in the i r s c ope o f p rac t ic e .

Pharmacis t A pers on keep ing open s hop fo r the d is pens ing o r c ompound ing o f med ic a t ions o r fo r the s a le o f po is ons under the Phar mac y Ac t , 1975 - 1977 . I t a ls o inc ludes a reg is te red pharmac eu t ic a l c he mis t and a reg is te red d rugg is t (M is us e o f D rugs Ac t , 1977)

Pract i t ioner Reg is te red Med ic a l Prac t i t ioner , Re g is te red Den t is t (M is us e o f Drugs Regu la t ion , 1988)

Presc r ip t ion A pres c r ip t ion is s ued by a reg is te re d med ic a l p rac t i t ioner fo r the med ic a l t rea t me nt o f an ind iv idua l , b y a reg is te red dent is t fo r the denta l t rea t ment o f an i nd iv idua l (Mis us e o f Drugs Regu la t io n , 1998)

Self -Admin is t ra t ion

The s e lec t ion and us e of a med ic a t i on b y c l ien ts to t r ea t s y mptoms /c ondi t ions o r i l l n es s . Th is ma y inc lude the us e o f p res c r ibed o r ov er the c oun te r med ic a t ions o r a l te rna t iv e med ic ines .

Note: A Glos s ary o f te r ms is av a i lab le in “ Gu idanc e to Nurs es and Midw iv es on Med ic a t ion Manage ment ” ( J u l y 2007 , An Bord A l t rana is )

1 N a t i o n a l C o u n c i l f o r t h e P r o f e s s i o n a l D e v e l o p m e n t o f N u r s i n g a n d M i d w i f e r y ( J u n e , 2 0 0 5 ) R e v i e w o f N u r s e s a n d M i d w i v e s i n t h e P r e s c r i b i n g a n d Ad m i n i s t r a t i o n o f M e d i c i n a l P r o d u c t s , D u b l i n : N a t i o n a l C o u n c i l f o r t h e P r o f e s s i o n a l D e v e l o p m e n t o f N u r s i n g a n d M i d w i f e r y


7.0 Scope of po lic y

7 .1 Th is po l i c y app l ies to a l l Reg is te red Nurs es /de lega ted s ta f f me mbers c harged wi th the res pons ib i l i t y o f o rder ing , s to r ing , d is pens ing and ad min is t r a t ion o f me d ic a t ions .

7 .2 Th is po l i c y app l ies to Stud en t Nurs es who d is pens e and

ad min is te r med ic a t ions under the s uperv is ion o f a Reg is te red Nurs e . The Reg is te red Nurs e re ta in s acc oun tab i l i t y fo r the ad min is t r a t ion o f med ic a l p roduc ts (An Bord Al t r anais , 2007 , p .11)

7 .3 Th is po l i c y c ov ers :

a ) Res iden t ia l Serv ic es b ) Da y Serv ic es c ) Shor t Brea ks /Res p i te Serv ic es d ) Ho me Suppor t Serv ic es e ) Co mmun i t y Se t t i ngs .

7 .4 Th is po l i c y app l ies to Reg is te red Nu rs es /De legated S ta f f

me mbers who s uppor t c l ien ts to s e l f -med ic a te /ad min is te r the i r own med ic a t ion .

7 .5 Rec ogn is ing tha t Reg is te red Nurs es hav e a s ta tu to ry

res pons ib i l i t y in th is r egard, Cope F ounda t ion ’s po l ic y c omp l ies wi th c u r ren t An Bord A l t r ana is requ i re ments , wh i le a t the s a me t i me p ro tec t ing a l l pa r t ies (c l ien ts , fami l ies and s ta f f ) in the i mp le menta t ion o f a s a fe , p rac t ic a l , opera t iona l po l i c y.

Admin is t ra t ion o f medicat ion in communi ty set t ings

7 .6 The ad min is t r a t ion of med ic a t ion in the c o mmun i t y s e t t ing b y

s ta f f o the r than nurs es /nurs e p resc ribe rs fa l l s w i th in the sc ope o f th is po l i c y.

7 .7 The ad min is t r a t ion of med ic a t ion s hou ld in as fa r as

reas onab ly prac t ic ab le be c a r r ied o u t b y s ta f f who hav e c omp le ted the med ic a t ion manage ment c ours e .

7 .8 A l l as pec ts o f th is po l i c y w i th r e fe re nc e to the ad min is t r at ion

o f med ic a t ion mus t be c o mp l ied wi t h .


T he admin is t ra t ion o f med icat ion in cen tres that p rovide shor t b reaks to people w e support .

7 .9 The ad min is t r a t ion of med ic a t ion in c en t res tha t p rov ide s hor t

b reaks mus t c omp l y w i th th is po l i c y .

7 .10 .W hen a pers on is be ing admi t ted fo r a s hor t b reak per iod , a c u r ren t p resc r ip t ion is fu rn is hed every 6 months o r a t c hange o f med ic a t ion . A Cope Fou nda t ion d rug ad min is t r a t ion rec ord c an be s upp l ied b y the s hor t b reak c en t re to pa ren t /guard ian fo r c omp le t i on b y f a mi l y GP on eac h ad mis s ion and i t i s s en t ho me w i th c l ien t a t the end o f eac h s hor t b reak.

7 .11 I t i s the res pons ib i l i t y o f pa ren t /gua rd ian to keep the rec ord up to da te a t a l l t i mes . The rec ord has to be rev iewed and s igned b y the GP a t s ix month i n te rv a ls i f no t r equ i red p rev ious ly.

7 .12 On l y med ic a t ion as p res c r ibed c an be ad min is te red b y the Nurs e / de lega ted s ta f f me mber . A l l med ic a t ions a re s upp l ied by the paren t /guard ian and re tu rned a t the end o f eac h s hor t b reak.

7 .13 In t he ev en t o f c r is is /emergenc y ad mis s ion a l l e f fo r t s wi l l be made to ga in the up to da te p res c r ip t ion and medic at ion . In s i tua t ions where the ad mis s ion oc c urs and the p resc r ip t ion and med ic a t ion is no t made av a i lab l e ev ery e f fo r t w i l l be made to ga in s u f f i c ien t in fo r mat ion to e na b le the Manager / Pers on in c harge to c on tac t the p res c r ib ing Genera l Prac t i t ion er . Sou th Doc /ou t o f hours GP s erv ic e /GP on c a l l c an be c on tac ted i f t he re a re c onc erns tha t c anno t be addres s ed .

7 .14 Pro toc o ls fo r the t r ans fe r o f med ic a t ion be t ween s hor t b reak and s c hoo ls o r day s e rv ic es , fo r ex amp le , s hou ld be d rawn up loc a l ly .

D a t e p r i n t e d 1 2 - J u n - 1 4 P a g e 1 0 o f 6 5 V e r s i o n 1 1 . 0

8.0 Administ ra tion of Medicat ion by Delegated Sta ff Members

8 .1 In a nu mber o f Cope Founda t ion c o mmun i t y ho mes the

ad min is t r a t ion o f med ic ines is de lega ted to c a re s ta f f . . I t i s Cope Founda t ion p o l ic y tha t d e lega t ed s taf f me mbers wor king in c o mmun i t y ho mes a re requi red to under take the t ra in ing p rogra mme ‘ Res pons ib le & Sa fe Me d ic a t ion Mana ge ment ’ . Th is p rogra mme is on -go ing to meet the t r a in ing needs o f bo th c u r ren t and new s ta f f in s a fe med ic a t ion manage ment .

8 .2 Th is 2 da y p rogra m me is de l i v e red by s ta f f nu rs es who hav e under ta ken s pec i f i c t ra in ing and wi l l g iv e des igna ted s ta f f t he kno w ledge a nd s k i l l s r equ i red to c ompeten t l y tak e on the res pons ib i l i ty inheren t to the ro le .

8 .3 The p rogra mme is d iv ided in to 6 modu les : 1 ) Po l ic y, r o le and res pons ib i l i t y 2 ) Re lev an t leg is la t ion 3 ) Med ic a t ion 4 ) Ob ta in ing , s to r ing and d is pos ing o f med ic a t ion 5 ) Repor t ing and rec ord ing p rac t ic es 6 ) C l in ic a l s k i l l s in s a fe admin is t r a t ion .

A ls o inc luded is t ra in ing fo r ad min is t r a t ion o f o ra l , eye / ear /nas a l and top ic a l med ic a t ions . Bo th the theor y ex amina t ion a nd ons i te as s ess ment s mus t be pas s ed by par t i c ipan ts

8 .4 The ‘ Res pons ib le & Sa fe Med ic a t ion Manage ment ’ Tra in in g Progra mme fo r des igna ted s ta f f me mbers requ i res upda t ing ev ery 2 years .

8 .5 Des ignated s ta f f me mbers a re res pons ib le fo r the i r o wn p rac t ic e wi th r egard t o med ic a t ion manage ment a nd mus t adhere to Cope Founda t ion ’s ‘ Po l ic y &Proc edures on the Ad min is t ra t ion o f Med ic a t ions ’ .


9.0 Staf f sel f - administ ra t ion o f medicat ion f ro m the service suppl ies

9 .1 On no ac c oun t mus t an y me mber o f s ta f f t ake fo r h i m o r

he rs e l f , o r g iv e to ano ther s ta f f me mber any med ic a t ion f ro m the s e rv ic e s upp l ies .

9 .2 S ta f f me mbers mus t no t b r ing med ic a t ion fo r pe rs ona l us e in to

the wor kp lac e un les s the med ic a t io n is ess en t ia l (e .g . inha le r ) . Th is med ic a t ion mus t be s to red in h is /he r pe rs ona l loc ked l oc ker . I t mus t no t be kep t o n the pers on , o r s to red in any o f the o rgan is a t ion ’s d rugs s to rage s ys te ms . Ac c ess mus t be res t r i c ted to the s ta f f me mber p r es cr ibed the med ic a t ion .


10.0 Policy fo r medicat ion prescript ions 10 .1 Med ic a t ions mus t be p res c r ibed by r eg is te red Med ic a l

Prac t i t ioners / Den ta l Surgeons /Reg is te red Nurs e Pres c r ibe rs (RNP) on ly .

10 .2 In a reas where t he Reg is tered Nurs e Pres c r ibe r i s pe rmi t ted

to p res c r ibe med ic a t ions i t i s the re s pons ib i l i t y o f eac h ind iv idua l nu rs e wor kin g in tha t a re a to ens ure tha t he /s he is kno w ledgeab le regard ing the c on ten ts o f the Cope Founda t io n “Po l ic y, Gu ide l ines & Pro toc o ls to Suppor t Nurs e Pres c r ib ing ” . Th is po l i c y app l ies to a l l Reg is te red Nurs e Pres c r ibe rs whos e na mes appear on the c u r ren t r eg is t e r fo r Nurs e Pres c r ibe rs w i th An Bord A l t rana is .

10 .3 The Reg is te red Nurs e Pres c r ibe r wi l l us e p resc r ip t i v e au thor i t y i n a s a fe , e f fec t iv e manner in ac c ordanc e wi th the Co l labora t iv e Prac t ic e Agreeme nt ( CP A) . Pres c r ipt i v e p rac t ic e ex tends on ly to t hos e d rugs norma l l y us ed in the na med c l in ic a l a rea , and o f t hes e , on l y fo r c a tegor ies o f med ic ina l p roduc ts o r na med med ic i na l p roduc ts c on ta ined on the CP A endors ed b y the Cope Fou ndat ion “Drugs and Therapeu t ic s Commi t tee ” and a l lo w ed under c u r ren t leg is la t ion .

