Medicine Matters

1. Medicine Matters Training programme in medicine management for carers

2. Introduction Medicine must be taken by: • Right person • Right dose • Right time • Right way

3. Learning Objectives • Understand carers role • Understand good practice • Understand problems • Understand and follow instructions • Understand and follow additional instructions • Identify side effects • Record • Know where to get help

4. Errors happen when • Lack of understanding of purpose and use • Believing more is better • Physical impairment • Confusion • Forgetfulness • Side effects unpleasant • Unhelpful comments

5. Errors continued • Failure to get the medicine • Poor storage • Old medicines

6. Roles & Responsibilities • Only trained carers can assist with medication • Only when authorised by managers • Consent from service user • Only those medications which have been prescribed with specific instructions

7. Needs assessment • The level of help needed will be assessed by GP practice • Sometimes in consultation with home care managers

8. Level 1 user • Can take full responsibility for her/his own medication

9. Level 2 user • Assistance with ordering, collection and disposal • Confirming reading of medicine label • Opening containers or strip packages

10. Level 3 user • Needs assistance with administration of oral dose medicine, some topical preparations and other types of medication where approved, e.g. eye drops

11. Taking the medicine what next? • Swallow • Stomach • Intestine • Blood • Eliminated Amount of medicine eliminated = amount of medicine absorbed

12. Types of medications • How many can you think of? Pills & capsules powders Liquids Patches Creams Drops Gels Sprays Inhaled Intravenous Subcutaneous Pessaries, suppositories.

13. Help is permitted with • Tablets • Liquids • Creams • Drops* • Gels* • Sprays* • Pessaries micro enemas* *with advice from primary health care team

14. Help is not permitted with • Intravenous medication • Subcutaneous medication • Diabetes testing

15. Risk Factors • What can go wrong? Forgetting to take it Taking too much, too little Taking wrong one Taking someone else’s

16. Risk factors • People factors Sensory Impairment Dementia Physical disability

17. Risk factors • Medication factors Unclear instructions Pills look alike Packaging hard to open

18. Ordering & Collecting Medication Level 2 user • Must request the carer to order • Must indicate what medicine, the strength and quantity. Level 3 user • Only medicines listed on the chart may be ordered

19. Storage of medication General • Safe • Cool & dry out of sun • Original containers • Some in fridge

20. Storage of medicines to be administered by carer • Keep together in sealed container labelled • Chart to be kept in care plan or alongside • Look for special storage instructions • Medicine in fridge to be kept separate from food • Oral medicine separate from external

21. Disposal of medication • Never throw into public waste system • List unwanted medicine on disposal form signed by client • Return to pharmacy • Get signature

22. Dispensing Labels • How to take the medicine what would you expect to find? Date of dispensing What is it and how much is there - strength Name DOB Pharmacy address Dosage amount When to take How to take Storage instructions * Expiry date may be on but is not a legal requiremnet

23. Additional instructions • Swallow whole Do not crush • Take before or on empty stomach 30 minutes • Take after food 30 minutes • Take regularly complete course Same times

24. Additional instructions • Take with or after food During meal • Do not take indigestion remedies at same time Minimum of 30 minutes preferably 2 hours • Dissolve or mix with water Ensure fully dissolved

25. Additional instructions • Allow to dissolve under tongue • Take with plenty of water Glassful • Apply sparingly No coating on skin about fingertip to cover size of a hand • Rinse mouth after use E.g. steroid inhalers may cause thrush • Shake the bottle Do it thoroughly

26. Ambiguous instructions or none! • When (or as) required • As directed • As before • No instructions Do not administer unless the instructions are clear

27. Side effects • List as many as you can think of Nausea - stomach upset Tiredness Motor function affected – dizzy – unsteady Hallucination paranoia Leg cramps Skin itching, skin pallor

28. Side effects Rashes Headaches Confusion Constipation – diarrhoea Restlessness Mood changes General aches and pains

29. Over the counter medicines List the types that client may buy or you may be asked to buy for them • Pain killers • Indigestion remedies • Cold remedies including vapour rubs e.g. Vick • Anti histamines • Laxatives • Vitamin supplements

30. Over the counter medicines • Homeopathic medicines • Cough medicine • Rub ins e.g. rheumatism • Steroid nasal sprays • Eye nose and ear drops • Herbal remedies • Antiseptics Check with pharmacist before buying OTC remedies

31. Documentation • Must be completed before assistance can be given • Self medication assessment • Medication permission (level 3) SHCO • Medication chart (level 3) GP team

32. Documentation • To be completed by carer • Medication administration chart (level 3) • Medicines disposal chart

33. Documentation emergencies • Emergency procedures form GP team • Action on reverse of medication chart GP team • Administration on reverse of medication administration record

34. Administration Practice All Formulations • Clean and tidy space • Wash hands • Check medicine has not been given • Select medicine to be given • For each item, read the label, compare with medication chart • Assemble medicines to be administered.

35. Administration Practice • Put medicine packages back into containers • Administer • Complete the administration record sheet • Wash your hands

36. Administration Practice Solid oral dose formulations (pills and capsules) • Transfer the correct number of units into a clean container without touching them • Prepare a drink of cold water • Ensure client is upright and comfortable • Hand the client the container and drink

37. Administration Practice • Ask client to take a sip of drink then place medicine on the middle of the tongue and swallow with remaining drink chin slightly down • Ensure dose had been swallowed • Encourage client to finish drink • If client cannot take medicine themselves use a spoon not your hands

38. Administration Practice Liquid oral dose formulations • Shake the bottle • Measure the correct dose • Offer medicine to client • If using oral dose syringe expel liquid to the middle of tongue NOT back of throat • Clean the bottle with damp tissue before replacing lid

39. Administration Practice Soluble dispersible formulations • Measure dose from original container • Place in a third of tumbler of cold water • Swirl the solution gently in the glass to ensure adequate mixing • Hand to client and offer drink afterwards

40. Administration Practice Sublingual formulations • Place tablet under the tongue and leave to dissolve Buccal formulations • Place the tablet high up between the upper lip and the gum on either side of the front teeth and leave to dissolve

41. Administration Practice Topical (external) preparations • Use only as instructed • Apply only where prescribed • Smallest quantity that will easily rub in • Use only for as long as stated • Return partly used tubes • Wear disposable gloves

42. Administration Practice • Transfer the quantity needed to a gloves • Gently rub into the skin • Dispose of gloves in a sealed polythene bag and place in general waste container

43. Administration Practice Eye Ear & Nose preparations • When approval has been given for carers to administer these s/he MUST be given a practical demonstration by the community nurse • Good practice guidance is in packs

44. Good Practice Points • Clean, tidy and systematic work reduces risk of errors • Good hygiene practice at all time never touch medication with your hands • Seek advice if in doubt • Never administer unless competent to do so • Always read the label, read what is written not what you expect to be there