administering medication safely in domiciliary care...if used correctly, medication can cure...

Administering Medication Safely in Domiciliary Care

Version 1.0 – 03/2020

Learner Resource

Self Study Guide

Administering Medication Safely

in Domiciliary Care

www.ascleader.co.uk


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Contents

About Self-Study Guides .......................................................................................................................... 1

Introduction ............................................................................................................................................................. 1

Structure and Layout ............................................................................................................................................. 1

Latest Version.......................................................................................................................................................... 2

Introduction ................................................................................................................................................ 3

Learning Aim ............................................................................................................................................................ 3

Learning Outcomes ................................................................................................................................................ 3

Legislation and medication ....................................................................................................................... 4

Classification of medicines ....................................................................................................................... 6

The Safe Handling and Administration of Medication .................................................................................... 8

Why do we have a Policy? .................................................................................................................................... 8

Who does the policy apply to? ............................................................................................................................ 8

Roles, Responsibilities and Duties ....................................................................................................... 10

Service User ........................................................................................................................................................... 10

East Riding of Yorkshire Council Adult Services (Community Wellbeing Teams) .............................. 10

East Riding of Yorkshire Council Business Management and Commissioning ....................................... 11

Domiciliary Care Agency (including Community Support Services) ........................................................ 12

Domiciliary Care Workers (Community Support Service and Domiciliary Care Workers) ............ 14

General Practitioners (GP)................................................................................................................................. 15

Dispensers (including Community, Hospital and GP Dispensaries) ......................................................... 17

Nursing Personnel ................................................................................................................................................ 18

Independence and Choice ..................................................................................................................... 21

Privacy, Dignity and Consent ................................................................................................................ 21

Privacy ..................................................................................................................................................................... 21

Consent................................................................................................................................................................... 21

Mental Capacity Act 2005 .................................................................................................................................. 22

The Five Principles of the Mental Capacity Act 2005 .................................................................................. 22

Administration of Medication ............................................................................................................... 23

What tells a Domiciliary Care Worker how to administer medication?................................................ 23

Barriers to Taking Medication ........................................................................................................................... 25

The Different Forms of Medication ................................................................................................................. 25

Administering of Medication .............................................................................................................................. 26

The 7 Rights of Administration ......................................................................................................................... 26

Before Administering Medication ..................................................................................................................... 27

Refusal of Medication ........................................................................................................................................... 27

What happens if the Service User does not want to take their Medication? .................................... 27


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Covert Medication ........................................................................................................................................... 27

When Required Medication (PRN) .................................................................................................................. 28

What to do if you have concerns about the administration of medication ........................................... 29

Non-Prescribed Medications ............................................................................................................................. 29

Recording Medication Administration ................................................................................................ 30

How does a Service User get a DomMAR? ................................................................................................... 30

Mid-Month Medications ...................................................................................................................................... 31

Hand-Writing Charts ........................................................................................................................................... 31

Hand-Writing Charts – Process ....................................................................................................................... 31

General Procedures for the Administration of Medication ........................................................... 33

Oral Tablets and Liquids ..................................................................................................................................... 33

Buccal Tablets ........................................................................................................................................................ 33

Sublingual Tablets ................................................................................................................................................. 33

Ear Drops ............................................................................................................................................................... 34

Eye Drops ............................................................................................................................................................... 34

Eye Ointment ........................................................................................................................................................ 35

Nasal Drops ........................................................................................................................................................... 35

Nasal Sprays ........................................................................................................................................................... 35

Creams, Ointments and Lotions ....................................................................................................................... 36

Patches .................................................................................................................................................................... 36

Mouthwashes ......................................................................................................................................................... 37

Throat Sprays ........................................................................................................................................................ 37

Nebules ................................................................................................................................................................... 37

Inhalers .................................................................................................................................................................... 38

Ordering, Collecting and Disposal of Medication for a Service User .......................................... 40