10 .4 In a l l a reas where the re is a v is i t ing Med ic a l Prac t i t ioner o r

Regis te red Nurs e Pres c r iber , med ic a t ions p resc r ibed mus t be c lea r ly ident i f ied in b lac k in k on the c l ien t ’s MP Char t / CR 21 (Append ix 2 ) s ta t ing :

i . Na me o f the pers on ( in fu l l ) f o r who m the med ic a t ion is p res c r ibed .

i i . C l ien t ’s Da te o f Bi r th

i i i . The da te o f p res c r ip t ion .

i v . The na me of the med ic a t ion p res c r ibed .

v . The dos age .

v i . The t i mes o f ad mi n is t ra t ion .

v i i . The rou te o f ad min is t r a t ion .

v i i i . The dura t ion o f t r ea tmen t and s top da te .

i x . The doc tor ' s s igna tu re /Regis te red Nurs e Pres c r ibe r ’s s igna tu re .


10 .5 The c l ien t ’s MP Char t /CR 21 mus t b e rev iewed b y the Med ic al Prac t i t ioner ev ery 6 months . In the ev en t tha t the p res c r ibed med ic a t ion is c hanged , c anc e l led o r the the rap y reg i me is c omp le ted then :

i . A l ine mus t be d ra wn th rough the p res cr ibed med ic a t ion on the c l ien t ’s MP Char t /CR 21 .

i i . I t mus t be da ted and s igned b y the med ic a l p rac t i t ion er in o rder to g iv e a c lea r ind ic a t ion th a t the med ic at ion reg i me is c omp le te , has been c hang ed o r i s c anc e l led .

10 .6 In a reas where t he re is no v is i t ing Med ic a l Prac t i t ioner ,

med ic a t ions p res c r ibed mus t be c lea r l y iden t i f ied o n e i the r :

o A reg is te red Med ic a l Prac t i t ioners p resc r ip t ion doc ke t ; o A G MS pres c r ip t ion ; o A p res c r ip t ion wr i t ten on a reg is te re d Med ic a l Prac t i t ioner ’s

headed paper . o Med ic a t ions tha t a re be ing b rough t i n by pers ons f rom ho me

mus t be in c u r ren t , c lea r ly labe l le d c on ta ine rs as f i l l ed by h is /he r phar mac is t . (See Append ix 1 – Le t te r to Paren ts /Guard ians )

10 .7 The Reg is te red Nurs e /de lega ted s ta f f me mber mus t no t ac c ep t

wr i t t en o r v e rba l r eques ts f r om fami l ies /guard ians regard ing the c o mmenc e ment o r c hange in a c l ien t ’s med ic a t ion reg i me .

10 .8 On l y r eg is te red Med ic a l Prac t i t ioners /Reg is te red Nurs e

Pres c r ibe rs wi l l d is c on t inue med ic a t ion p res c r ip t ions .

10 .9 In the ev en t o f med ic a t ions tha t a re pres c r ibed fo r a de f ined per iod (e .g . an t ib io t i c s ) the p resc r ipt ion mus t ind ic a te the dura t ion o f the p res c r ip t ion , fo r ex amp le : 1 wee k, 3 da ys , e tc . A s top da te mus t be en te red in t o th e c l ien t ’s MP Char t / CR 21 .

10 .10 Ox ygen mus t be pres c r ibed by a Re g is te red Med ic a l

Prac t i t ioner . I f us ed in Bas ic L i fe Suppor t /E mergenc y s i tua t ion , i t mus t be c har ted in the c l ien t ’s MP Char t / CR 21 b y a Med ic a l Prac t i t ioner as s oon as pos s ib le .


10 .11 W here the Medic al Prac t i t ioner i s r e qu i red , he / s he mus t be reques ted to a t tend . W here i t i s no t pos s ib le fo r the Med ic a l Prac t i t ioner to a t tend , and t he c l ien t i s in need of i mmed ia te t rea t ment , the med ic a t io n ma y be p res c r ibed by s end ing in the p res c r ip t ion b y fac s imi le . A p res c r ip t ion fo r c on t ro l led d rugs mus t adhere to the requ i re men ts o f the Mis us e o f Drugs Ac ts o f 1977 and 1984 and the Mis us e o f D rugs Regu la t ions , 1988 , 1993 and 2007 . A p res c r ip t ion the re fo re mus t be hand wr i t ten in i t s en t i r e t y fo r i t t o b e d is pens ed by a phar mac is t and s ubs equen t ly ad mi n is te red b y a reg is te red nurs e .

10 .12 In t he ins tanc e where med ic a t ions a re p res cr ibed by

fac s imi le the fo l lo wing c ond i t ions a ppl y : i . The o r ig ina l p res c r ip t ion mus t be p r ov ided

by the Med ic a l Prac t i t ioner and p lac ed in the c l ien t ' s f i le as s oon as poss ib le .

i i . The fac s i mi le mus t be p lac ed in the c l ien t ’s f i le .

i i i . The Med ic a l Prac t i t ioner mus t upda t e the c l ien t ' s MP Char t /CR 21 and no tes as app l ic ab le on h is /he r nex t v is i t . Th e Reg is te red Nurs e /De lega ted s ta f f me mber mus t in fo rm the Cl in ic a l Nurs e Man ager on Du ty .

10 .13 Adherenc e to th is po l i c y mus t be en s ured th rough s ys te mat ic aud i t .

10 .14 An Bord A l t rana is gu ide l ines s ta te the on l y ac c ep tab le t i me

a ve rba l o r te lephone order fo r m edicat ion s hou ld be taken f ro m a med ic a l p rac t i t ioner i s in an emergency s i tuat ion w here there is an immedia te unp lanned c l ien t need .

10 .15 A nurs e ac c ep t ing a v e rba l med ic a t i on o rder s hou ld repea t

the o rder to the med ic a l p rac t i t ioner fo r v e r i f i c a t ion . The med ic a l p rac t i t ion er s hou ld repea t t he med ic a t ion o rder to a s ec ond nurs e. Th is s hou ld be fo l lo wed b y bo th nurs es c on f i rming the med ic a t ion o rder be t wee n the m. A rec ord o f the v e rba l / te lephone med ic a t ion o rd er s hou ld be doc u mented in the c l ien t ’s no tes and Verba l / Te le phone Med ic a t ion Order (Append ix 6 )


10 .16 The Med ic a l Prac t i t ioner i s r es pons ib le fo r doc u ment ing the wr i t ten o rder on the p res c r ip t ion s hee t / med ic a t ion ad min is t r a t ion rec ord / med ic a l no tes as s oon as poss ib le w i th in b u t no t la te r than 72 hours a f te r the o rder has been rec e iv ed . .


11.0 Dispensing of Medicat ions

11 .1 The Reg is te red Nurs e /de lega ted s ta f f me mber , fa mi l y me mber o r bona f ide rep res en tat iv e wi l l b r i n g the med ic a t ions to the c ommun i t y s e t t ing and the Reg is te red Nurs e /de lega ted s ta f f me mber wi l l p lac e i t in the des igna t ed loc ked med ic a t ion c upboard .

11 .2 Med icat ions d ispensed in b l is ter packs /med icat ion

pouches must have a typed label deta i l ing:

i . C l ien t name and locat ion . i i . Name o f each med icat ion conta ined in each

b l ister /pouch. i i i . S trength /dosage of each capsu le /tab le t in the

b l ister /pouch. iv. Name o f the dispensing Pha rmacy. v. Date o f p resc r ipt ion. vi . Date and t ime med icat ion is to be admin is tered .

11 .3 Blis ter pac ks / med ic a t ion pouc hes a re us ed ma inl y fo r ora l

s o l id dos age med ic a t ions (An Bord A l t rana is , 2007) . 11 .4 Reference r es ourc es mus t be read i l y ac c ess ib le fo r the

reg is te red nurs e to c on f i rm p res c r ibed med ic a t ion in the b l i s te r pac k o r med ic a t ion p ouc h wi t h iden t i f iab le d rug in fo rmat ion , e .g . ph ys ic a l des c r ip t ion o f the med ic a t ion ( i . e . r eg . ob long , o r a c o lou r pho tograph o f the tab le t , An Bord A l t rana is , 2007) . The reg is te red nu rs e is res pons ib le fo r c hec king tha t the med ic a t ions in the b l i s te r pac ks / med ic a t ion pouc hes a re c o r rec t and mus t p lac e the m in the med ic a t ion p ress / t r o l le y.

11 .5 Regis te red Nurs es mus t doc u ment e ac h admin is t ra t ion v ia

b l i s te r pac k / med ic a t ion pouc h in t he s ame wa y as med ic a t ions ad min is te red f ro m the o r ig ina l d is pens ed c on ta ine r ( i . e . i t i s no t ac c ep tab le to doc ument “0800 h rs . b l i s te r pac k/ med ic a t ion po uc h g iv en ” in c l ien t no tes ) .


12.0 Prescr ip t ion and adminis tra t ion of Stesol id® 12 .1 A c l ient who is p res c r ibed PRN S tes o l id mus t hav e a c u r ren t

MP Char t / CR 21 c lea r l y s ta t ing :

i . The c i rc u ms tanc es when i t i s to be us ed .

i i . The in i t ia l dos age .

i i i . The t i m ing o f res pec t iv e dos es .

i v . The max i mu m dos age in a 24-hour p e r iod .

12 .2 I f a s ec ond dos e o f S tes o l id® is p res c r ibed , then the

p resc r ip t ion mus t s ta te the per iod o f t i me a f te r ad mi n is t ra t ion o f the 1 s t dos e in wh ic h the 2 n d dos e c an be ad min is te red .

12 .3 S tes o l id mus t on l y be ad min is te red by: -

i . Reg is te red Nurs e o r Reg is te red Me d ic a l Prac t i t ioner .

i i . De lega ted s ta f f me mbers who hav e s ucc es s fu l l y c o mple te d a s pec i f ic t r a in ing p rogra mme on ep i leps y and the ad min is t r a t ion o f Stes o l id to s pec i f i c c l ien ts .

i i i . S tuden t nu rs es under the s uperv is ion o f a Reg is te red Nurs e .


13.0 Prescr ip t ion and adminis tra t ion of Buccal midazolam

13 .1 C l ien ts who a re p res c r ibed PR N B uc c a l midaz o lam mus t hav e the fo l lo w ing in fo r mat ion on the i r Med ic a t ion Ad min is t r a t ion Rec ord MP Char t /C R 21 :

i . The c i rc u ms tanc es when i t i s to be us ed .

i i . The in i t ia l dos age .

i i i . The t i m ing o f res pec t iv e dos es .

i v . The max i mu m dos age in a 24-hour p e r iod .

v . Ac t ion to be ta k en i f s ympto ms pers is t .

Th is in fo r mat ion ma y a ls o be c on ta i ned in a p ro toc o l wh ic h has been p lac ed in the c l ien t ’s s uppor t p lan .

13 .2 Buc c a l mida zo la m mus t on l y be ad min is te red b y:

i . A Reg is te red Nurs e o r a Reg is te red Med ic a l p rac t i t ioner .

i i . A de lega t ed s ta f f me mb er who has c omp le ted t ra i n ing on the ad min is t ra t ion o f Buc c a l mida zo la m.

i i i . S tuden t Nurs es under the s uperv is ion o f a Reg is te red Nurs e .


14.0 Storage of medica t ions 14 .1 A l l med ic at ions mus t be s tored in a loc ked c upboard and in

the appropr ia te c ond i t io ns as ind ic ated on the lab e l o r pac kag ing o f the med ic a t ion o r as adv is ed by the Phar mac is t . Th is inc ludes a l l in jec tab le p repara t ions tha t a re s ens i t iv e to l igh t .

14 .2 So me med ic a t ions ma y requ i re s to r age in a re f r ige ra to r . I t i s

bes t p rac t ic e tha t th is re f r ige ra to r mus t no t be us ed fo r an y o ther pu rpos e and must be kep t loc ked . Da i l y te mpera tu re c hec ks s hou ld be c a r r ied ou t and rec orded . Suc h tempera tu re rec ord ing s hou ld be in the range 2 -8°C.

14 .3 Cupboards and re f r ige ra to rs mus t b e la rge enough to s to re

med ic a t ions and mus t be kep t c lean and t id y. Re fr ig e rato r s mus t be de fros ted regu la r l y ( s ee ma nufac ture r ’s ins t ruc t ions ) .

