Sheena Helyer 12.2012 BA.RGN.DN. PGCE. Nurse Prescriber.

1. HSC 3047: Part 1Support the use of medication in social care settings:Legislation, classification and responsibilities Sheena Helyer12.2012 BA.RGN.DN. PGCE. Nurse Prescriber. Photos supplied by: gename.fieldofscience.com, allcareprofessionals.com

2. Learning outcomes for HSC 3047 Understand the legislative framework for the use of medication in social care settings. Know about common types of medication and their use. Understand roles and responsibilities in the use of medication in social care. Understand techniques for administering medication. Receive, store and dispose of medication supplies safely. Know how to promote the rights of the individual when managing medication. Support the use of medication. Record and report on the use of medication. HSC 3047: Use of medication

3. What is a medicinal product ? The EC defines a medicinal product as: Any substance or combination of substances presented as having properties for treating or preventing disease in human beings. Any substance or combination of substances which may be used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or make a medical diagnosis. HSC 3047: Use of medication

4. Why is it necessary to have acts of parliament and regulations concerning medication? HSC 3047: Use of medication So that you know exactly what you are taking. So that medication is given to the appropriate people in the correct amounts. To try to prevent people from taking medicine which is harmful to them. To control infectious diseases amongst the whole population. To preserve principles such as ‘consent’ and free will. To protect the vulnerable. To try to minimise unpleasant/ dangerous side effects. To protect health care staff and pharmacy staff. To encourage research and manufacture of new medicine.

5. Agencies with responsibilities for medicine use Medicines and Healthcare Products Regulatory Agency MHRA A government agency responsible for ensuring that medicine and medical devices work and are acceptably safe. They send out alerts to people within health and social care to warn them of possible dangers or equipment which has be recalled. Royal Pharmaceutical Society of Great Britain Inspectorate RPS Inspection of all professional aspects of registered retail pharmacists. Care Quality Commission CQC This organisation sets minimum standards for care delivery. Outcome 9 sets out the expected standards for medication use. The CQC gathers information about care providers and inspects them to see if the standards are being met. HSC 3047: Use of medication

6. Name of legislation Content of legislation Medicines Act 1968 This act regulates the manufacture, supply, sale and import of medicines and medicinal products. Only authorised practitioners may prescribe: GPs, dentists, some nurses and pharmacists. The act divides medicinal products into 3 categories:- Prescription only (POM) Pharmacy (P) General sales list (GSL) Photos supplied by: thecourier.co.uk HSC 3047: Use of medication

7. Prescription only medicine Photos supplied by: pulsetoday.co.uk POM: These medicines can only be legally acquired with a valid prescription from a GP, a dentist or other independent prescriber. Independent prescribers are health professionals who have undertaken extra training in order to prescribe and will have their own prescription pads. Many GP surgeries employ nurse practitioners who can physically examine patients and prescribe from a limited formulary e.g. antibiotics for a UTI or chest infection. HSC 3047: Use of medication

8. Pharmacy medicine Photos supplied by: NHS photo library P: Pharmacists are very knowledgeable about medicines and are able to diagnose certain medical problems. They are able to recommend and sell certain medicines which are not generally available over the counter. They will also ask questions to check that the medicine does not interact with other medicines, to minimise side effects and to check that they are not given to people with specific health problems or conditions. HSC 3047: Use of medication

9. General Sales List Photos supplied by: dc.de GSL: These medicines are considered by the MHRA to be safe enough to be sold from a shop or supermarket. Sometimes the pack size and strength is lower than those available as P or POM medication. HSC 3047: Use of medication

10. Legislation Content of legislation This law controls the use of potentially dangerous or highly addictive drugs. These drugs are defined as ‘controlled drugs’. It states how they should be stored, recorded and administered. Controlled drugs are divided into classes A,B and C and specified penalties are given for illegal possession or supply. Misuse of Drugs Act 1971 Photos supplied by: medicines.org.uk HSC 3047: Use of medication

11. Drug types HSC 3047: Use of medication

12. Legislation Content of legislation Controls the storage of CDs in pharmacies and care homes All care homes must keep their schedule 2 and 3 controlled drugs in a locked cupboard which can only be unlocked by an authorised person This does not apply to a person’s own home Misuse of Drug Regulations 1973 Photos supplied by: harvarddapa.org HSC 3047: Use of medication