Ordering Medication ........................................................................................................................................... 40

Collecting Medications ........................................................................................................................................ 40

What about collecting new medication prescribed during the 28 day cycle?.................................... 41

Disposal ................................................................................................................................................................... 41

Medicines Storage ................................................................................................................................................. 42

Medication Errors .................................................................................................................................... 43

What to do if you identify a Medication Error .............................................................................................. 43

On Completion of this Self-study Guide ............................................................................................ 44

About the Appendices within this Self-Study Guide ........................................................................ 44

Appendix 1 – Competency Record - Tasks in Handling Medication ........................................... 45

Appendix 2 – Competency Record - Administration Techniques ............................................... 47

Appendix 3 – Record of Refresher Sessions for Medication Training for Domiciliary Care

Workers .................................................................................................................................................... 49


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Appendix 4 – Record of Additional Medication Training – including Specialised Techniques50


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About Self-Study Guides

Introduction

Self-Study Guides (SSGs) are flexible learning materials that enable you to develop

your knowledge and skills at your own pace.

Each guide provides information and instructions about a topic, which is supported

with examples, exercises and, if needed, direction to further help or information.

SSGs may be supported by other Learner Resources to support the completion of

additional exercises and activities that help embed learning.

Structure and Layout

Each guide has a common structure and layout that helps ensure consistency and

maintains the quality of the materials.

The following symbols are used to highlight key information or actions:

Information

This symbol highlights information on a particular point, topic or

area.

Key Point

This symbol highlights a key point on a particular topic or area.

Question

This symbol indicates a question.

Activity

This symbol indicates an activity.

Scenario

This symbol indicates a scenario or case study.

Tag

This symbol highlights where you can find more information, help,

support or a resource.


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Latest Version

Always check you have the latest version of the SSG. The issue number and date

appear on the cover page.

If you have been given this SSG by your Line Manager, Supervisor or Learning and

Development Champion – they will have checked it is the current version. The

Social Care Academy only provide copies of the current version of any SSG.


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Introduction

Welcome to the Administering Medication Safely in Domiciliary Care Self

Study Guide. This guide is for Domiciliary Care staff working in Adult Provider

Services and the Independent Care Sector.

Learning Aim

The aim of this self-study guide is to provide information and guidance to help

Domiciliary Care Workers to administer, record and dispose of medication safely.

Learning Outcomes

By the end of this Self-Study Guide, you will be able to:

State the name of the joint medication policy.

List key legislation and guidance governing medication.

State your role as a Domiciliary Care Worker with regards to medication.

List the Classifications of Medicines.

Understand the barriers that may arise when taking medication.

Help Service Users with their prescribed medication.

Record the administration of medication on the DomMAR.

Understand the different forms of medication and how to administer them.

Store medication appropriately at the Service User’s home.

Safely dispose of any medication, as needed.

Understand when to contact your line manager for advice and support about

questions or concerns about medication.

Understand the importance of reporting errors.


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Legislation and medication

If used correctly, medication can cure illness, relieve symptoms and prevent disease

but if misused can cause injury or worse. The presence of legislation and guidance

allows for the safe administration of medication. There are a number of Acts that

relate to medication and they are regularly reviewed and updated.

As a Domiciliary Care Worker you should be aware of the legislation and guidance

that governs the safe handling, administration and disposal of medication. For

example:

The Misuse of Drugs Act 1971 (Controlled Drugs) and amendments

This Act regulates Controlled substances.

The Health and Safety at Work Act 1974

This Act requires the control of risk with in the workplace.

Access to Health Records Act 1990

This act establishes a right of access to health records by the individuals to whom

they relate and other persons.

Control of Substances Hazardous to Health Regulations 1999 (COSHH)

These regulations require that any hazards are identified and assessed for risk.