14 .4 A l l c on tro l led med ic a t ions (MDA Sc hedu le 2 and MDA

Sc hedu le 3 ) wi l l be s tored in a s epara te , loc ked c upboard w i th in the loc ked c upboard .

14 .5 C l ien ts who w is h to s e l f -med ic a te mus t be p rov ided wi th a

s ec ure s to rage fac i l i ty .

14 .6 Mob i le Med ic a t ion Tro l le y ’s mus t be s ec ured to a wa l l when no t in us e . Emergenc y box es s hou ld be loc ked .

14 .7 The Reg is te red Nurs e /de lega ted s ta f f me mber res pons ib le fo r

ad min is te r ing med ic a t ions in an a re a wi l l c a r r y the med ic at ion ke ys on h is /he r pe rson th roughout h is /her sh i f t o f du ty .

14 .8 Med ic a t ion ke ys mus t no t be a t tac hed to a key r ing , wh ic h is

us ed fo r genera l do mes t ic pu rpos es. Ke ys to the c on t ro l led med ic a t ion p res s / t r o l ley mus t a l way s be kep t in the c us tody o f a Reg is te red Nurs e and no o ther me d ic a t ion ke ys mus t be kep t on the c on t ro l le d med ic a t ion k ey r ing .

14 .9 Los t o r mis la id med ic a t ion ke ys mus t be repor ted to the

C l in ic a l Nurs e Manager /pe rs on in c harge i mmed ia te l y . In the ev en t o f the med ic a t ion ke ys no t be i ng found the ma in tenanc e o f f i c e r mus t be c on tac ted to c hange the loc ks . The s ta f f me mber inv o lv ed mus t c o mp le te an Inc ident Form (CR 53) , and i t mus t be da ted and s igned b y the Cl in ic a l Nurs e Manager /pe rs on- in -c harge and the Reg is te red Nurs e /de lega ted s ta f f me mb er inv o lved in the inc iden t (See


Append ix 5 ) . An ev a lua t ion o f th is i nc iden t mus t ta ke p lac e to ens ure a l l e f fo r t s a re made to reduc e the pos s ib i l i t y o f r eocc ur renc e .

14 .10 In an y a rea o f t he s e rv ic e where the re a re ox ygen

c yl inders , thes e wi l l be kep t in a c lea r l y iden t i f ied “NO SMOK ING ” a rea . A "NO S MOK ING" s ign mus t be c lea r ly d is p layed bes ide the c y l inder . Eac h c yl inder mus t be c hec ked a t leas t onc e a month ; ho wev er , the f r equenc y of thes e c hec ks mus t r e f lec t the f r equenc y o f us e . A rec ord o f th is c hec k mus t be ma in ta ined and e mpt y c yl inders a re to be re tu rned to s upp l ie r s i mmed ia te ly .

14 .11 Med ic a l Ox ygen c yl inders hav e a c ol la r labe l wi th the

p roduc t na me and f i l l and ex p i r y da t e o f the c on ten ts . The labe l s hou ld be c hec ked p r io r to admin is t r a t ion . Por tab le Med ic a l ox ygen c y l inders hav e a s t ic ke r on the bod y o f the c yl inder ; th is s hou ld be c hec ked fo r the f i l l and ex p i r y da te p r io r to admin is t r a t ion .

14 .12 Med ic a t ions mus t nev er be re mov ed f ro m i t s o r ig ina l

c on ta ine r un t i l i t i s be ing ad mi n is te red (mus t no t be t r ans fe r red f r o m one c on ta ine r to an o ther ) .

i . B l i s te r pac ks / med ic a t ion pouc hes mus t nev er be c u t

down to s i ze . i i . Tops o f box es and o r pac kages tha t ac c ompan y

med ic a t ions mus t no t be de fac ed o r to rn o f f . Storage o f med icat ions during s ta f f accompan ied vacat ions:

14 .13 Plac e the requ i red amount o f c l ien t med ic a t ion in a l oc ked box . Th is box is p lac ed in a loc ked p res s /s a fe a rea upon a r r iv a l a t des t ina t ion where pos s ib le . The Reg is te red Nurs e /de lega ted s ta f f me mb er mus t re ta in pos s ess ion o f ke ys to bo th box and c upboard where app l ic ab le .


15.0 Administ ra tion of Medicat ions Admin is t ra t ion invo l ves ass is t ing c l ien ts in the ingest ion , app l ica t ion , inha la t ion , in ject ion , insert ion and se l f -management o f med icat ions accord ing to the di rect ion o f the p rescrib ing med ica l p ract i t ioner.

15 .1 On l y Reg is te red Nurs es , Studen t Nu rs es under s uperv is ion and de lega ted s ta f f me mbers in des igna ted a reas mus t ad min is te r med ic a t ions . The pers on who admin is te r s the med ic a t ion mus t r ec ord i t s ad min is t r a t ion .

15 .2 The Reg is te red Nurs e mus t kno w th e the rapeu t ic us es , no rma l

dos age , s ide e f fec ts , p rec au t ions and c on t ra - ind ic a t ions o f the med ic a t ions tha t the y a re ad min is te r ing .

15 .3 S taf f me mbers who ad min is ter med i c a t ions mus t kno w the

reas on why a c l ien t i s r ec e iv ing a par t i c u la r med ic a t ion and i t s po ten t ia l s ide e f fec ts .

15 .4 On ly Reg is tered Nurses , Regis te red Med ica l

Pract i t ioners o r Student Nurses under the d irect superv is ion o f a Reg is tered Nurse are pe rmi t ted to adminis ter paren tera l in ject ions ( I n tra -muscu lar, subcutaneous or in tradermal ) .

15 .5 Med ic a t ion ma y be w i thheld f r om a c l ien t where , in the

p ro fes s iona l judge ment o f the Reg is te red Nurs e , the re ma y be a c l in ic a l ind ic a t ion wh ic h c on t rad ic ts the ad min is t ra t ion o f the med ic a t ion .

15 .6 I t w i l l be nec es s ary to c ons u l t w i th a Med ic a l Prac t i t ioner ,

Pharmac is t o r C l in ic a l Nurs e Manager wi th r egards to w i thho ld ing med ic a t ion .

15 .7 Ac c ura te and c on temporaneous doc u menta t ion s hou ld be

made fo r a n y med ic ina l p roduc t wi th he ld .

15 .8 Shou ld a med ic a t ion need p repara t i on be fo re i t i s to be ad min is te red to a c l ien t , t he s a me R eg is te red Nurs e /de lega ted s ta f f member mus t pe r fo r m the c o mp le te p roc es s .


15 .9 The Reg is te red Nurs e /de lega ted s t a f f me mber who re mov es the med ic a t ion f r om the c on ta ine r /p ac kage /b l i s te r pac k/pouc h mus t be the pers on who ad mi n is te r s the med ic at ion to the c l ien t .

15 .10 The pers on ad min is ter ing the med ic a t ion mus t c hec k the

med ic a t ion p res c r ip t ion to c on f i rm:

i . Tha t the da te o f p res c r ip t ion and s igna tu re o f the Med ic a l Prac t i t ioner /Reg is te red Nurs e Pres c r ibe r i s p res en t ;

i i . Na me o f the pers on ( in fu l l ) t ha t the med ic a t ion is to be g iv en to ;

i i i . Da te o f b i r th o f c l ien t .

i v . The med ic a t ion tha t i s to be g iv en;

v . The dos age to be g iv en;

v i . The rou te t hat i t i s to be g iv en by ;

v i i . The t i me o f ad min is t ra t ion .

v i i i . Chec k the ex p i r y da te o f the med ic a t ion to be ad min is te red .

i x . I f a dmin is te r ing IM in jec t ions the ba tc h nu mber and ex p i r y d a te mus t be c hec ked and doc u mented .

15 .11 The pers on ad min is ter ing the med ic a t ion mus t ens ure tha t

i t i s g iv en to the pers on fo r w hom i t i s p resc r ibed . 15 .12 Med ic a t ions mus t on l y be ad mi n is te red f ro m c lea r l y

labe l led c on ta ine rs /pouc hes . 15 .13 Med ic a t ions mus t a l wa ys be ad min i s te red f r o m the i r

o r ig ina l d is pens ing c on ta ine r /pac ka ge /b l i s te r pac k/pouc h .

15 .14 I t i s p re fe rab le to hand le med ic a t ions min i mal l y wh en ad min is te r ing the m.

15 .15 The Reg is te red Nurs e /de lega ted s ta f f me mber mus t pay

fu l l a t ten t ion to the p repara t i on , ad min is t ra t ion and rec ord ing o f the med ic a t ion – no o ther ac t iv i t y i s to be engaged in s imu l taneous l y.

15 .16 I f a c l ien t is unab le to ta ke a p res c ribed med ic a t ion in

tab le t fo r m, w i thou t the p res c r ibed tab le t be ing c rus hed , the


Regis te red Nurs e mus t f i r s t c ons ul t w i th the Reg is te red Med ic a l Prac t i t ioner and the Pharm ac is t to d isc uss a l te rna t iv es fo r the c l ien t .

15 .17 I f t he GP agrees that th is tab le t ma y be c rus hed , th is mus t

be s ta ted on the Pres c r ip t ion Char t .

15 .18 In t he ev en t o f s p i l lages o f med ic a l p roduc ts , the Regis te red Nurs e /delega ted s ta f f me mber mus t :

• C lean up an y s p i l lages as s oon as pos s ib le . • In fo rm t he s en io r C l in ic a l Nurs e Manager on du t y o f the

s p i l lage . • Co mp le te an Inc ident Form (CR 53) and s end to the Sa f e ty

O f f i c e r .

15 .19 In t he ev en t o f med ic a t ions be ing mis la id / los t the Regis te red nurs e /de lega ted s ta f f m ember mus t :

i . Searc h the a rea where the i te m was las t s een . Th is ac t ion mus t a ls o be ta ken in the ev en t o f a c l ien t s p i t t ing , r e mov ing o r h id ing an ad mi n is te red med ic a t ion .

i i . P lac e any s po i led med ic a t ions in th e “Spo i l ed med ic a t ions ” c on ta ine r in the med ic a t ion p res s .

i i i . Ma ke a c lea r and ac c ura te wr i t ten ac c oun t us ing the Inc ident Form (CR 53) o f the med ic a t ions mis p lac ed , the ac t ions taken and the ou tc o me o f the ev en t .

15 .20 If a c l ien t v omi ts o r regurg i ta tes fo l lo wing t he

ad min is t r a t ion o f h is /he r p res cr ibed o ra l med ic a t ion , the Regis te red Nurs e /de lega ted s ta f f me mber mus t :

i . No te the t i me o f med ic a t ion a d min is t r a t ion i i . No te the t i me o f v omi t ing /regurg i ta t i on . i i i . I f o ne hour has e laps ed s inc e the med ic a t ion has been

ad min is te red no ac t ion is nec es s ary. I f in do ub t c hec k w i th the med ic a l p rac t i t ioner .

i v . I f les s than one hour has e laps ed , the med ic a l p rac t i t ioner mus t be c on tac ted . He /s he ma y adv is e tha t the med ic a t ion is to be re -ad mi n is te red . A c lea r and ac c urate ac c oun t o f the in for ma t ion g iv en and the ac t ions taken mus t be rec orded in the c l ien t ’s no tes .


16.0 Administ ra tion of med ications via entera l tubes. 16 .1 Regis te red Nurs es mus t re fe r to The Roy a l Mars den Hos p ita l -

Manua l o f C l in ic a l Nurs ing Proc edures ( 6 t h Ed .) , pages 436-437 .


17.0 Se lf -Admin is trat ion o f Medications by Cl ients

Se l f - ad min is t ra t ion o f med ic ines invo lv es the independen t us e o f a med ic a t ion (s ) b y a c l ien t in ac c ordanc e wi th h is /he r wis hes and p re fe renc es .

17 .1 Cope Founda t ion is c ommi t ted to s u ppor t ing and fac i l i ta t ing oppor tun i t ies to ind iv idua l c l ien ts who ex press a des i r e to ad min is te r h is /he r o wn med ic ines .

