Sunshine Care Training

Sarah Yorwerth & Tara Hollinshead

Medication

MOST IMPORTANT

It is an Organisational requirement that you check the Care Plan of every client

on every visit

There are 8 core principles that apply to any care setting or service that might be involved in the handling and administration of medicines and drugs on behalf of service users. People who use social care services have freedom of choice in relation to their provider of pharmaceutical care and services including dispensed medicines.

Stored safely

Care staff are competent

Care staff know about medication, and keep records

Care staff preserve dignity

and privacy.

Medication is accessible and

disposed of correctly

Access to Pharmacy

advice

Medication is used to cure/prevent

disease.

LegislationHandling medicines in accordance with all legal requirements and professional guidelines including:

Medicines Act 1968Misuse of Drugs Act 1971Misuse of Drugs (Safe Custody) Regulations 1973Safer Management of Controlled Drugs Regulations 2006Health and Social Care Act 2008; (Regulated Activities) Regulations 2010Care Quality Commission: Essential Standards of quality and safety March 2010Controlled Drugs (Supervision of Management and Use) Regulations 2013Guidelines of the Royal Pharmaceutical Society and other relevant professional guidance (such as the Nursing and Midwifery Council standards).

Self Medicating

For client’s who are self medicating we DO NOTNeed to record anything to do with medication

on their report sheets

Check the care plan it should read self medicating

Self-Administering Service Users.Helping the Service User to order and collect prescriptions under the direction of the Service User. Giving advice on safe storage.

On medication, requires help ordering and collecting prescriptions and advice on safe storage.

Tasks to be Included:

Ensuring safe and secure storage of medicines in the Service User’s home; Prompting or helping Service User to order prescriptions; Prompting or helping Service User to collect prescriptions; Note and record any change in Service Users ability to manage their

medication.

Level 1: Category 1

Level 1: Category 2.General Support- Working under direction of the Service User.

CQC guidance adds that a persistent need to remind a service user to take their medication might indicate that they do not have the ability to take responsibility for their own medicines at this level and might need more support.

Many service users requiring this level of support will use compliance aids.

Tasks to be Included:

Ensuring safe and secure storage of medicines in the Service User’s home; Prompting or helping Service User to order prescriptions; Prompting or helping Service User to collect prescriptions; Note and record any change in Service Users ability to manage their medication.

Level 2: Category 3.Administering MedicationRequires supervision with Self-administration or total medication management which may include some direct administration.

If an adult is unable to communication informed consent, the prescribed must indicate formally that the treatment in the best interests of the individual. This must be documented and recorded.

Tasks to be Included:

Ensuring safe and secure storage of medicines in the Service User’s home; Ordering Prescriptions, collection or delivery of medicines. Supervise self administration or directly administer. Select and prepare dose of medication. Record administration of prescribed medicines on Daily Report Sheet.

Level 2: Category 3.Permanent/regular medication recorded here.Clear information/direction how medication is given.

Any changes to medication must be report to office, a new list will need to be completed and old sent to office. No editing/adaptations to list permitted.

List must be reviewed weekly be the keyworker. It must be reported if this is not happening.Any changes must be reported to office and a new sheet completed, implementing the change.

Every Delivery of medication should be checked, and signed by the Care Worker present.

Level 3: Category 4.Administering Medication by Specialised Techniques.

It will include more complex tasks, some may be invasive.Total medication management which may include some direct administration and invasive procedures.

The care worker MUST receive extensive training by a Health Care Professional and signed off as competent with the task.

Tasks may Include: (will be applicable to the needs of the Service User)

Administration of Auto-Injector (Epi-Pen) Insulin Pens. Vaginal/ rectal creams. Suppositories/ Enemas. Intra musclar/ Intravenous/subcutaneous injections. Pessaries. PEG feeding.

What is a drug?A medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.

What makes a drug become a medicine?

A drug becomes a medicine when it is used

in the treatment or prevention of a disease

Interlinked areas of law

Duty to profession

Duty under civil law

Duty to employer

Duty under statutory law

Legal categories of Medicines

• GSL – General Sales List, can be bought anywhere, supermarket, garage. Can only be sold in limited quantities.

• P – Pharmacy Only Medicines, can be bought from chemist without prescription – but only if pharmacist is in attendance.

• POM – Prescription Only Medicines, only supplied on prescription signed by doctor, dentist or registered nurse prescribing practitioners.

• Controlled drugs – These prescriptions are normally written in the doctor’s own handwriting

• Complementary medicines – vitamins etc

• Homeopathic medicines – natural products

The Journey of a Prescription

• Prepared instruction from a doctor to a pharmacist to supply the medicine to the named patient

• Care homes often have different mechanisms for obtaining supplies of medicines, usually explained within the individual local policies and procedures

• All prescribed medication from the GP will be written on a FP10 prescription form

Prescriptions

• May be hand written or computer generated.

