Medicines Management

1. Medicines Management Training Day for Managers, Seniors & Support Workers

2. Why are you here? • Revised Medicines Management Guidance implemented by SBC. • Significant change to current practice – Service users will now be assessed for the medication support they require. • Support Staff will be administering a range of medicines from original packaging. • Training required to meet Care Inspectorate Guidance.

3. So-why do we need training? • To learn the right way to administer medicines • To be in line with the new Medicine Management Guidance • Build confidence • Equity of access • So questions can be answered

4. Today • Four modules: • Policy & Guidance • Medicines and their use • Monitoring & Supporting use • Medicine & Older people

5. Competency • A multiple choice questionnaire will be part of your training to test your knowledge and understanding. During this training • A Competency Assessment will be carried out by your supervisor. In your place of work at a later stage. • Your Line Manager must advise you before you can start administering Medicines.

6. Medicines Management Policy and Guidance

7. Session 1 • Policy on medicines • Medicines and the law • Medication Assessment and levels of support • Self administration • Administration of medicines • Awareness of MDS systems • MAR charts and record keeping • Medication Errors • Session 1 Evaluation Exercise

8. National Care Standards Standards for each Registered Service Area: • Care at Home • Care Homes • Support Services (Day Services) Standards make reference to what service users should expect from services - includes support with medication (Workbook Appendix 1) Page 71 of workbook

9. Scottish Social Services Council Codes of Practice Codes of practice for social service workers and employers of social service workers describing the standards and conduct of practice within which they should work. Pg 75 of workbook

10. Activity 1 Page 6 of workbook

11. The Law • The law states that anyone can administer a medicine to another person if that is in accordance with the directions of a prescriber. (The Medicines Act 1968)

12. On whose authority am I giving this medicine Prescription written Support worker administers prescription Support worker writes in support plan Support worker picks up prescription Pharmacist dispenses prescription

13. Authority to Administer Medicines • A Medicines Administration Record Chart is NOT an authority to administer. • A Palliative Care Medicines chart signed by a Doctor is an authority to administer. • Sign the prescription (look at both sides) when it is picked up and to document this in the Service user’s support plan. • If they are not prescribed they may not legally be administered. • Document medication on delivery to service user.

14. Medicine Management Guidance • In place to promote the safety and wellbeing of the service users and ensure safe practices of all support staff . • All support staff must be aware and understand their role and responsibilities while working with medicines.

15. Activity 2 Page 8 of workbook

16. Procedure for Service User Medicines Management • See Guidelines • Appendix 1 • Appendix 2 • Appendix 3, 4, 5

17. Administration Levels (Full Details in Workbook)(See Appendix 2 of guidelines) • Assessed at Level 1 – Service Users will retain full control of their medication. • Assessed at Level 2 – Service Users will maintain overall responsibility but will require assistance with prompts to take their medicines and collection of prescriptions.

18. Support Worker Tasks at Level 2 • Reminding the patient to take medicines– prompting • Confirm the reading of labels. • Provide assistance with opening medication packaging Performing and interpreting blood glucose monitoring. Order repeat prescriptions from the medical practice. The service user must specify the name, strength and quantity of the medicines to be ordered. • Collect the prescription from the medical practice, take it to the nominated pharmacy for dispensing and collect the dispensed medications from that pharmacy.

19. Assessed at Level 3 • Service Users are unable to manage their own medication and will require their medicines to be administered. • Medicines to be administered will be listed on a specific chart “Medicines Administration Chart” (MAR). • The MAR chart is provided by the Pharmacist who dispenses the medicines. • The MAR chart is supplied monthly along with the supply of medicines.

20. Support Worker Tasks at Level 3 • Only those medicine management tasks that have been agreed by the service user or his/her representative and are specified in his/her support plan may be undertaken. • Support Staff can Administer those medications that are listed on the medicines administration record, including those contained in a Medicines Compliance Aid (MCA) filled by a Pharmacist or a Dispensing Doctor

21. Level 3 - Support Worker Tasks • Care at Home Staff are not permitted to administer “as required” medication for service users assessed at Level 3. • In care homesmedicines that are prescribed on an ‘as and when required’ basis may be administered provided that it is listed on the medicines administration record (MAR) with full instructions as to the frequency of administration and the maximum daily dose. This should be clearly documented in the support plan.

22. Warfarin • CARE AT HOME STAFF SHOULD NOT ADMINISTER WARFARIN • In Care Homes the GP practice may give verbal instruction over the phone or in person to the Senior Support Worker on duty and they should repeat the instruction back to the GP practice to ensure clarity. This then needs to be recorded in the Social Care & Health recording notes and in the Warfarin Dose and INR Recording Form. This form should be stored along with the service users MAR record and the MAR record should read “as prescribed on WD/INR/Form”.