17 .2 Ind iv idua l c l ien ts who w is h to ad min is te r h is /he r own med ic a t ion mus t be as s ess ed as ab le to do s o wi thou t c ompro mis ing h is /her s a fe ty o r t ha t o f o the r c l ien ts .

17 .3 An in te r -d is c ip l ina ry approac h mus t be adop ted to de te r mi ne the v iab i l i t y o f the c l ien t to s e l f - me d ic a te , and the c ond i t ions under wh ic h i t t a kes p lac e . Th is wi l l inv o lve ass es s ment o f c apac i t y, c o mpetenc e , c ogn i t i v e func t ion and manua l dex te r i t y. An ind iv idua l r i s k as s essment mus t be c o mp le ted to in fo rm the dec is ion -mak ing p roc es s a t a l l t i mes .

17 .4 Th is Se l f - Med ic a t ion As s es s ment wi l l es tab l i s h c l ien t ’s lev e l o f ab i l i t y and an y r i s k, r es ourc es , superv is ion and s uppor ts r equ i red to s uppor t h is /he r goa l to s e l f -med ic a te (Append ix 7 ) .

17 .5 The d i f fe r ing lev e ls o f admin is t ra t ive s uppor t a c l ien t ma y requ i re a re:

i . ‘Par t ia l Se l f - Ad min is t r a t ion ’ i s i f the c l ien t i s onl y ab le to s e l f -ad min is te r s ome med ic ines . For ex amp le , the c l ien t ma y be ab le to s e l f - ad min is te r h is /he r o ra l med ic ines bu t no t an y c reams o r o in t ment , o r he /s he ma y be ab le to us e h is /he r inha le rs , bu t ma y requ i re as s is tanc e wi th o ra l med ic ines .

i i . C l ien t a d min is te rs the med ic ines , wi th the Nurs e /Des igna ted s ta f f me mber p ro v id ing s uperv is ion

i i i . C l ien t a d min is te rs the med ic ines us ing aug menta t iv e c ommun ic a t ion too ls or adap t iv e dev ic es , wi th Nurs e /Des igna ted s ta f f me mber p ro v id ing s uperv is ion and /o r as s is tanc e


i v . C l ien t a d min is te rs the med ic ines independen t l y and /o r u t i l i s es aug mentat iv e c ommun ic a t io n tools o r adap t iv e dev ic es (wi thou t an y s uperv is ion ) .

17 .6 The c l ien t mus t be mon i to red ov er an agreed per iod o f t i me

and mus t demons tra te an ab i l i t y to med ic a te wi th ac c urac y.

17 .7 The lev e l o f s uppor t / s uperv is ion requ i red b y the c l ien t r egard ing d rug ad min is t r a t ion mus t be doc umented in h is /he r Care P lan . The s e l f - ad min is t ra t ion p lan wi l l be ev a lua ted and rev iewed a t iden t i f ied t i me f ra mes o r as c l ien ts ’ needs and c i r c ums tanc es c hange e. g . c hange in me d ic a l needs .

17 .8 Appropr ia te , s a fe and s ec ure s to rage o f me d ic ines fo r s e l f -ad min is t r a t ion s hou ld be bas ed on a n ind iv idua l r i s k as s ess ment an d ac c es s l imi ted to th e c l ient and /o r nu rs e /des igna ted s ta f f me mber . For ex amp le , s ec ure c on ta ine r in the c ommuna l d rug p re ss , s ec ure loc ker in da y s e rv ic e o r bedroom.

17 .9 To c o mp l y wi th An Bord A l t r ana is gu ide l ines the p rac t ic e o f

s e l f - ad min is t r a t ion mus t be aud i ted a t regu la r in te r v a ls . (Gu idanc e to Nurs es & Mid wiv es on Med ic a t ion , J u ly 2007) .


18.0 Administ ra tion of PRN Medicat ions Def in i t ion : ‘ ’W hen requ i red ’ ’ (P RN) med ic a t ion is ad min is te red when the c l ien t p res en ts wi th a d e f ined in te rmi t ten t o r s hor t - te rm c ond i t ion i .e . no t g iv en as a regu la r da i l y dos e o r a t s pec i f i c t i mes e .g. med ic a t ion rounds .2

18 .1 W hen a c l ien t i s p resc r ibed a ‘P RN ’ med ic a t ion , the ev idenc e s uppor t ing the need fo r th is p resc r ibed med ic a t ion s hou ld be iden t i f ied in th e c a re p lan and med i c a l r ec ords (wh ic h de mons t ra tes tha t the c l ien t ’s in te r mi t ten t o r s hor t ter m c ond i t ion has been as s ess ed and rev iewed by the med ic a l p rac t i t ioner ) . W hen the us es o f PRN med ic a t ions a re c ons idered , they a re par t o f the c l ie n ts in teg ra ted c a re p lan and ou tc omes s hou ld be ev a lua ted on an on-go ing bas is .

18 .2 W hen PRN med ic a t ion is p res c r ibed fo r a c l ien t , i t i s es s en t ia l t ha t c lea r ins t ruc t ions a re rec e ived f ro m the Med ic a l Prac t i t ioner /Nurs e Pres c r ibe r des c r ib ing the c ir c u ms tanc es when P RN med ic a t ion s hou ld b e g iv en ( i . e . s igns , s ympto ms ) , the med ic a t ion to be g iv en , dos e to be g iv en , t i me in te rv al be t ween dos es , max i mu m dos e tha t c an be g iv en in 24 hours . Th is in fo r mat ion mus t be doc u mente d .

18 .3 The Med ic a l Prac t i t ioner /Nurs e Pres c r ibe r mus t c hec k wh a t r egu la r med ic a t ion the c l ien t ma y be ta king da i l y be fo re p resc r ib ing PRN med ic a t ion , t o s a fe guard the c l ien t f r o m rec e iv ing ex c es s ive amoun ts o f s i mi la r med ic a t ions o r a c omb ina t ion o f med ic a t ions tha t a re c on t ra indic ated .

18 .4 The Med ic a l Prac t i t ioner mus t r ev iew PRN med ic a t ions ev ery 6 months , in i t ia l and da te o n a c l ien t ’s med ic a t ion c har t and rec ord in c l ien t ’s med ic a l no tes . Th e med ic a l Prac t i t ioner mus t r ev iew and re wr i te a l l a c l ien t ’s PRN med ic a t ions ev ery 12 months in the c l i en t med ic a t ion c har t /med ic a l no tes .

18 .5 PRN med ic a t ions a re ne i the r p res c r ibed nor d is pens ed to c ov er ho l ida y per iods wh i le the c l ie n t i s a t ho me . A c l ie n t who is go ing on ho l ida ys s hou ld hav e the i r needs rev iewed in a t i me l y manner and wi t h wr i t ten ins t ruc t ions f r om the i r Med ic a l Prac t i t ioner to c ov er the s pec i f i c hol ida y per iod .

2 ( ‘ ‘Good P r a c t i c e g u i d an ce med i c a t i on p r e sc r i bed t o b e t a ke n ‘whe n r equ i r e d ’ ( PRN) i n Car e H ome s ’ ’ Cope l and , Cumbr i a C l i n i c a l Comm i s s i on i n g G ro up , NH S) .


18 .6 Shou ld th e PRN med ic a t ion no t have the des i r ed e f fec t the p resc r ib ing Med ic a l Prac t i t ioner /Nurs e Presc r ibe r where appropr ia te , s hou ld be c on tac ted . In the ev en t of ou t o f hours , the ou t o f hours GP s erv ic e /Sou th D oc /Doc to r on c a l l s e rv ic e s hou ld be c on tac ted . The p res c r ibe r wi l l au thor is e an y c hanges wh ic h s hou ld be doc umented in the c l ien t ’s med ic a t ion c har t / med ic a l no tes .

18 .7 C l ien ts p res c r ibed ps yc ho t rop ic me d ic a t ion mus t hav e a t leas t a 6 mon th l y r ev iew w i th a ps yc h ia t r i s t o r more f requen t l y where reques ted b y a ps yc h ia t r i s t .

18 .8 PRN med ic a t ion (s ) may fa l l in to an y d rug c las s i f i c a t ion , and ma y inc lude bu t a re no t l i mi ted to th e fo l lo w ing :

* An a lges ic s (med ic a t ions us ed fo r pa in – e .g . Parac e ta mo l ) * An t i - in f la mmator y d rugs ( med ic a t i ons us ed fo r in f la mmat ion and pa in –e .g . Ibuprof en * Gas t ro in tes t ina l t r ac t d rugs ( med i c a t ions us ed fo r hear tbu rn , c ons t ipa t ion , e tc . , i . e . S enna o r Pepc id ) * Se da t iv es o r hypno t ic (med ic a t ion s us ed fo r s leep , e .g . Loaze p ine)

Admin is t ra t ion o f PR N Med icat ion

18 .9 PRN med ic a t ion mus t be ad minis te r ed s t r i c t l y in ac c ordanc e

w i th the wr i t ten ins t ruc t ion o f the med ic a l p rac t i t ioner / nu rs e p resc r ibe r who has p resc r ibed i t .

18 .10 Al l PRN pres c r ip t ion mus t inc lude the fo l lo wing c r i ter ia : i . The da te o f p res c r ip t ion and s igna tu re o f the med ic a l

p rac t i t ioner / nu rs e p resc r ibe r i s p res en t i i . Name o f the c l ien t ( in fu l l ) .

i i i . Da te o f b i r th o f c l ien t i v . Name o f med ic a t ion tha t i s to be g iv en v . The dos age to be g iv en

v i . The rou te tha t i t i s to be g iv en by v i i . The t i me o f ad min is t ra t ion

v i i i . The min i mu m t i me in te r v a ls be tween dos es ix . Chec k ex p i r y da te of the med ic a t ion to be ad min is te red x . The purpos e o f the PRN med ic a t ion

x i . The c i rc u ms tanc es when i t s hou ld b e us ed x i i . The to ta l da i l y dos e o f the c l ien ts r egu lar and PRN

med ic a t ion , s o as to no t to ex c eed the max i mu m (B NF) rec ommended d os e

x i i i . The max i mu m dos e in 24 hours x iv . Ac t ion to be ta ken i f s ympto ms pers is t


18 .11 Al l PRN med ic a t ions ad min is te red mus t be rec orded in the c l ien t ’s CR 23 nurs ing no tes , and s i gned and da ted i n the c l ien t ’s med ic a t ion c har t

18 .12 Cl ien ts mus t be c los e ly mon i to red f o l lo wing the ad min is t r a t ion o f PRN med ic a t ion to as s ess whe ther the med ic a t ion has had the des i red e f fec t

18 .13 I f a P RN med ic a t ion is be ing ad min i s te red regu lar l y/ f requen t l y b y Reg is te red Nurs es / De lega ted S ta f f Me mber th is mus t be b rough t to the a t ten t ion o f the Med ic a l Prac t i t ioner as i t ma y be an ind ic a t ion tha t a rev iew o f tha t c l ien t ’s regu la r med ic a t ion is r equi r ed .

18 .14 W here PRN ps yc ho t rop ic med ic a t ions a re us ed they mus t be par t o f the c l ien t ’s agreed p ro -ac t iv e s t ra tegy in the manage ment o f es c a la t ing de te r io ra t ion o f men ta l hea l th , in ac c ordanc e wi th i ns t ruc t ions f r om a ps yc h ia t r i s t .

18 .15 In a reas where a nurs e is no t av a i lab le to ad min is te r PRN med ic a t ion the de lega ted pers on mu s t c on tac t a s ta f f nu rs e /nurs e manager in ano ther a rea be fo re ad min is te r ing th is med ic a t ion . A loc a l p ro toc o l wi l l g i ve gu idanc e as to the a rea and /o r pe rs on to c on tac t .

18 .16 The res pons ib i l i t y fo r the s a fe ad mi n is t ra t ion o f P RN med ic a t ion (s ) l ies wi th the pers on who admin is te r s i t .