• Usually written for 28 days or multiples of for continuous treatment.

• Should be reviewed at least annually, but if taking more than four types of medication, 6 monthly.

What should be on the prescription?

• Name of patient• Address• Age/date of birth• Name of medicine• Strength/dose of medicine• Quantity to be supplied• Date• Doctor’s name and address• IT MUST BE SIGNED

Names of MedicationAll medicines have two namesGeneric name chemical composition, e.g. ParacetamolBrand namegiven by the manufacturer, e.g. Panadol

A medicine can have many brand names but will only have one generic name, however sometimes generic medicines made by different manufacturers can look different.

Prescriptions will usually be written as the generic name.

AbbreviationsAbbrev. Meaning Latin (or New Latin) origina.c. Before meals ante cibumq.o.d Every other day quaque otra diea.m. Morning ante meridiemb.i.d. (or bid) Twice a day/daily bis in diegtt. Drop(s) gutta(e)h. Hour horah.s. At bedtime hora somnio.d. Right eye oculus dextero.s. Left eye oculus sinistero.u. Both eyes oculus uterquep.c. After food post cibump.m. Afternoon post meridiemp.o. or po Orally per osp.r. or pr Rectally per rectum

p.r.n. as needed pro re nataq. every quaqueq.2.h. Every two hours quaque secunda horaq.4.h. Every four hours quaque quarta horaq.6.h. Every six hours quaque sexta horaq.8.h. Every eight hours quaque octava horaq.d. or qd Every day/daily quaque dieq.i.d Four times a day quater in dieq.h. Every hour, hourly quaque horaq.s. A sufficient quantity quantum sufficiatRx or ℞ prescription recipeSig. or S. directions signa

Stat. Immediately, with no delay statim

t.i.d. or tid Three times a day ter in dieu.d. As directed ut dictum

Routes for Medication.Term What it means?

Buccal Between cheek and gum

Sublingual Under the tongue

Topical On skin

Oral (p.o) Per Oral

Transdermal Patch form

Intra Aural In Ears

Intra Ocular In eyes

Intra Nasal In nose

IM (Intra Muscular) Injection in muscle

IV (Intra Venous) Injection in vein

Subcutaneous Injection in fatty tissue

GI Gastro Intestinal

NG Naso Gastric

General considerations for storage

All medication should be stored correctly in accordance with the practitioner’s instruction and per Risk Assessment. Medication may be locked and have restricted access if it is assessed the Service User could be at risk. Some medications may need to be kept at a lower temperature e.g. Refrigerator. Out of Date medication must be returned the pharmacist.

Five R’sRight

Medicine

Right Dose

Right Time

Right Route

Right service

user

Royal College of General Practitioners

• Elderly patients must be treated with dignity and respect. They should not be forced to take medication against their will. If they have swallowing difficulties the most suitable preparation of the drug should be used – usually in the liquid form if available. If a person has difficulties, they, or a carer, should contact the prescribing doctor.

Consent

• All service users have the right of refusal and should consent to the administering of medication.

• Have the right to information about the medication being administered.

• Service users’ beliefs and views are a key influence on whether , when and how they take their medicines.

Crushing medication• This should not be routine practice and as stated above it is

preferable to use a product in the way it was licensed to be used. The prescriber should take responsibility for using a medicine in a manner that is outside its licence and should specify the exact directions on the prescription, e.g. “crush, mix with water and administer”. These instructions should be added to the dispensing label.

• Altering the form of medicine must only be undertaken under the guidance of an authorised prescriber.

• A written direction to crush or disperse tablets or to open capsules should be documented in the patient’s care plan (where care staff are involved in administration.)

• A pharmacist or Medicines Information service should be referred to and every effort must be made to ensure Health and Safety guidance is followed.

Crushing NMC• The NMC gives advice on crushing

medication in its Standards for Medicines Management 2010 and says

“Medicinal products should not routinely be crushed unless a pharmacist advises that the medication is not compromised by crushing, and crushing has been determined to be within the patient’s best interest.”

Covert AdministrationStaff MUST NOT disguise medication and administer to Service User’s without their knowledge.Only Service User’s detained under section 3 under the Mental Health Act can legally be given medication against their will.

With Service User consent, making the medication more palatable by taking it with food or drink is not the same as disguising. This consent must be in writing and confirmed by the Prescriber.

Crushing or Covert medication should only take place with written consent from the GP and appropriate recorded on the care plan.

Controlled drugsPrompt 9B of CQC Essential Standards state that clear procedures must be in place.Controlled drugs are those that have been agreed as potentially addictive or dangerous thus requires special provisions.The Misuse of Drugs Act 1971 classifieds controlled drugs into 5 schedules. The Controlled Drugs (Supervision of Management and Use) Regulation 2013 came into force with Department of Health and replace previous guidance and regulations.