Hazardous Waste regulations 2005

These regulations set out the regime for the control and tracking of hazardous

waste in England and Wales.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

(Part 3) as amended

This Act details the fundamental standards which service providers must meet. The

safe care and treatment standard (regulation 12) includes “The proper and safe

management of medicines”


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Other standards relevant to medicines, such as person-centred care, the need for

consent, good governance and Duty of Candour.

General Data Protection Regulations (GDPR) 2016/Data Protection Act

2018

This modernises laws that protect the personal information of individuals and alters

how businesses and public sector organisations can handle the information of their

customers.

However, you may not be as familiar with the following regulations and documents

Legislation and Guidance – What they are and where to find them…

Care Quality Commission (Registration) Regulations

2009 (Part 4) as amended

https://www.cqc.org.uk/files/care-quality-commission-registration-

regulations-2009

CQC Guidance for providers on meeting the

regulations (February 2015) replaces CQC’S Essential

Standards of quality and safety

https://www.cqc.org.uk/sites/default/files/20150210_guidance_for_pr

oviders_on_meeting_the_regulations_final_01.pdf

CQC Guidance for providers on meeting the

regulations (February 2015) replaces CQC’S Essential

Standards of quality and safety.

https://www.cqc.org.uk/sites/default/files/20150210_guidance_for_pr

oviders_on_meeting_the_regulations_final_01.pdf

NICE ‘Managing medicines for adults receiving social

care in the community’ (NG67, March 2017). This

guidance covers medicines support for adults (aged 18 and

over) who are receiving social care in the community.

https://www.nice.org.uk/guidance/ng67

You may wish to do some further reading to familiarise yourself with these.

https://www.cqc.org.uk/files/care-quality-commission-registration-regulations-2009

https://www.cqc.org.uk/files/care-quality-commission-registration-regulations-2009

https://www.cqc.org.uk/sites/default/files/20150210_guidance_for_providers_on_meeting_the_regulations_final_01.pdf




https://www.nice.org.uk/guidance/ng67


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Classification of medicines

The Medicines Act 1968 and amendments also defines three categories of medicines:

General Sales List medicines (GSL) – medication that can be sold in any shop

(e.g. pharmacy, supermarket, corner shop etc.) without a prescription.

Pharmacy Medicines (P) – medicines that can only be sold in a pharmacy under

the supervision of a pharmacist.

Information

These medicines can include some larger pack sizes or different

strengths of some GSL medicines.

For example:

16 Paracetamol 500mg tablets are a GSL medicine and

32 Paracetamol 500mg tablets are a P medicine

Prescription Only Medicine (POM) – medicines which may only be obtained

with a valid prescription. Some Prescription Only Medicines are further

classified as Controlled Drugs (CD POM) which have stringent regulations

regarding prescribing, supply and destruction.

Information

Prescriptions can be written for GSL, P and POM and CD POM

medicines. As a Domiciliary Care Worker you are only allowed to

administer medication that has been supplied by a prescription.

Both General Sales List Medicines and Pharmacy Medicines can be bought

over the counter. They are sometimes referred to as OTC medicines or Homely

Remedies. Some Service Users may arrange to buy OTC or Homely Remedies.


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Question

What are the possible consequences of taking over the counter

medication with prescribed medication?

Activity

Read the two statements below and write down what they might

mean to you as a Domiciliary Care Worker administering medication:

“Anyone can administer a prescription medicine to another person

provided it is in accordance with the directions of a Prescriber”

“Medicines prescribed for a person are that person’s property”

https://pixabay.com/en/flat-design-symbol-icon-www-internet-gui-2126884/



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The Safe Handling and Administration of Medication

The East Riding of Yorkshire Council’s Adult Social Care Services have worked in

partnership with the NHS East Riding of Yorkshire Clinical Commissioning Group, in

consultation with the relevant services, to produce a joint medication policy:

“Administering Medication Safely in the Domiciliary Care Sector” November 2018. The

Policy has been written in line with the Legislation and Guidance surrounding

medication.

Why do we have a Policy?