18 .17 Ex c es s ive s toc ks o f PRN med ic a t io n needs to be av o ided by o n l y s toc k ing es s en t ia l med ic a t io ns as iden t i f ied in PRN c har ts and c a re p lans . Chec k s toc k be fo re o rder ing.

18 .18 Shared PRN med ic a t ions (e .g . Para c e tamo l ) s hou ld be l i mi ted to a c en t ra l s toc k in e ac h a rea . Th is s toc k is r ec orded in a s pec ia l ‘s toc k log ’ he ld on the un i t .

18 .19 PRN med ic a t ion s hou ld be s upp l ied in i t s o r ig ina l pac kage as th is enab les the ex p i ry da te to b e c hec ked and reduc es unnec ess ary med ic a t ion was te .

18 .20 I f PRN med ic a t ion is o f fe red and re f us ed by a c l ien t , then

s ta f f mus t doc u ment th is in the c l ie n ts ’ Med ic a l Char t /CR2 3 Nurs ing No tes .


19.0 Control led Medicat ions

19 .1 A c on tro l led med ic a t ion is one whos e us e , s to rage and d is t r ibu t ion a re t igh t l y c on tro l led b y the M is us e o f Drugs Ac ts 1977 , 1984 and the M is us e o f Drugs Regu la t ions 1988 to 1993 and 2007 . The lega l te rm fo r th es e d rugs is the abbrev ia t ion “MDA ” f o l lo wed b y the appropr iate Drug Sc hedu le Number (1 to 5 ) . (See Append ix 4 ) .

19 .2 For the purpos e o f th is po l i c y , c on t ro l led med ic a t ions re fe r to

MD A Sc hedu le 2 and 3 med ic a t ions on l y ( fo r a l i s t o f the more c ommon MDA Sc hedu le 2 and 3 me d ic a t ions s ee Append ix 3 ) .

19 .3 An y MDA Sc hedu le 2 o r 3 med ic a t io ns may be ad min is te red

by, o r in ac c ordanc e wi th , the d i rec t ion o f a Med ic a l Prac t i t ioner . I t i s un la wfu l fo r a Me d ic a l Prac t i t ioner to i s s ue , o r fo r a phar mac is t to d is pens e , a p resc r ip t ion fo r a MD A Sc hedu le 2 o r 3 med ic a t ion un les s i t c o mp l ies wi th the fo l lo wing requ i re ments :

i . The p res c r ibe r mus t be s a t is f ied as to the iden t i t y of

the c l ien t and c hec k the c l ien t ’s name and da te o f b i r th.

i i . The p res c r ip t ion mus t :

a ) Be in b lac k in k (o r o the r wis e inde l ib le ) and be s igned by the Prac t i t ioner i s s u ing i t w i th he r /h is us ua l s igna ture and dated b y her /h i m.

a . Clear l y ind ic a te the na me o f the Med ic al Prac t i t ioner

i s s u ing i t and , ex c ep t in the c as e o f a Genera l Med ic a l Serv ic es p res c r ip t ion (GMS) , s pec i fy he r /h is addres s .

b . Spec i f y ( in th e p res c r ibe r ’s handwr i t ing ( the na me and addres s o f the pers on fo r whos e t rea t men t i t i s i s s ued ( in the c as e o f a c l ien t in Co pe Founda t ion o r res iden t in Cope Founda t ion , the a ddres s o f the c l ien t need no t be s pec i f ied , p rov ided the p res c r ip t ion is wr i t ten in the c l ien t ’s c as e no tes ).

c . Spec i f y a te lephone nu mber a t whic h the p res c r ibe r ma y be c on tac ted .


d .

e . Spec i f y ( in th e p res c r ibe r ’s handwr i t ing ) :

Ø The dos e to be tak en ,

Ø The for m, in the c as e o f med ic at ion s , Ø The s t reng th (when appropr ia te ) an d in bo th

words and f igu res , e i the r the to t a l quan t i t y o f the med ic a t ion o r Med ic a l Prepara t ion o r the nu mb er o f dos age un i t s to be s upp l ied .

Ø Rou te .

19 .4 The C l in ic a l Nurs e Manager in c harge o f the a rea may be s upp l ied wi th a c on t ro l led med ic a t io n , s o le l y for the purpos e o f ad min is t r a t ion to a c l ien t in tha t a rea , in ac c ordanc e wi th the d i rec t ions o f a r eg is tered Med ic a l Prac t i t ioner o r den t is t .

19 .5 On re turn to the re lev an t a rea , the Reg is te red Nurs e mus t

t r ans fe r the c on t ro l led med ic a t ion t o the c on t ro l led med ic a t ion c upboard . In re la t ion to MDA Sc he du le 2 med ic a t ions , the t r ans fe r wi l l be wi tnes s ed by a s ec ond pers on ( I t i s des i r ab le tha t th is i s a Reg is te red Nurs e) , wh o wi l l a ls o c on f i r m the iden t i t y o f the pers on tha t the med ic a t ion is p res c r ibed fo r and the a mount p res en t . A rec ord o f th is w i l l be made in the appropr ia te c on tro l led med ic a t ion b ook on the un i t and bo th s ta f f members wi l l s ign th is .

19 .6 A l l c ont ro l led med ic a t ions (MDA Sc hedu le 2 and MDA

Sc hedu le 3 ) wi l l be s tored in a s epara te , loc ked c upboard w i th in a c upboard .

19 .7 The Reg is te red Nurs e res pons ib le fo r ad min is te r ing

med ic a t ions mus t c a r r y the med ic a t i on c upboard ke ys on h is o r he r pe rs on a t a l l t i mes . The ke y s to the c on t ro l led med ic a t ion c upboard mus t be kep t s epara te l y on i t s o wn ke y-r ing .


20.0 Administ ra tion of con trol led medicat ions

20 .1 W hen a MD A Sc hedu le 2 c on t ro l led med ic a t ion is ad min is te red , the fo l lo w ing p roc edure app l ies :

i . MD A Sc hedule 2 c on t ro l led med ic a t ion is ad min is te red b y a Reg is te red Nurs e who c onduc ts the p roc edure ( inc lud ing c hec king , prepara t ion , ad min is t r a t ion and doc u me nta t ion )_ and a wi tnes s , p re fe rab l y a ls o a Reg is te red Nurs e , who obs erv es the c o mp le te p roc es s .

i i . The p res c r ip t ion mus t be read c a re fu l l y and the da te and doc to r ' s s igna tu re c hec ked .

i i i . The t i me o f las t ad min is t r a t ion mus t be c hec ked .

i v . The c on t ro l led med ic a t ion requ i red mus t be s e lec ted and i t s labe l c hec ked to en s ure i t c o r res ponds wi th the p res c r ip t ion .

v . The a mount o f the c on t ro l led me d ic a t ion p res en t mus t be c hec ked to ens ure tha t the ba lanc e c o r res ponds wi th the b a lanc e rec orded as be ing s upp l ied in the c on t ro l le d med ic a t io n boo k.

v i . The c on t ro l led med ic a t ion mus t be p repared fo r ad min is t r a t ion b y a Reg is te red Nurs e in the p res enc e of the wi tnes s wh o mus t ve r i f y the p resc r ipt ion , the c on t ro l led med ic a t i on and i t ’s ex p i r y da te , the c a lc u lat ion ( i f an y) , the me as ured dos e , the na me o f the pers on rec e iv ing i t and the rou te o f ad min is t ra t ion .

v i i . The c on t ro l led med ic a t ion mus t be taken to the pers on fo r who m i t i s p res c r ibed and ad min is te red in the p res enc e o f the wi tnes s .

vi i i . The de ta i l s mus t then be en te red in the c on t ro l led med ic a t ion bo o k, toge ther wi th the s ignatu res o f the pers on who has ad min is te red i t and the w i tnes s . N.B. the book must be s igned fo l low ing adminis t ra t ion o f the cont ro l led med icat ion.


i x . A p res c r ip t ion is inc o r rec t i f the doc to r does no t s pec i f y the to ta l nu mber o f dos es o f a c on t ro l led med ic a t ion tha t a re to be admin is te r ed , and in th is c as e the doc to r mus t be c on tac ted to a mend the p resc r ipt ion be fo re ad min is t ra t ion .

x . An y s p i l lag e o f a c on tro l led med ic a t ion mus t be c lea r ly doc u mented and s igned b y t he pers on ad min is te r ing the med ic a t ion , and the i r s igna ture w i tnes s ed in the c ont ro l led med ic a t i on boo k. An Inc ident Form (CR 53) mus t be c omp le ted and s en t to the Sa fe t y Of f i c e r .

x i . Shou ld th e a mount o f c on t ro l led me d ic a t ion p res en t no t equa te to the a mount tha t mus t be p res en t acc ord ing to the c on t ro l led med ic a t ion book, the C l in ic a l Nurs e Manager o n du t y mus t be c on tac ted and in fo rmed. An Inc ide nt Form (CR 53) mus t be c o mp l e ted and s en t to t he Sa fe t y Of f i c e r . The Nurs e Manager mus t i n fo r m the D i rec to r o f Nurs ing .

20 .2 Communi ty c are invo lving MDA Sc hedule 2 drugs . Regis te red Nurs es mus t fo l lo w th e g u ide l ines g iv en in the An Bord A l t r ana is “Gu idanc e to Nurs es and Midw iv es on Med ic a t ion Manag eme nt ” , J u l y 2007 , p . 24 ) .


21.0 T he procedure to fo l low where a cl ient re fuses to take thei r prescribed medicat ions/medicat ions.

21 .1 W here a c l ien t r e fus es to take h is /h e r p res cr ibed med ic a t ions

the de lega ted pers on /s ta f f nu rs e s hou ld o f fe r the med ic a t ions aga in 2 fu rthe r t imes a t 15 minute interva ls . I f a f te r r eas onab le enc ourageme nt , the c l ie n t does no t ta ke h is /he r med ic a t ion th is r e fus a l mus t be no t ed in the i r n o tes and in h is /he r MP Char t /CR 21 and adv ic e ob ta ined f r o m a med ic a l p rac t i t ioner as s oon as poss ib le . A ny reas on(s ) for re fus a l mus t a ls o be doc u mented . Th is r ecord mus t be da ted and s igned by the Reg is te red Nurs e /de lega ted s ta f f me mber inv o lved . The med ic a t ion wh ic h has been re fus ed mus t no t be t r ans fe r red bac k in to i ts o r ig ina l c on ta ine r ; i t mus t be s to red in a marked c on ta ine r w i th the s toc k to be re tu rned to the s upp lying Phar mac y. .

21 .2 I f a c l ien t a t tend ing on a da i l y bas is r e fus es to take h is /he r

med ic a t ion a fa mi l y me mber /guard ia n mus t be in fo r med and th is must be doc umented in the c l i en t ’s no tes .

21 .3 W here pers is ten t r e fus a ls oc c ur , o r where ad min is t ra t ion

pos es a d i f f i c u l t y, t h is mus t be addres s ed wi th in a c as e rev iew. Al l r e lev an t peop le mus t be p res en t a t th is r ev iew, where an agreed p l an o f c a re mus t be d ra wn up to ad dres s the p rob le m.


22.0 Cove rt Ad minis tra t ion of Medicat ions When Med ic ine may be g i ven in fo od

22 .1 Crus h ing med ic a t ion and /o r m ix ing med ic ines wi th food o r

d r in k to ma ke i t more pa la tab le o r e as ie r to s wa l lo w – when the c l ien t has c ons en ted to th is - does no t c ons t i tu te c ov er t ad min is t r at ion o f med ic a t ions .

22 .2 Crus h ing med ic a t ion and /o r m ix ing med ic ines wi th food o r d r in k fo r c l ien ts una ware the y a re r ec e iv ing med ic ines bec aus e he /s he lac k the c apac i t y to c ons en t o r wi thho ld c ons en t , does no t c ons t i tu te c over t ad min is t r a t ion o f med ic ines .