13. Legislation Content of legislation Employers must take all reasonable measures to protect their employees from any potentially harmful substance that they may come in contact with whilst at work Personal protective equipment must be provided The Control of Substances Hazardous to health Regulations 1999 COSHH Photos supplied by: tradekorea.com HSC 3047: Use of medication

14. Legislation Content of legislation Controlled drugs are divided into 5 schedules depending on their medicinal benefit/potential for harm Schedule 1 drugs have no recognised medicinal use and have the highest level of control The legislation specifies who can produce, possess and supply these drugs and how they should be stored administered and destroyed It gives permission for the person’s representative to administer, collect or return schedule 2,3 and 4 drugs to a person in the community in accordance with the doctor/dentist’s directions Misuse of drugs regulations 2001 HSC 3047: Use of medication

15. Legislation Content of legislation This defines household and industrial waste and includes medicines which are no longer required. Householders and residential care homes may return their waste medicines to the pharmacy for disposal or destruction. They should not be flushed down the toilet. Hazardous Waste Regulations 2005 Photos supplied by: weblogs.baltimore.com HSC 3047: Use of medication

16. Legislation Content of legislation An individual is assumed to have capacity to make decisions about their medicine A lack of capacity must be clearly demonstrated People with capacity should be allowed to make unwise decisions If an individual lacks capacity then staff must act in the person’s ‘best interest’ The least restrictive option must be chosen The Mental Capacity Act 2005 Photos supplied by: inhomecaretodaytona.com HSC 3047: Use of medication

17. Legislation Content of legislation This act strengthened the monitoring arrangements for controlled drugs following the Shipman enquiry. Healthcare organisations need to appoint an accountable officer to oversee management of CDs All healthcare organisations involved with CDs have a duty to collaborate The police may enter any premises to inspect stocks and records of CDs The Health Act 2006 Accountable Officer Photos supplied by: gatesheadccg.nhs.uk HSC 3047: Use of medication

18. The Medication Policy It is important that all staff administering medication are familiar with the organisation’s medication policy. The policy must comply with the law but will also outline:- The roles and responsibilities of different people within the organisation regarding medication administration The necessary training required to undertake the task Authorised and prohibited procedures Action to take in case of error or unexpected circumstances Local procedures regarding receipt, storage and disposal of medication HSC 3047: Use of medication

19. What about homeopathic, herbal remedies and vitamins? Photos supplied by: atoneonline.com, guardian.co.uk Many people buy homeopathic and herbal remedies and take them alongside their prescribed medication. These remedies are not so strictly controlled but may still interact with the prescribed medicine and cause side effects It is advisable for the GP’s advice to be sought and care staff should not give any remedies to service users without GP authorisation HSC 3047: Use of medication

20. What is the difference between a ‘brand’ name and a ‘generic’ name ? Photos supplied by: poundland.co.uk, medicine.co.uk morningsidepharmacy.co.uk The generic name is the official medical name for the active substance. It is chosen by the Nomenclature Committee of the British Pharmacopoeia. The brand name is chosen by the manufacturer. The aim is To have a name which is easily recognised and remembered so more is sold HSC 3047: Use of medication

21. Categories of medication How many categories of medication can you think of? Analgesia Antibiotics Sleeping tablets Diuretics Anti-anxiety drugs Cardiovascular drugs Anti-depressant Anti-hypertensive drugs Anti-convulsant Lipid-lowering drugs Anti-psychotic drugs Anti-coagulants Anti-parkinson’s drugs Antacids Anti-emetic drugs Laxatives Drugs for asthma Anti-inflammatory Anti-histamine Steroids Cytotoxic Drugs for diabetes HSC 3047: Use of medication

22. Latin terms In the past many latin terms were used by doctors and pharmacists when giving instructions about medicine. These days all written instructions must be in english but occassionally you may hear the following :- STAT statim Immediately PRN pro re nata As required QDS quarter die sumendum 4 times a day TDS ter die sumendum 3 times a day BD bis die 2 times a day PO per os by mouth PR per rectum by rectum HSC 3047: Use of medication

23. What is the role of the Prescriber? Photos supplied by: pharmafile.com The prescriber should select suitable medicine according to the National Institute for Clinical Excellence(NICE) guidelines. The prescriber must check that there are no known allergies to the medicine, no interactions with existing medication and no contraindications. The prescription must include the following :- The patient’s name and address The drug name and strength When to take the drug How much to dispense The prescriber’s signature The prescriber’s address HSC 3047: Use of medication