We a Policy to:

Safely enable, promote and maximise Service Users’ independence.

Give clear guidance.

Unify procedures.

To meet all legal requirements and the Good Practice Standards.

Who does the policy apply to?

The Policy applies to all Domiciliary Care Workers (and staff who are being

redeployed into the Domiciliary Care Sector), including the Independent Care

Sector, delivering care packages commissioned by East Riding of Yorkshire Council

involved in administering medication.

The Policy does not apply to non-commissioned services, i.e. people funding their

own care or receiving personal budgets, unless these are commissioned by the

Council.


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Questions

Find out where the policy is kept in your organisation?

What is the organisation’s procedure for informing you of updates

to the policy or procedures?

Activity

Discuss with your Line Manager, and make brief notes, on the

procedures you will need to follow for the Safe Handling and

Administration of Medication, in line with the Joint Policy.




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Roles, Responsibilities and Duties

Service User

The level of responsibility for medication assumed by an individual Service User will

depend on their ability to manage this aspect of their life.

The Medication Risk Assessment for Domiciliary Care Providers, which includes the

Fullers Self-Medication Risk Assessment tool, (Appendix 1) will identify the level of

assistance required.

If assistance with medication is required then the Service User must provide

Domiciliary Care Agency with access to the prescription, medicine and other

relevant information and if they have capacity consent must be given to assist with

medication.

If support is required for ordering repeat medications, and the Domiciliary Care

Agency has been identified as giving that support, then consideration should be given

to allow the care agency to order medication on-line from the Service User’s GP.

This would require the Service User to allow third party access to their patient

record.

East Riding of Yorkshire Council Adult Services (Community

Wellbeing Teams)

Adult Services workers are responsible for undertaking an Adult Care and Support

Assessment in accordance with The Care Act 2014. If support with medication is

identified as part of the assessment process, Adult Services will undertake the

Medication Risk Assessment and Fullers assessment (or agreed risk assessment).

They will use this Risk Assessment to identify the appropriate support the Service

User needs with their medication (as defined in section 2 – 1.1.7 of the Joint Policy)

and records this in the Care and Support Plan. (The score should guide the decision

as to the support required).

In Community Support Services, Assessment Officers / Team Leaders are also

responsible for undertaking Medication Risk Assessments and Fullers Assessments

(or agreed risk assessments) to help identify a Service User’s care and support

needs.


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It is also their role to liaise with health care professionals as appropriate to confirm

medication requirements, any allergies, special storage or administration details, etc.,

and to complete a domMAR Request Form and send this to the GP, community

pharmacy and / or dispensing practice commissioned by East Riding of Yorkshire

CCG to provide the Medicines Record Chart for Carers Service (Service

Specification B1).

It is important that responsibility for managing medicines is not taken away from the

Service User unless the assessment indicates a need. Independence in taking

medication should be supported where possible.

Key Point

If a Service User has been assessed as lacking the mental capacity

to make decisions around their care and support needs then

decisions need to be made in the persons best interests.

The best interest decision around taking / administering medication

is made by a health care professional (e.g. GP) and must follow the

statutory principles in the Mental Capacity Act (2005) Code of

Practice.

The Council’s Adult Services (Community Wellbeing Teams) continue to hold

responsibility for ensuring that care and support reviews are conducted whenever

there is a significant change in the Service User’s circumstances. Where there is no

change reviews must take place every 12 months.

East Riding of Yorkshire Council Business Management and

Commissioning

The Business Management and Commissioning Service ensures that regular audits

are carried out to ensure that Domiciliary Care Agency are complying with this

Policy.

They make regular checks to ensure that Domiciliary Care Agencies employ only

domiciliary care workers with appropriate medication training, if involved with

medication support, and maintain up-to-date records of this training and ensure that

associated competency assessments have been completed.


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They also ensure that the agreed and documented level of assistance is provided to

the Service User on a day to day basis.