22 .3 The s u i tab i l i t y o f the med ic ine to be g iv en in th is way mus t be c hec ked w i th the Reg is te red Med ic a l Prac t i t ioner / Pharmac is t and doc u mented in the c l ien t ’s c a re p lan / to be k ep t w i th the med ic a t ion p res c r ip t ion c har t .

22 .4 C l ien ts r ec e iv ing med ic a t ion ad min i s te red in food o r d r in k

mus t be s uperv is ed un t i l the med ic i ne has been c ons umed.

Procedur e to be fo l low ed w here med icat ions are admin is tered cove rt ly to c l ien ts

Def in it ion : ‘ ‘Cov er t admin is t r a t ion o f med ic ines inv o lv es the ad min is t ra t ion o f a med ic ine d is gu is ed in food o r d r in k to a r es ident who res is ts i t when g iv en open ly ’ ’ 3

22 .5 Med ic ines s hou ld no t be ad min is te red to a c l ien t wi thou t

h is /he r kno w ledge ( c ov er t admin is t r a t ion ) i f t he c l ien t has the c apac i t y to make dec is ions abou t h i s /he r t rea t ment and c a re .

22 .6 Cope Founda t ion rec ogn is es the r ig h t o f ind iv idua l c l ien ts to

r e fus e to take me d ic a t ion . Ho wev er the re a re c e r ta in c i r c ums tanc es in wh ic h c ov er t med i c a t ion ma y be nec es s ary o r appropr ia te , tha t i s , in the c as e o f c l ien ts who ac t iv e ly r e fus e med ic a t ion bu t who a re ju dg ed no t to hav e the c apac i ty to unders tand the c ons equenc es o f h is /he r re fus a l , / o r to p rev en t c l ien ts mis s ing ou t on es s en t ia l t rea t men t .

3 (NHS Oxfordshire Clinical Commissioning Group 2013).


22 .7 In s uc h c i r c ums tanc es and in the abs enc e o f in fo rmed c ons en t , a c as e rev iew is nec ess ary to d is c uss c ov er t ad min is t r a t ion o f med ic a t ion i f : i . A l l a t te mpts a t c onv en t iona l me thod s o f admin is t ra t ion o f

med ic a t ion hav e been uns ucc es s fu l i i . The c l ien t to r ec e iv e the med ic a t ion c anno t or wi l l no t

g iv e c ons en t i i i . I t ma y be nec es s ary to s a fe l i f e i v . I t ma y be nec es s ary to ens ure the i mprov ement and /o r

ma in t enanc e o f the c l ien t ’s ph ys ic a l we l l - be ing v . I t ma y be nec es s ary to ens ure i mprov ement and /o r

ma in t enanc e o f the c l ien t ’s menta l we l l - be ing v i . I t ma y be nec es s ary to ens ure s a fe ty o f o the rs .

• The c as e rev iew s hou ld inc lude : G P/ps yc h ia t r i s t , manager , f a mi l y and an y o t her me mbers o f the mu l t i -d is c ip l ina ry tea m i f requ i red

22 .8 The dec is ion to ad min is te r med ic a t i on c ov er t l y s hou ld no t be

c ons idered rou t ine bu t as a las t r esor t , and s hould be c l ien t s pec i f i c and s hould be rev iewed on a regu la r bas is ( at leas t 6 month l y in te r v a ls ) . Any dec is ion to do s o be mus t be reac hed a f te r d is c uss ion wi th Reg is te red Me d ic a l Prac t i t ioner , C l in ic a l Nurs e Manager , Re gis te red Nurs es , c a re rs , c l ien t ’s fa mi l y and /o r adv oc a te (o r a f te r c as e rev iew) .

22 .9 The c ov er t admin is t ra t ion o f medic ine mus t be doc u ment ed in the c l ien t ’s Med ic a t ion Ad min is t r a t i on Char t / CR 23 N urs ing No tes /CR 19 Med ic a l No tes .

22 .10 The method o f ad min is t r a t ion o f me d ic ines s hou ld be

agreed wi th t he pharmac is t , on whe t her a par t i c u la r med ic ine c an be g iv en wi t h food o r d r i n k, and doc ume nted in the c l ien t ’s Med ic a t ion Ad min is t ra t ion Char t / CR23 Nurs ing No tes /Care P la n. .

22 .11 Cl ien ts rec e iv ing med ic a t ion ad min i s tered c over t l y in h is /he r food mus t be s uperv is ed un t i l med ic a t ion is c ons umed.


23.0 Procedure to fol low in the eve nt o f an acc ident wi th medicat ions (medicat ion er rors/near misses)

23 .1 A med ic a t ion e r ro r ma y inv o lv e the :

o ad min is t r a t ion o f inc o r rec t med ic a t ion , o ad min is t r a t ion o f an inc or rec t dos e , o ad min is t r a t ion a t inc o r rec t t i me , o o mis s ion o f the ad mi n is t r a t ion o f a p resc r ibed med ic a t ion , o ad min is t r a t ion o f a med ic a t ion to th e incorrect c l ien t , o ad min is t r a t ion o f ou t o f date medicat ion , o Admin is t ra t ion by incorrect rou te.

23 .2 Al l e rro rs /near misses must be re ported immedia te ly to the C l in ica l Nurse Manager on duty a nd to the re levant Med ica l Pract i t ioner .

23 .3 The c l ien t mus t be obs erv ed c los e ly and an y Med ic a l adv ic e

g iv en mus t be fo l lo wed .

23 .4 The inc iden t mus t be doc u mented o n an Inc ident Form (CR 53) and th is mus t be s en t to the Cl i n ic a l Nurs e Manager /Manager o f the Un i t / Area , who in tu rn mus t s end th is to the Sa f et y O f f i c e r . The purpos e o f r epor t ing o f e r ro rs /near mis s es is to lea rn abou t the i r c aus es , i mprov e the s ys tem fo r the admin is t r a t ion of me d ic a t ions and the reb y improv e the qua l i t y o f s e rv ic e and the we l l - be ing o f the c l ien t .

23 .5 In the c as e o f day at tendees , the c l i en t ' s fa mi ly mus t be

c on tac ted and in fo rmed o f the s i tua t ion and an y ac t ion tha t ma y be requ i red a t ho me.

23 .6 In the ev en t tha t p resc r ip t ion and m edic at ion

c on ta ine rs /bo t t les do no t matc h , the Reg is te red Nurs e /de lega ted s ta f f me mb er mus t wi thho l d the med ic a t ion and i mme d ia te l y r eques t e i the r :

i . The p res c r ib ing med ic a l prac t i t ioner to r e -wr i te the p res c r ip t ion … .o r … .

i i . The pharmac is t to d is pens e the med ic a t ion ac c ord ing the me d ic a l p rac t i t ioners p resc r ipt ion .

i i i . In fo rm t he Cl in ic a l Nurs e Manager o n du ty .


24.0 Medicat ions tha t must be returned to the Dispensing Pharmacy

24 .1 Unus ed med ic a t ions mus t be re tu rned to the D is pens ing

Pharmac y.

24 .2 Spo i l t med ic a t ions mus t be re tu rned to the d is pens ing Pharmac y fo r s a fe d is pos a l .

24 .3 S ta f f mus t c hec k ex p i ry da tes o f med ic a t ions on a wee kl y

bas is and re tu rn unus ed and ou t-o f -da te med ic a t ions .

24 .4 A l l med ic a t ions re tu rned to a d is pen s ing Phar mac y mus t be rec orded and s igned fo r in the re tu r ns rec ord ing s hee t s upp l ied b y the phar mac is t .

Note – USE OF OUT OF DAT E ME DICAT ION IS AN OFFE NCE.


25.0 Ad ve rse react ions to medicat ions

25 .1 An adv ers e me d ic a l reac t ion is a “ r es pons e to med ic a t ion tha t i s nox ious and un in tended and oc c urs a t dos es norma l l y us ed in ma n fo r p roph y lax is , d iagnos is o r the rapy o f d is eas es o r fo r the res to ra t ion , c o r rec t ion o r mod i f i c a t ion o f ph ys io log ic a l func t ion ” ( 2001 /83 /E C) .

Guide l ines to iden t i fy Adve rse D rug React ions (Adapted from Wo rl d Hea l th Organ isat ion ( WHO) 2008) .

1a ) Shou ld an y adv ers e reac t ion be no ted in a c l ien t ’s c ond i t ion fo l lo w ing ad min is t r a t ion o f an y me d i c a t ion i t mus t i mmed ia te l y be repor ted to the re lev an t med ic a l p rac t i t ioner to s eek fu r the r adv ic e and gu idanc e . The s en io r c l i n ic a l nu rs e manager on du ty mus t a ls o be in fo r med.

1b ) Es tab l is h tha t the med ic a l p repara t i on p res c r ibed is the

med ic a t ion rec e iv ed and taken b y th e c o r rec t c l ien t in the c o r rec t dos age , a t the c o r rec t t ime , and in the fo r m p resc r ibed .

1c ) As c er ta in tha t the s us pec ted adverse med ic a t ion reac t ion

s igns and s ympto ms were no t p res en t p r io r to ad min is t r a t ion o f the med ic a t ion . .

1d ) An ac c ura te rec ord o f the s us pec ted adv ers e med ic a t ion

reac t ion and ac t ions taken mus t be rec orded in the c l ien t ’s no tes . The c l ien t ’s paren ts /guard ians mus t be in fo r med.


26.0 Recording and adminis t ra t ion of med ications.

26 .1 Rec ord ing is an in teg ra l pa r t of the Ad min is t r a t ion o f med ic a t ions . Cope Founda t ion us es Med ic a t ion Ad min is t ra t ion Pres c r ip t ion Char ts (c l ien t MP Char t /CR 2 1 ’s ) as par t o f th is po l i c y ( See Append ix 2 )

26 .2 W hen a med ic a t ion is ad min is te red , the Reg is te red Nurs e /

de lega ted s ta f f mus t de ta i l t he t i me g iv en , the da te and h is /he r in i t ia ls on the re lev an t c l ien ts MP Char t /CR 21. W hen s uperv is ing a S tuden t Nurs e in the ad min is t r a t ion o f med ic a t ions , the Reg is te red Nurs e mus t c lea r l y c oun te rs ign the s igna tu re o f the Studen t Nurs e .

a ) In the ev en t o f the Reg is te red Nurs e /De lega ted s ta f f ma k ing

an e r ro r on the c l ien t ’s MP Char t /C R 21 , the y mus t c ros s ou t the e r ro r onc e - then in i t ia l and date i t .

b ) Medicat ions must neve r be recorded prio r to

admin is t ra t ion . T he Reg is tered Nurse /de legated s ta f f member ’s s ignature estab l ishes a ccountabi l i ty fo r med icat ion adminis t ra t ion .

26 .3 W hen PRN med ic a t ions are ad min is te red , the dos age , reas on

fo r ad min is t r a t ion and e f fec t o f the med ic a t ion on the c l ien t mus t a ls o be doc u mented in tha t c l i en t ' s notes .

26 .4 A rec ord o f kno wn med ic a t ion a l le rg ies mus t be c lea r l y

v is ib le on the c l ien t ’s f i le ( wi th a red t r iang le on the ou ts ide ) and on h is /he r MP Ch ar t /CR 21 . Th ere is a mutua l r es pons ib i l i ty on Reg is te red Nurs es /De lega ted S ta f f t o in fo r m paren ts /guard ians o f any a l le rg ies .

26 .5 Eac h a rea mus t ho ld a c u r ren t l i s t o f s igna tu res and in i t ia ls

fo r eac h reg is te red nurs e /de lega ted s ta f f .

26 .6 The res pons ib i l i t y fo r doc u ment ing a c l ien t ’s med ic a t ion in the c l ien t ’s MP Char t / CR 21 is the reg is te red med ic a l p rac t i t ioner /nu rs e p resc r ibe r .

