Medication Administration Policy

Purpose and Scope

This Policy is not intended for nurses who are qualified and still registered and who are accountable for their own professional practice and must adhere to the Code of Conduct of the Nursing and Midwifery Council (NMC). A copy of the NMC Code of Conduct and Standards for Medicines Management can be obtained from the NMC.

Where a nurse has qualified but is no longer registered with the NMC, they will need to adhere to this Policy.

Aim

To promote and maintain the client’s rights, dignity, and independence.
To provide a baseline set of standards for the administration of medication within the domiciliary setting.
To outline care workers’ responsibilities when administering medication.
To provide guidelines on the use of Medication Administration Aids.
To assist in compliance with the United Kingdom minimum standards for medication administration in domiciliary care.

Administering Medication in a Domiciliary Care Setting

Many clients are capable of self-administration of medication therefore Cavendish Professionals will not assume that clients need assistance. Self-administration should be the preferred option for all clients who are able to do so. Often, by discussing their needs during the assessment process, ways can be found to maintain the client’s independence in respect of self-medication.

The type of assistance a client may require falls broadly into three categories:

First tier (formally ‘assist’) – The client is independent and needs physical assistance only with their medication. All interventions are initiated at the request of the client. Care workers might be asked to help with opening bottles and packets; shaking bottles; removing lids from bottles; popping pills out of packages; pouring out medicine etc.

Second tier (formally ‘prompt’) – The client is not totally independent, but they can manage their medication independently sometimes. At other times, however, they might need oral reminders from care staff to take their medication. This means the care worker may need to ask the client whether they have taken their medication or remind them to take their medication.

Third tier (formally ‘administer’) – The client is not able to manage their medication administration, for whatever reason, without the help of care staff. This means that the care workers will need to administer medication to the client at each visit. This will include checking the medication requirements against the Medication Administration Record (MAR), preparing the medicines by opening bottles and packets of tablets and removing them for the client to take; pouring out and giving a dose of medicine; opening a Monitored Dosage System and giving the medication to the client to take; applying creams; applying eye, ear, and nose drops, and sometimes administering specialist medication, following additional training.

Covert medication administration

Covert medication is the administration of a medicine without the knowledge or consent of a client e.g., disguising medication or hiding it in food and drink. It is a client’s right to decide whether they take a medication or not. Giving covert medication could be seen as assault. At each administration time, where possible, the consent of the client should be sought before administering medication. A procedure of how to react or what to do when a client refuses medication must form part of the Medication Administration training. In extreme cases, and when a person lacks the capacity to be able to consent, covert medication may be considered. If this is the case, ‘best interest’ meetings with people who know and understand the client e.g., family members, doctors, nursing staff, power of attorney or advocates, should take place beforehand to decide whether covert administration is in the best interest of the person. These joint meetings and the decisions made will be documented and will form the basis for the care planning process. Any suggestions to crush medication, open capsules, etc. should follow the rules for unlicensed medication i.e., provided the prescriber has prescribed the medication (using a written prescription) to be given in an unlicensed way, this is acceptable. Ideally the pharmacist is included in any debates about the use of unlicensed medication during best interest discussions. If a decision is made for a care worker to give covert medication, the Care Plan will outline the decisions made and care workers must be made aware, through training and supervision, of what covert medication is to be given and how this should take place.

Medication in behavioural modification

It is poor practice to use medication to either control, sedate or punish people and could bring about cases of neglect or abuse. Care workers and managers should not be put under pressure to administer medication of this sort and should not try to influence health care professionals to prescribe medication for this reason.

Purchase of Over The Counter (OTC) medication

It is recommended that care workers should not give any advice about over-the-counter medication or to give over-the-counter medication without the consent of a prescriber.

As and when required (PRN) medication

If a decision is made to give PRN medication this must be fully documented on the Care Plan and written on the Medication Administration Record (MAR).

Responsibilities

Cavendish Professionals Responsibilities

Ensure that a medication policy and procedures exist for the organisation and that all staff are aware of these and adhere to them. The procedure should include the actions taken to deal with medication administration errors.
Ensure that Cavendish Professionals keeps up-to-date with new medication requirements from regulators or patient safety alerts and that any changes are planned, implemented and communicated to staff.
Ensure care workers receive Administration of Medication training preferably during induction, ensuring that they know what they can and cannot do for a client at each stage of their medication training, and know when, why, how and who they should contact within Cavendish Professionals if they experience any problems.
Ensure someone is available at all times to answer care worker queries during a crisis or in an emergency.
Ensure a Risk Assessment is carried out for all clients who require assistance with medication. This should include any medication allergies, storage and use of controlled drugs. Individual COSHH assessments will be required if clients are receiving oxygen and cytotoxic medication.
Have a Medication Administration Record (MAR) sheet as part of the medication Medication records should indicate who the prescriber of each medication is, and how they can be contacted.
Ensure that a named health or social care professional from Cavendish Professionals has drawn up the medication administration record (MAR) and a copy is kept at the client’s home and forms part of the Care Plan and review.
Ensure the assessment process includes the nature and extent of support required by clients and indicates how the client normally gives their consent to assistance with medication. These items should be recorded in the Care Plan.
Put systems in place to ensure that a person authorised by Cavendish Professionals makes changes to the medication chart and that these changes are communicated to all relevant staff.
Be responsible for liaising with any other members of the community care team involved in the client’s care and to ensure that they are kept aware of any changes in a clients’ circumstances.
Maintain the client’s rights to privacy, dignity, confidentiality, independence and their choice not to take medication, at all times.
Ensure that all records and information relating to a client’s treatment are kept confidential.
Provide an environment that enables care workers to report mistakes and incidents without fear of recrimination.
Have a clear medication incident reporting system in place.