24. What is the role of the Prescriber? The prescriber should explain what the drug is for, why it should be taken and any common side effects. The prescriber should review the need for long term medication at regular intervals whilst monitoring the person’s medical condition. HSC 3047: Use of medication

25. What is the role of the pharmacist? Photos supplied by: NHS photo library The pharmacist will check the validity of the prescription and accurately dispense the medication and legally label the container with:- The name of the individual Date of supply Name and address of the supplier Name of the medication Dosage of the medication Route of administration Directions for use/frequency Special instructions, warnings or cautions Expiry date HSC 3047: Use of medication

26. What is the role of the pharmacist? Photos supplied by: NHS photo library Some will deliver medication to the house bound. Dispose of medicine brought back from care homes and private homes Give advice on all aspects of medication delivery Supply devices and containers to help people take their medicine HSC 3047: Use of medication

27. The role of the community care manager Photos supplied by: NHS photo library Ensure the staff are trained properly Put policies and procedures in place Provide personal protective equipment if needed Assess how the service user likes to take their medicine Risk assess the capabilities of the service user to self medicate Write a plan of care describing the help needed to order, collect, store and administer medication Keep and store accurate records of care episodes HSC 3047: Use of medication

28. Role of the community carer Photos supplied by: von.ca To assist with medication according to the plan of care To only give authorised medication from a labelled container To give medication respecting the person’s dignity and choice To give the medication according to the training received To help to inform and educate the person about their medicine To be aware of common side effects To record episodes of care accurately To report any problems to the manager HSC 3047: Use of medication

29. Levels of assistance Care staff must be aware of what level of assistance is required and be trained to administer at the appropriate level:- General support. Care staff will prompt and remind the service user. They may help to open containers but the service user is predominantly in control of their medicines. Assistance may be given in collecting and returning medicine. Administration of medicine. Care staff are trained to take full responsibility for correct administration of medicines which can be delivered via a non-invasive route e.g. pills, creams, nasal spray, eye drops, ear drops or inhaled medication. Administration of medication via specialised techniques. Some care staff may be trained to give medicine rectally, by injection or through a PEG tube. This will NOT be covered in this training package. HSC 3047: Use of medication

30. Consent to give medication: Person with full mental capacity. It is an important principle that all people receiving a service should be fully informed and consulted in matters relating to their health and well being and agree to the care provided. Some care providers will ask the service user to sign a consent form to allow their medication to be administered by care staff. On each occasion medication should only be given with full consent. This can be implied by positive body language and cooperative behaviour. If the service user declines or refuses, this choice should be documented. The manager and/ or GP should be informed. HSC 3047: Use of medication

31. Can medication ever be given to a person without their consent? Photos supplied by: intellectual disability.info If the person has mental capacity the answer is ‘NO’ Sometimes confused people will refuse medication Is there sufficient evidence that the person is unable to make choices about their medicine? Do they lack mental capacity? Is the medicine essential ? Is there a nominated person who has Lasting Power of Attorney to make health and welfare decisions on their behalf? If not a ‘Best Interest’ meeting should be convened to decide on the best way forward. This must be documented. HSC 3047: Use of medication

32. Crushing and/or disguising medication Photos supplied by: objectsofuse.com, guardian.co.uk If it is decided that medicine should be either crushed or disguised then the GP and pharmacist must be in agreement that this is a safe course of action. Some medicines can act very powerfully if their protective coating is removed. This is an important decision and must be thoroughly documented. Without proper decision making and documentation it is totally unacceptable to crush and disguise medicine HSC 3047: Use of medication

33. The following outcomes have now been covered:- Outcome 1 Identify legislation that governs the use of medication in social care settings. Outline the legal classification system for medication. Explain how and why policies and procedures or agreed ways of working must reflect and incorporate legislative requirements. Outcome 2 Identify common types of medication Outcome 3 Describe the roles and responsibilities of those involved in prescribing, dispensing and supporting use of medication. Explain where responsibilities lie in relation to use or ‘over the counter’ remedies and supplements Outcome 6 1. Explain the principle of ‘consent’ in the use of medication HSC 3047: Use of medication