27.0 Al te rnat ive medications (Vi ta min supplements / homeopath ic medicat ions and essentia l o i ls )


27 .1 There a re oc c as ions where c l ien ts wi l l b r ing a l te rna t iv e med ic a t ions f ro m ho me. It i s es s en t ia l tha t p r io r to ad min is t r a t ion o f thes e med ic a t ions the reg is te red nurs e /de lega ted s ta f f me mber rec e i ves a no te f r om the pers on 's Med ic a l Prac t i t i oner c on f i rming the s u i tab i l i t y o f th is t r ea t ment .

27 .2 A l terna t iv e med ic a t ions rec e iv ed f r om fa mi l y me mbers o f

c l ien ts mus t s ta te on the c on ta ine r /pac ke t /box :

i . C l ien t ’s na me. i i . Na me o f a l te rna t iv e med ic a t ion . i i i . Dos age to be g iv en . i v . Rou te to be us ed . v . T i me o f ad min is t r a t ion. v i . Ex p i ry da te .


28.0 The adminis t ra tion of ove r th e counter Medicat ions (i .e. items purchased without prescrip tion )

28 .1 Med ic a t ions , inc luding fo r ex a mp le : Panado l , Parac e ta mo l ,

Ca lpo l , c ough mix tu res and c o ld remed ies mus t be p res c r ibed . 28 .2 I t i s v e ry i mpor tan t to ens ure tha t th e rec ommended da i l y

dos e o f thes e me d ic ines is no t ex c eeded and that c los e mon i t o r ing o f thes e med ic a t ions ta kes p lac e ( inc lud ing any us e a t ho me o r i n o ther s e t t ings ) p r i o r to the i r ad min is t ra t ion .

28 .3 W here c l ien ts us e thes e med ic a t ion s on a regu la r bas is a

r ev iew wi th the pers on 's Med ic a l Pr ac t i t ioner mus t oc c ur .

28 .4 For th is reas on i t i s i mpera t iv e the dos age is c los e ly mon i t o red th rough e f f ec t iv e c ommu n ic a t ion be t ween a l l pa r t ies inv o lved in ad min is te r ing s uc h med ic a t ion ( i . e . s ta f f in day/ res iden t ia l s e rv ic es and the c l ien t ’s fa mi l y) .

29.0 General Notes

Eac h a rea mus t hav e the fo l lo wing doc umen ta t ion f o r c ons u l ta t ion : o M IMS o Res ourc e book on Med ic a t ions o “Guid anc e to Nurs es and Midw iv es on Med ic a t ion

Manage ment ” ( J u l y 2007 , A n Bord A l t rana is )

Th is po l i c y w i l l be rev iewed annua l l y. Th e nex t r ev iew o f th is po l i c y i s due in Ma y 20 15 . Loc a l a rea / res idenc e s pec i f i c p ro toco ls /p roc edures ma ybe dev e loped but a t a l l t i mes mus t adh ere to th is Po l ic y.


30.0 References:

An Bord A l t rana is , “Gu idanc e to Nurs es and Mid w iv es on Med ic a t ion Manage ment ” ( J u l y 2007) Dubl in : An Bord A l t rana is Bri t ish Nat iona l Formulary ( BNF) B r i t i s h Med ic a l As s oc ia t ion , B MJ Pub l is h ing G roup L td o r PS p ub l is h i ng, London . Th is i s a jo in t b i -annua l publ ic a t ion o f the B MA and Ro ya l Pharmac eu t ic a l Soc ie ty o f Grea t Br i ta in ( www.bn f .o rg ) . Counc i l o f European Co mmun i t ies 2 001, Counc i l D i rec t iv e 2001 /83/EC on Co mmu n i t y Code Re lat ing to Me dic ina l Produc ts fo r Hu man Us e . Brus s e ls : Counc i l o f European Co mmun i t ies . Dough te r y, L & L is te r , S, The Roy a l Mars den Hos p i ta l Manua l o f C l in ic a l Nurs ing Proc edures (ed ) , B l ac kwe l l , 2004 . Nat iona l Counc i l f o r the Pro fes s iona l Dev e lop ment of Nurs ing and Mid w i fe r y ( J une, 2005) Rev ie w o f Nurs es and Mid w iv es in the Pres c r ib ing and Ad min is t r at ion o f M ed ic ina l Produc ts , Dub l in : Nat iona l Counc i l f o r the Pro fes s iona l Dev e lop ment o f Nurs ing and Mid wi fe r y

http://www.bnf.org/


Append ix 1 –Lette r(s ) to Pa rents / Guard ians

Dear Paren t / Guardian ,

To ens ure the s a fe ad min is t r a t ion o f med ic a t ions to your s on /daugh te r wh i le a t tending Cope Founda t ion , the fo l lo wing gu ide l ines mus t be adhered to :

1 ) A l l med ic a t ions s upp l ied b y you mu s t be in a c ur ren t , c lea r ly

labe l led c on ta ine r , f i l l ed b y a phar mac is t .

2 ) S ta f f a t the c en t re /s c hoo l mus t be in fo r med o f an y c hanges to med ic a t ions and a ne w, c u r ren t p resc r ip t ion fo r the med ic a t ion c hange mus t be s upp l ied to the c en t re .

3 ) Cope Founda t ion s ta f f mus t be in fo rmed i f your s on /daugh te r has had any kno wn a l le rg ies to any med ic a t ions .

W e look fo r ward to your c o -opera t ion in th is mat te r . Yours s inc ere ly Bern ie O ’Su l l i v an Head o f Ho mes & Co mmun i t y 2 / D i rec to r o f Nurs ing 12 Ma y 2014


Append ix 1 (a ) – Le t ter to Pa ren ts /Guard ians re short brea k . A le t te r to pa ren ts /guard ians whos e re la t iv e av a i ls o f s hor t b reak s hou ld be s en t annua l ly o r more f r e quen t ly i f needed

Da te : _______ Dear Paren t / Guard ian W e a re de l igh ted to we lc o me _____ ____ to s tay w ith us in _____________ . So tha t we c an p rov ide the bes t s e rv ic e to ________dur ing h is /he r s tay wi th us we requ i re t he fo l lo win g :

• I f your s on /daugh te r /nex t o f k i n is p resc r ibed medic at ion (s ) , the

p resc r ip t ion s upp l ied o r on f i le mus t be up to da te . • A l l p res c r ip t ions mus t be wi th in a s ix month per iod a f te r wh ic h

t i me a new p res c r ip t ion mus t be fu rn is hed to us . • The med ic a t ion p res c r ibed mus t be s en t in to us in the o r ig ina l

pac kag ing /b l i s te r pac k as d is pens ed by your pharmac is t .

• P leas e f ind enc los ed the Cope Founda t ion Ad mi n is t ra t ion Rec ord . Your GP mus t wr i te in an y p res c r ibed med ic a t ions and rev iew ev ery 6 months o r s ooner i f t he re ar e an y c hanges to med ic a t ions .

• W e a re unab le to ad min is te r ana lge s ics , fo r ex amp le

parac e tamo l , c ough bo t t l es , mu l t i v i tamins , un les s thes e hav e been p res c r ibed by the Doc to r and l i s ted on the p res c r ip t ion . P leas e adv is e us o f any a l le rg y tha t your s on /daugh te r /nex t o f k in ma y hav e .

Fa i lu re to c o mp l y wi th th is r eques t w i l l c aus e your s hor t b rea k a l loc a t ion to be d e la yed un t i l t he ab ov e c an be proc ess ed . W e a re happy to d is c uss /adv is e on any c on c erns you may h av e in re la t ion to the p res c r ip t ion and s upp ly o f med ic a t ion . Yours s inc ere ly Nurs e Manager /Pers on in Charge


Append ix 2 – Cl ient Med icat ion P rescr ipt ion Char t (s ) – MP Cha rt /CR 21 ’s

1) CR.21 Med ic a t ion Pres c r ip t ion Char t – Shor t Ter m 2) CR.21 Med ic a t ion Pres c r ip t ion Char t – Long Ter m

3) Cope Founda t ion - M ed ic at ion Pres c r ip t ion Char t (PRN

med ic a t ions , Shor t Ter m med ic a t ion s ) Note : In c en tres where med ic a t ion ad min i s t r a t ion rec ords a re s uppl ied by ind iv idua l d is pens ing phar mac ies , thes e d i f fe r in p res en ta t ion to the abov e , fo r ex amp le MARS rec ording s hee ts .


CR.21 Med icat ion P resc rip t ion Ch art – Short Term


CR.21 Med icat ion P resc rip t ion Ch art – Long T erm


CR.21 Med icat ion P resc rip t ion Ch art – PR N


Append ix 3 - T he more common MDA Schedule 2 & MD A Schedu le 3 Med icat ions Common M DA Sc hedu le 2 Med ic a t ions Class of Cont ro l led medicat ion

Prop r ie tary P roducts

Al fen tan i l Rap i fen Ampheta mine Buprenorphr ine Te mges ic Coc a ine Code ine Dex a mpheta mine Dex edr ine Dex t ro mora mide Pa l f i u m Dih ydroc ode ine DF118 , DHC Cont inus Dip ipanone D ic ona l Fen tany l Sub l i ma ze Hydroc odone Tus s ionex Hydro morphone D i laud id Lev orphano l D romoran Med ic ina l Op iu m ( th is inc ludes Papav ere tu m and Op iu m T inc tu re BP)

O mnopon

Methadone Ph ys e tone Meth y lphen ida te R i ta l in Morph ine C yc l i morph , Mors te l SR ,

MST Cont inus , Oramorph Conc . , Sev redol

Nab i lone Ces a met Pe th id ine Pho loc od ine Phenoper id ine Oper id ine Qu ina lbarb i tone Sec ona l , Tu ina l Su fen tan i l Su fen ta


Common M DA Sc hedu le 3 Med ic a t ions

Class o f Cont rol led Med icat ion

Prop rie tary P roducts

A mylobarb i tone A myta l , Sod iu m Amyta l Bu tobarb i ton e Sonery l C yc lobarb i tone Phanodorm D ie thy lprop ion Ap is a te , Tenua te Dos pan F lun i t ra zepa m Roh ypno l Ma z indo l Teronac Meproba mate Equages ic , Equan i l Me th y lphenobarb i tone Pro minal 20 0 mg Methohex i tone Br ie ta l Pen tax oc ine For t r a l , Fo r tages ic Pen tobarb i to ne Phenobarb i ton e Gardena l Sod iu m 200 mg Phen te rmine Duro mine , Ionami n Te ma zepa m Euh ypnos , Normis on ,

Nor te m, Tenox .


Append ix 4 - Schedule o f Cont ro l le d Med ic ina l Products MD A Schedu le 1

A s pec ia l l i c ens e is r equ i red fo r an y ac t iv i ty in r es pec t o f thes e d rugs . In p rac t ic e , s uc h ac t iv i t ies a re s t r i c t l y l i mi ted to s c ien t i f i c r es earc h o r fo rens ic ana lys is . Ex a mp les o f thes e d rugs a re : c annab is , c oc a lea f , raw o p ium and the ma jo r ha l luc inogen ic drugs (LSD, Mes c a l ine , and Ps i loc in ) .

MD A Schedu le 2

A l i c ens e is r equ i red fo r the i mpor t and ex por t o f thes e d rugs and thos e en t i t led to p roduc e , s upp l y o r pos s ess them are l i s ted . Pos s es s ion wi thou t an appropr ia te author i t y i s an o f fe nc e . A pharmac is t may s upp l y to a pa t ien t on l y on the au thor i t y o f a p resc r ip t ion wr i t ten in the p res c r ibed fo r m. Rec ord -keep ing requ i re ments ( inc lud ing MDA reg is te r ) app l y in fu l l . Des truc t ion mus t be wi tnes s ed and s a fe c us tody ma in ta ined . Ex a mp les of Sc hedu le 2 d rugs a re op ia tes ( morp h ine and hero in ) , a mpheta mi nes and s yn the t ic na rc ot ics ( pe th id ine , methadone , hydroc odone) .

