Managing Medicines Laura Bucknell Lead Pharmacist May 2012

1. Managing Medicines Laura Bucknell Lead Pharmacist May 2012

2. Medicines • POM (Prescription Only Medicine) Patient can only obtain the medicine with a prescription • P (Pharmacy Medicine) Medicine available through a pharmacy. It can only be sold under the supervision of a pharmacist • GSL (General Sales List) Medicines can be sold in general shops as well and in pharmacies

3. Often, P and GSL medicines are called Over the Counter (OTC) Medicines. • Some medicines are GSL in small quantities, but P in larger quantities or strengths e.g. paracetamol, ibuprofen. • GSL medicines and P medicines are aslo able to be prescribed

4. Authorisation to supply and/or administer • Patient Specific Direction (PSD) • Patient Group Direction (PGD)

5. Patient Specific Direction (PSD) • used when a patient has been assessed by a prescriber and instructs another health care professional in writing, to supply or administer a medicine directly to a named patient or to several named patients. • A prescriber can be a doctor, dentist, independent non medical prescriber or supplementary prescriber Examples – correctly completed drug chart for administration, FP10.

6. Patient group Direction (PGD) • A Patient Group Direction (PGD) allows specified registered health care professionals to supply and / or administer a medicine directly to a patient with an identified clinical condition without the patient necessarily seeing a prescriber. • Generally used to manage specific treatment episodes where supply/administration of a medicine is necessary for example unscheduled care. • not appropriate for managing an individual patient’s condition over the long term where a prescribing relationship with a prescriber is more appropriate.

7. As assistant practitioners you can administer medicines • which have been prescribed by an authorised prescriber • Prescribed for an individual patient • You are trained and competent to do so • The role of administration has been delegated from a registered professional Assistant Practitioners CANNOT administer medicines under a PGD

8. POPAM • Care Service’s Policy for Ordering, Prescribing and Administration of Medicines • Must be familiar with and operate within POPAM

9. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

10. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

11. Right Patient? How can you /should you ensure the correct identification of a service user? POPAM states: ‘The identity of the patient must be confirmed. For inpatient units the wristband and prescription chart should be checked. In the community or if no wristband is available, then the identity must be checked using verbal checking of patient’s name and date of birth’.

12. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

13. Right Drug • Check the medication name carefully. • Make sure you read what is actually there not what you think is there! • Commonly confused drugs:

14. Check the formulation LiquidsMultiple Routes • Suspensions e.g. salbutamol • Syrups - tablets - SR tablets - inhalers - combination inhalers - injections - nebules Controlled Release • MR Drops • SR - eye • XL - ear • XR - nose

15. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

16. Right dose • Double check • Check the dose on the drug chart vs the strength of the medication • Dose calculation e.g. drug charts states: Furosemide 80mg in the morning Furosemide box states ‘40mg tablet’ How many tablets are required?

17. Measuring liquid medication • If less than 5mls use an oral syringe • Consider how many 5mls spoonfuls are required to give the correct dose e.g paracetamol 250mg/mls Dose = 1g four times a day How many 5ml spoonfuls?

18. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

19. Right time • Abbreviations • OD– daily • BD – twice a day • TDS – three times a day • QDS – four times a day • Double check the times marked on the drug chart • Special attention to ‘when required ‘ medicines to ensure the maximum daily dose is not exceeded

20. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

21. Right route • Some medicines are formulated for various routes: • - salbutamol- tablets, inhaler, injection, nebules • Some drops are for administration by more than one route e.g. betamethasone drops for eye, ear or nose • Tablets – oral, vaginal, sublingual

22. 6 Rights of Meds Administration RIGHT DOSE RIGHT PATIENT RIGHT TIME Safe Medicine Administration RIGHT DOCUMENTATION RIGHT DRUG RIGHT ROUTE

23. right documentation • By law medicine administration must be documented • The exact time and date of the administration and the name of the prescriber and the person administering must be recorded • Record of administration - initial the drugs chart to indicate administration OR - Annotate the chart to explain why the medicine was not administered

24. Medication not administered must be recorded Patient refuses A Patient not present B Medicine not available C Instructions not clear or legal D Patient self administering medication/or prepared for Patient to self administer E Nil by mouth F Asleep/comatosed/drowsy G Unable to swallow H Vomiting/nausea J Time varied on doctor’s instructions K • Venflon not insitu or not patent L • Other (Specify in review notes) M

25. The 6 rights • If a person administering a medicine is unsure of the drug , dose or regime- do not guess. Check with a second person prior to administration • Never administer a medicines you do not know about • Part of the administration is ensuring the patient actually takes the medication

26. Principles of medicines administration apply to all individuals who administer medicines whether a registered practitioner or not

27. General Standards for Safe Medicine Administration • Only administer from a valid prescription • Do not administer from illegible, incomplete or unclear prescriptions • Check the identity of the service user • Know the general therapeutic use of the medicines they are administering (normal dose range, side effects, precautions etc) • Be aware of the patient’s care plan • Check the expiry date of the medicine • Check the allergy status of the patient • After administration check the medicine has been taken • Complete the administration record

28. Covert Administration • By disguising medication in food or drink, the patient/client is being led to believe that they are not receiving medication, when in fact they are. • Must be in the best interests of the patient/client • a clear distinction should always be made between: -Those patients/clients who have the capacity to refuse medication and whose refusal should be respected -Those patients/clients who lack capacity • Any decision regarding covert administration must be made with the MDT and the carers/relatives

29. 2 staff administration • Certain procedures e.g administration of controlled drugs, IV drug administration –best practice for 2 registered nurses to check all aspects • POPAM allows in certain circumstances one registered nurse and another suitably trained member of staff or a relative/carer to carry out the check

30. Controlled drugs • Some prescription medicines contain drugs that are controlled under the Misuse of Drugs legislation e.g morphine, benzodiazepines • Stricter legal controls apply to controlled medicines to prevent them being misused, causing harm or being obtained illegally. • These controls govern how these drugs are obtained, stored, prescribed, supplied and disposed of.

31. In the community medication is the property of the person it is prescribed for • CS have procedures in place for stock checking Controlled drugs in patient home • To protect staff

32. Patches • Disposal of a used patches containing Controlled Drugs e.g. fentanyl, bupronorphine: • Patches removed from patients should be folded in on themselves, place back in the packaging and disposed of in the household waste. • Gloves should be worn during this process • Different process for inpatient units

33. Unwanted medicine • Patient medication in the community is the personal property of the patient. • Community staff should not offer to remove unwanted out of date medication but should advise the patient/carer to take to a community pharmacy for safe disposal. • In exceptional circumstances when this is not possible and leaving the medication in the home would be a risk, a risk assessment should be carried out by a registered particitioner before removing medication from the home and taking to a community pharmacy. This must be documented this in the patient’s notes

34. Risk • Medication errors are the third most common incident reported to the NPSA • 72,000 medication incidents were reported to the NPSA from Jan- Dec 2007 • Majority have cause no or low harm but are important tools for learning (NPSA 2009)

35. If things go wrong • Tell someone • Well being of the patient is paramount • Complete a datix (be sure you are familiar with the incident reporting procedure) • Incidents are followed up and investigated NOT to apportion blame but to allow others to learn and minimise the risk of someone else making the same mistake

36. Any Questions?

37. contact details Laura Bucknell 08456 598200 07909533414 Laura.bucknell@glos.nhs.uk