Controlled drugs classificationSchedule Drug

Schedule 1Controlled Drugs licence.

Cannabis (resin), coca leaf, lysergide (LSD).They have no recognised medicinal use

Schedule 2Controlled Drugs

Diamorphine (heroin), Amfetamine, Morphine, Cociane, Pethidine, Methadone, Oxycodone.Misuse of Drugs (safe custody) regs 1973.

Schedule 3No Register

Barbiturates, Temazepam, Phentermine, Pentazocine, Meprobamate, Buprenorphine.

Schedule 4 Benzodiazepines (except temazepam/midazolam)Anabolic and Androgenic Steriods.

Schedule 5Invoice.

Codeine cough syrups, pholcodine, morphine.(exempt from full control when low strengths)

Disposal / Ordering of medication

Medicines belong to the Service User so must be disposed of with prior consent.

Unused tablets must be placed in sealed envelope and returned to pharmacy.

Complete a Disposal form and Pharmacist to sign for.

Reasons for Disposal• Service User refused medication• Service User no longer taking medicine• Medicine dropped on the floor• Medicine out of date.

Omitted Doses.If you wrongly administer or omit to give a dose of medicine to a Service User in your care, or become aware than an error has been made, you must report to the line manager immediately.The line manager will:

Immediately seek Professional advice. Enter details onto an issue log. Inform NOK. Report to CQC.

Types of medicationsAnalgesics - Painkillers• Paracetamol• Aspirin• Co Dydramol • Co CodamolOPIODS (reduce intensity of pain signals to the brain)• Morphine • Diamorphine (heroin)• Pethedine• Fentanyl• Oxycodone

ContdNon Steroidal Anti Inflammatory Drugs

(NSAIDS) – for pain Ibuprofen Naproxen Diclofenac (Voltarol)

NSAIDs are generally prescribed for people who have pain and inflammation - for example, if you have pain in your joints (arthritis) or muscles (back pain).Although cannot be taken for people who have stomach ulcers.

ContdAntibiotics – For treatment of Infections• Penicillin• Erythromycin• Trimethoprim• Cephalexin• Amoxycillin• TetracyclidesThe main side effects for antibiotics are diahorrea, skin rashes and some penicillin’s can cause anaphylactic shock.

Contd

Respiratory Drugs• Ventolin• Salbutamol• Atrovent• PrednisoloneThese are used to open up the

breathing tubes.

Contd

DiureticsThese drugs are designed to make the kidneys pass

more urine. They are useful in treating high blood pressure,

heart failure and severely swollen legs.• Frusemide• Co Amilofruse• Amiloride• FrumilPeople that take certain diuretics, must increase potassium foods within their diet. Diuretics can cause dizziness.

ContdHeart DrugsUsed for Atrial fibrillation or heart failure.• Digoxin • LanoxinAnti Convulsants These are used in the control of Epilepsy• Carbamazepine• Phenytoin• Phenobarbitone• Gabapentin • Midazolam.

Contd

Anti Depressants These are mood altering drugs that affect brain

chemistry to relieve depression• Amitryptilline• Dothiepine• Fluoxetine (Prozac)• Lorazepam• Diazepam

Contd

Sedatives Reduces brain chemistry thus relieving anxiety,

agitation, and /or psychiatric disturbances, and sleeplessness.

Temazepam Zopiclone AmitryptillineAnti CoagulantsUsed for thinning the bloodWarfarinHeparinAspirin

Warfarin To prevent and treat the formation of harmful blood clots within the body by thinning the blood and/or dissolving clots. • There will be given an anticoagulant record book; read this

carefully and carry it with you at all times.• It is important to have regular blood tests to check the level of

warfarin in the blood - these blood tests are very important.• Any changes to diet must be discussed with GP prior. • Avoid drinking cranberry juice whilst taking warfarin.• Only drink alcohol in moderation whilst taking warfarin.

Check Therapy (INR) book for correct dosage.

DN/GP will complete this 1-week or 2-weekly.

You MUST check every time before you administer, doses can change within 24 hours.

Select and prepare correct dosages. E.g. 2mg Warfarin (2x1 mg tablets)

Contd

Anti Hypertension (reduce High Blood Pressure)

• Clonidine • Diazoxide • Furosemide • Hydralazine • Minoxidil • Nitroprusside • Lisinopril

Contd

Cytotoxics -All cytotoxic are anti cancer drugs, the interfere with cell division and can kill tumours.

• Anastrozole – antibiotic for cancers• Tamoxifen• Letrozole

Working with cytotoxic drugs has also been associated with negative health effects for developing fetuses including higher incidences of spontaneous abortions, congenital malformations, low birth weight, and infertility