MD A Schedu le 3

Les s s t r i c t c on t ro ls app ly to th is s c hedule o f d rugs . Rec ord keep ing requ i re ments in a MDA reg is te r does no t app ly. Des truc t ion of the d rug does no t ne ed to be wi tnes s ed . The s a fe c us tody p rov is ions a re app l ic ab le to thes e d rugs as a re the c on t ro l led d rug p res c r ip t ion wr i t ing requ i re ments . Mos t ba rb i tu ra tes , s ome po ten t ana lges ic s , minor s t i mulan ts and two benzo d ia zep ines – f lun i t r az epam an d te ma zepa m – are ex a mp les .

MD A Schedu le 4

Cont ro l o f thes e d rugs is mi n i ma l an d in p rac t ic e they s hou ld be s upp l ied in ac c ordanc e wi th the Medic ina l Produc ts (Pres c r ip t ion and Con t ro l o f Supp ly ) Re gu la t ions , 2003 . Rec ord keep ing in a c on t ro l led d rugs reg is te r , the re ten t ion o f inv o ic es and the s a fe c us tody regu la t ions do no t pe r ta in t o d rugs in th is s c hedu le . Mos t benzo d ia zep ines , phenobarb i tone , meth y lphenobarb i tone p repara t ions c on ta in ing les s than 100 mg and Sel eg i l ine a re ex amp les .

MD A Schedu le 5

Th is s c hedu le l i s t s med ic ina l p rodu c ts exempt f r om mos t r es tr i c t ions under the regu la t ions . Inv o ic es regard ing thes e p roduc ts mus t be re ta ined fo r t wo y ears . The l i s t inc ludes :

a ) Prepara t ions (no t in jec t ions ) c on ta in ing c ode ine , n ic oc od ine ,

n ic od ic od ine , no rc ode ine , ac e tyld ih ydroc ode ine ,


e thy l morph ine ph o lc od ine mix ed wi t h o ther s ubs tanc es and c on ta in ing les s tha t 100mg per dos age un i t o r no t more than 2 .5% in und iv ided p repara t ions .

b ) Prepara t ions o f d ih ydroc ode ine (no t be ing in jec t ions )

c on ta in ing no t more than 10 mg per dos age un i t o f d ih ydroc ode ine as bas e and , in the c as e o f und iv ided p repara t ions , no t more than 1 .5% a s bas e

c ) Prepara t ions o f c oc a ine c on ta in ing no t more than 0 .1%

c a lc u la ted as c oc aine bas e

d ) Prepara t ions o f med ic ina l opiu m or morph ine , c on ta in ing no t more than 0 .2 % as c a lc u la ted as anhydrous morph ine bas e

e ) Prepara t ions o f d iphe nox yla te c on ta in ing no t more than 2 .5 mg

o f d iphenox y la te c a lc u la ted as bas e and a quan t i t y o f a t r op ine s u lpha te equ iv a len t to a t leas t 1% o f the dos e o f d iphenox y la te (e .g . Lo mo t i l )

f ) Prepara t ions fo r o ra l ad mi n is t ra t ion c on ta in ing no t more than

135 mg o f dex t rop ropox yphene (e .g . Dis ta lges ic , Do lox ene Co . ) .

“Guid anc e to Nurs es and Midw iv es on Med ic a t ion Management ” (J u l y 2007 , An Bord Al t r ana is )


Append ix 5 – Inc ident Form CR 53






Append ix 6 - Verba l / te lephone med icat ion order fo rm

VE RB AL/T ELE PHONE MEDICAT IO N ORDER FORM C l ien t n a me :________________ ___ _______ D .O. B. ______________ C l ien t I .D. _______________ Loc a t ion : __ ______________ Date :________________ T i me:_________________ Doc to r Na me_____ _______________ Con tac t De ta i l s _________________ _ C l in ic a l e mergenc y: Med ic a t ion Order : Nurs e 1 ______________________ _______ Da te : ______________ Nurs e 2 ______________________ ________ Da te : ______________


Append ix 7 . Se l f - Admin is t ra t ion o f Medicat ion (s ) by Cl ients . To enab le peop le we s uppor t to s e l f - ad min is te r med ic a t ion (s ) p resc r ibed fo r the m, p leas e c o mp le te the fo l l o wing As s ess ment Too l . Sect ion A - C l ien t

1. Deta i ls o f Cl ient Se l f -Admin is teri ng: Name o f c l ien t :

Da te o f Bi r th :

Cur ren t Da y Serv ic e :

Res ident ia l Serv ic e :

2. L is t o f Curren t medicat ion (s ) ( inc l ude rou te i .e . l iqu id , t able ts etc . ) :

Medic a t ion Na me Dos age T i mes o f Ad min is t ra t ion

3. Deta i ls o f p resc rib ing GP: Name: Surger y Addres s : Te lephon e No . : ( Surgery) Mob i le : 4 . Who curren t ly admin is ters the med icat ion? (P lease l is t a l l people ) 1 .

Re la t ions h ip :

2 .

Re la t ions h ip :

3 .

Re la t ions h ip :


5 . Please s ta te the reason(s) w hy med icat ion is necessary: 6 . Does the person w e support have any a l le rg ies? Please T ick Yes or No þ Yes o No o I f Yes , p leas e l i s t : 7 . Does the person you support have any othe r physica l / med ica l condi t ion that may a f fect med icat ion regimes? Die ta r y ( i . e . c oe l iac , ea t ing p rob lems )

Yes o No o

Res p ira to ry ( as th ma) Yes o No o Ep i leps y Yes o No o Other Yes o No o I f Yes , p leas e l i s t : 8 . Are there any factors that w i l l impact on h is /her ab i l i t y to se l f -med icate? Yes No I f Yes , p leas e ex p la in : 9 . Does the person you support w ant to part ic ipate in se l f -med icat ion? Yes No 10 . Does the person ha ve a h is to r y of se lf -medicat ing re l iab ly? Yes No


Sect ion B – Cogn i t ive Sk i l ls fo r S e l f -Admin is t ra t ion o f Med icat ion (s ) L i teracy S k i l ls 1 . Can the pers on we s uppor t r ead? Yes No I f Yes , p leas e g iv e read ing age equ i va len t : R .A . : _________

2 . Can the pers on rec ogn is e the i r n a me as t yped on the med ic a t ion c on ta iner?

Yes No

Nume racy S k i l ls Is the pers on ab le to rec ogn is e wr i t t en numbers ?

• (Tes t on s a mp le ins t ruc t ions s uc h as “ t ake 2 tab le ts 3 t i mes a day ” )

Yes No

2 . Can the pers on c oun t? Yes No P leas e t i c k bes ide nu mber to ho w h i gh the y c an c oun t 1 2 3 4 5 6 7 8 9 1 0 11 12 13 14 15 16 17 1 8 19 20 Siz e Can the pers on d is c r i mina te b y s i ze ?

• (Tes t b y p res en t ing a “ l i t t le ” and “b ig ” t ab let and as k the pers on to s ho w you the s ma l l and la rge tab le t ov er a number o f t r ia ls )

Yes No

Colour Can the pers on read i ly iden t i f y c o lo u r?

• (Tes t c o lou r r e l iab i l i t y on a t leas t 4 - 5 d i f fe ren t c o lou r tab le ts e .g . wh i te , p in k, ye l lo w, b lue , t wo tone b y matc h ing c o lou red c a rds to c o lou r tab le t , o r b y as king the pers on to po in t to the na med c o lour , r epeat ing th is 2 -3 t i mes to ens ure c ons is tenc y)

Yes No

Shape Can the pers on d is c r i mina te b y s hape o f med ic a t ion?

• ( to Tes t , p res en t tab le t /p i l l and c aps u le in r ound and ov a l fo rma t and as k the p ers on to po in t to the c o r rec t s hape when n a med)

Yes No

L iqu id I f t he pers on is on l iqu id s us pens ion s how the p ers on two o r more bo t t les and as k the pers on to p ic k t he i r bo t t le . I f t he l iqu id s us pens ion has to be meas ured ou t , does the pers on demo ns t ra te an ab i l i t y to p repare the c u r ren t dos age?

Yes No

Sect ion C – Communicat ion Sk i l ls


Express i ve Language 1 . Can the pers on ta l k f r ee l y? Yes No 2 . Does the pers on in i t ia t e c o mmun i c a t ion wi th o thers ?

Yes No

3 . Does the pers on as k fo r he lp whe n the y need i t? Yes No Recept ive Language 1 . Can the pers on fo l lo w s i mp le one -s tep ins t ruc t ions ? Yes No

Yes No

2 . Can the pers on fo l lo w c o mp lex ( two o r more s tep ) ins t ruc t ions ? Yes No

Yes No

T ime 1 . Can the pers on re la te t i me to da i l y ev en ts ( e .g . mea l t i mes )?

Yes No

2 . Does the pers on kno w what t i me to ta ke h is /he r med ic a t ion?

Yes No

3 . Can the pers on rec ogn is e and ex p la in the wr i t ten t i me on med ic a t ions ? (e .g . 8 .00a m, 1800p m e tc . )

Yes No

4 . In the c as e o f P .R. N. ’s , c an the p ers on deduc e the nex t dos age t i me? (e .g . ev ery fo u r hours )

Yes No

Phys ica l Ba r rie rs 1 . Can the pers on ge t and open med ic a t ion? Yes No 2 . Can the pers on c hoos e and pu t awa y med ic a t ion?

• ( hav e the pers on demons t ra te th is sk i l l ; c hec k wha t adap ta t ions /as s is t iv e tec hno logy c an be us ed to d i min is h ph ys ic a l ba r r ie r s e .g . p lac ing med ic a t ions in one un i t c on ta ine r )

Yes No

3 . Does the pers on wear eye g las s es o r c on tac t lens es ?

Yes No

4 . Is the pers on v is ua l ly i mpa i red ? Yes No 5 . Does the pers on wear a hear ing a id? Yes No 6 . Is the pers on hear ing i mpa i red? Yes No 7 . Can the pers on ge t a d r in k to ta ke wi th the med ic a t ion?

Yes No

8 . Does the pers on hav e any d i f f i c u l t y s wa l lo wing? Yes No


Heal th Se l f - Main tenance 1 . Does the pers on kno w bas ic f i rs t a id? Yes No 2 . Does the pers on kno w the des i re d e f fec t o f eac h med ic a t ion?

Yes No

3 . Does the pers on kno w the pos s ib le adv ers e e f fec ts o f eac h med ic a t ion?

Yes No

4 . Does the pers on rec ogn is e an emergenc y s i tua t ion?

Yes No

5 . Does the pers on kno w what to do in an e mergenc y?

Yes No

6 . Can the pers on us e a te lephone o r mob i le phone?

Yes No

7 . Can the pers on s tate h is /he r na me? Yes No 8 . Can the pers on s tate h is /he r addr es s ? Yes No 9 . Can the pers on s tate h is /he r pho ne nu mber /mob i le phone n u mb er?

Yes No

T hank you fo r t ak ing the t ime to complete this assessment too l . P lease t ick the cond i t ions under w h ich a named service use r can se l f -med icate : Is c o mpeten t t o s e l f -med ic a te wi tho u t s uperv is ion Yes Is c o mpeten t t o s e l f -med ic a te wi th s uperv is ion Yes Is c o mpeten t t o s e l f -med ic a te wi th v e rba l /ph ys ic a l p ro mpts

Yes

Is no t c apab le o f s e l f - med ic a t ion a t the p res en t t i me , bu t migh t do s o g iv en t ra in ing

Yes

Is no t c apab le and is un l i ke l y to do s o a t any s tage Yes N.B . I t w i l l be necessary to reasse ss a person(s ) capac ity to se l f -adminis ter the i r med icat ion (s ) a t regu lar in ter va ls .

Name o f Pers on Co mple t ing t h is fo rm (b loc k l e t te r s )

S igna tu re :

Date o f th is Rev iew:___________

Da te o f Nex t Rev iew : ________

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Policy and Procedures on the Administration of Medication & Standards/Policies for Website... · Date printed 12-Jun-14 Version 11.0 Policy and Procedures on the Administration of