23. Don’t Forget • Right Person • Right Medicine • Right Dose • Right Time • Right Route

24. Those Assessed at Level 4 • Administration requires medical training and knowledge

25. Who Does What? • Relevant training done by all support workers • Assessment of need – by care manager/Parmacist • Support plan – added to by everyone • Consent – from the service user or their legal representative www.sehd.scot.nhs.uk/mels/HDL2006_34.pdf • Medication Administration Record (MAR) Chart – pharmacist produces • Medicines Administration Record (MAR) Chart – support worker writes on it

26. SUPPORT WORKER’S RESPONSIBILITY Check the service User’s support plan And Medicines Administration Record Chart or Kardex and get all The medicines ready Service user Sitting up preferably Level 2/ 3 Wash hands Put medicine away, check if They need ordered Check Identity Sign medicines Administration Record if level 3 Offer a glass of water Measure and Give dose(s) order

27. CARE MANAGER’S RESPONSIBILITY Remember Consent Service user is assessed by Support manager For level of medicines administration needed Level 1,2,3, or 4 agreed Support plan written Detailing Support level And Community Pharmacy address Community Pharmacist asked for MAR chart, if level 3 All instructions will Need to be very Clear on the MAR So they will be understood Support worker checks the service User’s support plan And Medicines Administration Record Chart

28. Administration of Medicines • Preparation is important • Wash hands, • MAR chart, - look at the time of day it is • Medicines – select the ones needed • Administer, remember to offer a drink • Record – exactly what you administered and when • Put away – making sure that those needed are ordered • Wash hands – washing hands is the thing that has been shown to reduce transfer of infection the most.

29. Important points to note • If you are unsure about the service user’s identity or there is a discrepancy with medicines or the instruction is not clear then do not administer - contact your line manager immediately. . Do not handle medication: disposable gloves should be worn as an extra precaution when administering cytotoxic medication. • Push tablets out of blister packs directly into a medicine pot or other receptacle used for this purpose. • You must not administer medicines which are not prescribed on the MAR chart. • You must report immediately if medication that should have been administered previously has been missed by another worker. • You must report immediately if when administering you notice a missing signature on the MAR

30. What Does a Medicines Administration Record Chart look like?

31. This is what some Of the Medicines Administration records look like. Others will be similar.

32. Activity 3 Page 19-22 of workbook

33. Administering Tablets or Capsules • Tap from the container, or pop out of the blister, into a lid or small cup or the service user’s hand • Should not be touched by your bare hands • Service user should be offered a half glass of cool, but not too cold, water to help with swallowing

34. SOLUBLE/DISPERSIBLE ORAL FORMULATIONS • Take the dose from its original container • place in a third of a tumbler of cold water and allow to dissolve • swirl the solution gently in the glass to ensure adequate mixing • hand to the client to drink and offer a drink after the dose has been taken • SUBLINGUAL FORMULATIONS - under tongue • BUCCAL FORMULATIONS – between cheek and upper teeth

35. LIQUID ORAL DOSE FORMULATIONS Only one liquid bottle should be open at any one time. §shake the bottle §measure the correct dose – How? §offer the medicine to the patient §when using an oral dose syringe empty the syringe slowly onto the tongue, or towards the cheek AVOID ‘SQUIRTING’ INTO THE BACK OF THE THROAT §clean the neck of the bottle with a clean damp tissue before replacing the cap

36. TOPICAL (EXTERNAL) FORMULATIONS • use only as often as instructed • apply only to the areas of the skin for which it has been prescribed -support plan • use the smallest quantity that will easily rub into the skin • use only for as long as instructed and return partly used tubes to the Community Pharmacy for safe disposal at the end of the treatment period

37. APPLICATION OF EXTERNAL PREPARATIONS • Look at Patient Information Leaflet (PIL) • wear disposable gloves • Transfer quantity required to gauze or clean tissue and re-seal tube • Apply to affected area rubbing in if needed • Dispose of gauze and gloves in sealed polythene bag in the general waste.

38. EYE PREPARATIONS, Drops • Tilt the head back and gently pull down the lower lid asking the client to look up • Bring the dropper close to the eye • Gently squeeze the dropper allowing the prescribed number of drops to be placed inside the lower lid • Ask the client to close the eye and then blot away any excess solution with clean cotton wool • Replace the cap on the container immediately after use • May Cause blurred vision – falls risk

39. Eye Ointments: • Tilt head back • Gently pull down lower lid • Apply half an inch of ointment • Ask service user to close eye and blink several times • May cause blurred vision – falls risk • Replace cap immediately after use • Expiry of eye products

40. Ear Preparations • Tilt head to one side • Place prescribed number of drops/ applications in the ear • Keep head tilted for several minutes • Have cotton wool or tissue to absorb any run off

41. Nasal Drops • Ask client to blow nose • Tilt head back or ask client to lie down • Ask service user to breath through mouth • Place prescribed number of drops in nose • Ask service user to keep head back or remain lying down for several minutes • Tasting the drops is no cause for concern

42. Activity 4 Page 19, 23-25 of workbook

43. Mistake? What do you do? • Anyone can make a mistake • Reporting - no blame culture, near misses • Documentation • Learning from Audit • Wrong drug • Wrong dose • Wrong strength • Wrong time

44. Activities 5,6 & 7 Page 19, 26-28 & 29-30 of workbook

45. Alcohol & medicine What do you do?

46. MCQ’s