Domiciliary Care Agency (including Community Support Services)

Domiciliary care providers ensure that the Joint Policy is implemented in their

service / organisation. They must also ensure that training is provide for all

Domiciliary Care Workers. Ideally this should be the face-to-face, but alternative

media may be considered during exception events, such as a pandemic or epidemic.

However, all learning must be in accordance with the Joint Policy and associated

Standard Operating Procedures (SOPs).

A record of all training and competency assessments for the safe administration of

medication must be held by all provider.

Providers will ensure that they provide the agreed and documented level of

assistance to the Service User on a day-to-day basis. Medications must be

administered from the original pharmacy filled container and that this is recorded on

a domMAR by trained and competent person.

Key Points

The Domiciliary Care Agency:

Ensures that if a medication is prescribed mid cycle this is

(in order of preference and risk):

o Ideally, added to the existing domMAR; or

o A second domMAR is obtained; or

o Where the above is not possible (for example Out

of Hours when the pharmacy is closed) the

Domiciliary Care Agency directs the Domiciliary

Care Worker to handwrite a temporary domMAR

chart, ensuring that the care worker follows the

agreed process (see Appendices 3 and 4 of the Joint

Policy).

Ensures that Domiciliary Care Workers are able to

prioritise their visits for people who need support with

time-sensitive medicines (7 Right’s).

Has robust processes in place for handling urgent changes

to a Service User’s medicines from a prescriber, received


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preferably via secure email, safe-haven fax or verbally in an

emergency, including :

o Recording details of the requested change (including

who requested the change, date and time of request

and who received the request.

o Ensuring that a second member of staff is present to

verify transcription/transfer of information in the

request.

And where instructions are given verbally:

o Reading back the information that has been

recorded to the prescriber requesting the change to

confirm it is correct (including spelling of the

medicine).

o Ensuring that a second member of staff is present to

verify the information, e.g. by speakerphone.

Providers will monitor and review the service provided via regular audit of domMAR

charts and they inform the Adult Services Community Wellbeing Team of any

significant change(s) that may trigger the need for a review.

All incidents and ‘near-misses’ must be recorded appropriately and used as a learning

tool to improve the service. An example of incident reporting form is available in

Appendix 8 of the Joint Policy. Providers will takes responsibility for resolving

problems and investigating incidents. Where necessary specialist support should be

involved in these investigations and learnings disseminated to all parties.

Providers will also take responsibility for reporting to the Care Quality Commission

(CQC) and Safeguarding, where appropriate.


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Domiciliary Care Workers (Community Support Service and

Domiciliary Care Workers)

Domiciliary Care Workers should only assist with medication where they have

completed the appropriate training and they are competent to do so. This includes

support with opening bottles and passing inhalers, etc.

It is the responsibility of Domiciliary Care Workers to follow the Care and Support

Plan and administer / record medication in line with the Policy using a domMAR

chart or handwritten chart as appropriate.

If there is any doubt about the capacity of the Service User then the care worker

should not administer the medication. The Domiciliary Care Worker should

immediately contact their Supervisor or Line Manager for further advice. The

person’s GP or appropriate professional should also be contacted.

If the Domiciliary Care Workers have any concerns about the administration of

medication to a Service User they should report these to their Supervisor or Line

Manager and document in the Care and Support Plan, ensuring that the concern is

logged in the Domiciliary Care Agency’s incident reporting system.

Domiciliary Care Workers should not undertake any duties which fall within the

responsibility of the Nursing service (e.g. sutures or catheter removal) or primary

medical services.

Domiciliary Care Workers must not make any clinical decisions or judgments, e.g.

increase or change of dosage, regarding the administration of medication. If there is

any change of circumstances relating to a Service User’s medication, the Domiciliary

Care Worker must report it to their Supervisor, Line Manager, a health professional

or a nominated person (e.g. next of kin).