Care Workers’ Responsibilities

Care workers should:

Be aware of and follow the organisation’s policy and procedure to ensure the safe administration of medication to a client within their own home.
Maintain the client’s rights to privacy, dignity, confidentiality, independence and their choice to refuse medication, at all times.
Attend training sessions when asked to do so.
Request training for any situation for which the worker does not feel suitably prepared.
Inform Cavendish Professionals of any changes in the client’s circumstances.
Keep all information about a client’s medication and treatment confidential.
Never introduce, sell, offer advice, or recommend any form of medication, remedy, or preparation, including homeopathic and herbal.
Never crush tablets or open capsules unless a prescriber has prescribed the medication (using a written prescription) to be given in the unlicensed way. Details of this requirement will be contained within the Care Plan.
Never disguise a medication, hide it in food and drink, or coerce a client into taking a medication against their will, unless instructed to do so by Cavendish Professionals, before which there will have been extensive consultation on covert administration and details will be contained within the Care Plan.
Always report medication mistakes, accidents, and incidents to Cavendish Professionals, as stated within the organisational policy.

Training

Training programmes will help the healthcare worker to:

Understand Cavendish Professionals’ Medication Policy.
Provide a basic understanding of the different legal categories of medication e.g., over the counter (OTC), prescription only medication (POM), pharmacy medicine (P), general sales list medication (GSL/OTC), controlled drugs (CDs) and as and when required (PRN).
Understand the safe procedure for handling medicines.
Prepare medication for ingestion or application.
Administer medication by non-invasive routes (e.g., oral, topical).
Support people who are self-administering medication.
Be able to administer medication safely and effectively.
Understand and maintain medication records.
Understand the use of Medication Administration Aids.
Know the procedure for reporting any problems arising with medication.
Understand the possible side effects and allergic reactions to commonly used drugs.
Identify commonly occurring side effects such as nausea, vomiting, diarrhoea, drowsiness, dyspnoea (shortness of breath) and skin rashes.
Know what necessary action to take if a client experiences side effects.
Know how to store medication safely in a clients’ home.
Understand how to dispose of medication.
Understand the importance of maintaining confidentiality.

Guidelines on the Use of Medication Administration Aids

Medication Administration Aids are devices that may assist clients to maintain their independence in taking their own medication. There are two main types of medication administration aids commonly known as:

Monitored dosage systems (Tamper-proof systems) e.g., a blister pack: These are sealed appliances, which can only be filled by a pharmacist or dispensing GP.
Medication compliance aid (non-tamper-proof systems): e.g., a dossett box: These unsealed units can be filled by the client or their family and are therefore, unsafe for care workers to administer medication from. However, many medications are not suitable for monitored dosage systems and medication compliance aids e.g., elixir, dissolvable tablets, pessaries, patches and so these will have to be managed by administering out of original dispensed containers. Home care workers should not fill medication compliance aids as this involves transferring medicines from the original dispensed container. Care workers must never administer medicines from medication compliance aids filled by relatives, friends etc. as:
- they are unsealed (and therefore not tamper proof) and
- there is no label on them and therefore no authority from the prescriber as to how they should be administered. In this instance, it is safer to administer medication from the original containers in which it was dispensed. These carry the name of the medicine, the dose, the timing, and any other instructions, enabling administration that is more accurate.

General

Clients should always be encouraged to maintain their independence where possible and administer their own medication. If a client is unable to do this, the care worker may administer medication using sealed monitored dosage systems where they are available or from original containers.

Care workers should not accept verbal instructions for new medications to be given, however, verbal instructions for dose changes may be acceptable if procedures are in place to ensure the safety of the client. Old, unused, or out-of-date medication must be returned to the pharmacist and a note should be made about this in the Medication Administration Record (MAR) and in the Daily Nursing / Care Report.

Medication Administration Records

A Medication Administration Record (MAR) will be available if care workers are to assist with or to administer medication, whether they are from monitored dosage systems or original containers. They are used to check medication required against the medication container/monitored dosage systems. Cavendish Professionals will always decide who is allowed to change the record, the manner the changes will be made and to whom this information should be communicated. Cavendish Professionals will always strive to maintain a list of medications being taken by the client if care workers are prompting or reminding them to take medication. Refusal to take medication, or any adverse reactions from the medication, should always be recorded. Doses of OTC medication should be recorded on the MAR sheet in the same way as the prescribed medication.

Ensuring the right medication is taken

Care workers must always follow the instructions for administration, issued on the container. Care workers must not administer medicines against the wishes of the client. If the client refuses their normal medication, or is unable to take it, a record should be made, and the care worker should inform Cavendish Professionals without delay. Care workers must also ensure that medication is administered in the right way, at the right time and that the right dose is given.