Handling of Medication

1. Handling of Medication Jane Hancock DipClinPharm BPharm MRPharmS

2. NEWS HEADLINES Seven in ten care home residents is 'victim of drug error',The Daily Telegraph, October 6 2009 Fears over care home drug errors, BBC News, October 6 2009 Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009 More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009 Elderly hit by muddles over drugs, Daily Express, October 6 2009

3. Medication errors affect three quarters of care home residents 6 October, 2009

4. Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people The University of Surrey, in conjunction with the London School of Pharmacy and Leeds School of Pharmacy Qual Saf Health Care 2009;18:341-346 doi:10.1136/qshc.2009.034231

5. Study Details • 55 Care Homes • 256 Service Users • Average of 8 items of medication each

6. Findings • 178 (69.5%) of Service Users had one or more errors • 57 Service Users had 116 administration errors, including being given the wrong dose of medication or not being given their medication at all

7. Contributing Factors • G.P.s not readily accessible • Did not know the service user • Lacked information in the homes when prescribing

8. Contributing Factors • Home Staff had high workload • Lack of medicine training • Interruptions during medicine rounds • Lack of team work between Home, Surgery and Pharmacy • Inefficient ordering systems • Inaccurate medication records • Verbal communication

9. Conclusion from the study • "People in care homes are a frail and vulnerable population at particular risk from medication errors, and it is a cause for concern that two-thirds of care home residents in this study were exposed to one or more errors."

10. How can this be improved?

11. The five rights of administration • Right service user • Right medicine • Right dose • Right time • Right route

12. Types of medicines • Systemic • Topical

13. Systemic medicines - One Oral medicines - Solid dose forms - Tablets and capsules - Soluble/dispersible/effervescent tablets - Lozenges - Enteric coated tablets - Sustained release tablets and capsules - Liquid dose forms - Solutions - Syrups - Suspensions • Mixtures • Linctus

14. Systemic medicines - Two • Rectal medicines • Injections • Medication given via PEG tubes • Transdermal Patches

15. Topical medicines • Eye, ear, nasal drops • Creams and ointments • Inhalers • Rectal medicines • Vaginal preparations

16. Applying topical medicines • Just as important as oral medicine • When opening new tubes or drops etc. always record opening date • Unless labelled otherwise the general guidance is: - Jars - discard one month after opening - Tubes - discard three months after opening - Eye drops and eye ointment - discard four weeks after opening

17. * * Measure the dose - Liquids Read at the bottom of the Meniscus Giving the medicines - One • Be prepared • Check the medicine record • Find the medicine • Measure the dose* • Check the label

18. Giving the medicines - Two • Take the medicine to service user • Check service user is the correct person • Make sure they are in an upright position

19. Giving the medicines - Three • Give the medicine • Offer a drink • Record immediately what has been given or declined

20. MARR sheet

21. Medication Administration Records and Request (MARR) TRACK MEDICATION – EVERY SERVICE USER – RECORD IMMEDIATELY The Home is expected to carry out a minimum of five audits: 1. Quantity received audit 2. Quantity disposed audit 3. Administration audit 4. Ordering audit 5. Information audit Therefore: Medication Containers & Labelling + Reminder Cards + MARR + Returns Book = FULL AUDIT TRAIL

22. Storage • Locked cupboard or trolley • Cool, dry room • Key security • Self medicator’s medicine • Fridge temperature • Oxygen

23. Waste Medication • Hazardous Waste Regulations 2005 • Care Homes classed as domestic waste record and return to Pharmacy • Care Homes with Nursing classed as industrial waste collected from home by specialised waste contractor e.g. Cannon, PHS

24. Controlled Drugs • Medicines Act 1968 • Misuse of Drugs Act 1971

25. Service User’s name & address Age (if under 12) Name of Medicine Strength Dose Form Quantity (in words and figures) Dose Doctor’s Signature Prescribing Date Requirements of a Controlled Drug Prescription

26. Must comply with Misuse of Drugs (safe custody) regulations Made of steel 5 lever or 6 pin lock Fixed to a solid wall or a wall that has a steel plate mounted behind it Fixed with rag or rawl bolts Storage of CDs

27. Controlled drugs Register

28. The five rights of administration • Right service user • Right medicine • Right dose • Right time • Right route

29. NEWS HEADLINES Seven in ten care home residents is 'victim of drug error',The Daily Telegraph, October 6 2009 Fears over care home drug errors, BBC News, October 6 2009 Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009 More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009 Elderly hit by muddles over drugs, Daily Express, October 6 2009