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General Practitioners (GP)

GPs have a duty of care for all of their listed patients to provide general health and

medical care or refer for specialist health care or social care.

In looking after an individual’s health and wellbeing, the GP or other non-medical

prescriber will prescribe medication to their patient to prevent, treat or relieve

medical conditions. It should be noted that individual Service Users might also

receive medication prescribed by specialists who might have been supplied to them

in hospital. Within primary care, other professionals may be involved in prescribing

for Service Users, such as; dentists, suitably qualified nurses, pharmacists or

physiotherapists.

Key Points

GPs should record details of the Service User’s medicines

support and who to contact about their medicines (the Service

User and their Domiciliary Care Agency) in their medical

record, when notified that the person is receiving medicines

support from a social care provider. This information is

available on the domMAR request form.

The details should be immediately obvious to anyone accessing

the patient’s record by adding an alert, reminder or pop-up

box. Such support should be Read coded:

o SystmOne: XaN5J – needs domiciliary care work to

administer.

o Emis Web: 8BML – needs domiciliary care worker to

administer.

Prescribers should communicate any changes to a Service

User’s medication, e.g. when stopping or starting a medicine,

by:

o Informing the Service User and their named contact.

o Providing written instructions of the change or issuing a

new prescription.

o Informing the Service User’s supplying community

pharmacy and DCA.


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Any changes in medication, where there is a need to avoid

delays in treatment or avoid confusion, should be made

preferably by secure e-mail or safe-haven fax.

GP Practices should consider identifying at least 2 members of

the administration team to be responsible for managing the

prescription process for domiciliary care patients requiring

domMAR charts.

GP’s should provide clear written directions on the

prescription to show how each prescribed medicine should be

taken or administered, including:

o What dose should be administered?

o For ‘when required’ medicines when there is no

alternative: What the medicine is for?

o What exact dose should be administered (for example,

avoid 1 or 2 tablets) unless the person can direct the

Care Worker to the dose needed?

o For external medicines, on what area of the body to be

applied.

o The minimum time interval between doses.

o The maximum dose to be taken in a 24 hour period.

Review medication at least annually or sooner if needed and

communicate any changes as above.


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Dispensers (including Community, Hospital and GP Dispensaries)

Dispensers have a professional responsibility to supply medication prescribed by GPs

and other recognised prescribers and in a timely manner.

The medication must be of a suitable quality and comply with legal and ethical

requirements for the packaging and labelling.

Key Points

Additionally, pharmacists have a responsibility to ensure that a

patient or carer receives appropriate information and advice to

support them in gaining the best effect from any medicines

supplied. This will include annotating the domMAR on the best

time of day to administer the medication, for example; morning,

lunch, tea, evening, which will need collaboration with the

Domiciliary Care Agency to fit within the care call window.

Upon receipt of a domMAR Request Form, community pharmacies

/ dispensing practices and local hospitals participating in the NHS

England – Local Enhanced Service are to produce the domMAR

chart in accordance with the prescription. The Service User

record should be marked accordingly so future dispensing is

accompanied by a domMAR chart.

For a mid-month medication, for a Service User who the pharmacy

is aware already has a domMAR in place (in ascending order of

risk):

The original DomMAR should be returned to the pharmacy

and the mid-month medication added.

Where it is not possible for the original domMAR to be

brought into the pharmacy, they will provide a second

domMAR chart and write ”Supplementary Chart” on the

front of the chart to ensure that the carer is aware that this

is an additional chart for the same person.

Liaise with the patient or carer to, ensure that the new

medication is collected in time, or delivered by the

pharmacy where there is an agreement to do so.


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Dispensers should also:

Check if any changes or extra support may be helpful for example by

checking if the person’s medication regimen can be simplified, if any

medications can be stopped or if there are any formulation changes needed.

Liaise with the prescriber where prescription details are ambiguous and do

not give sufficient information to the carer to safely administer the

medication.

Supply a Service User / Patient information leaflet for every dispensed

medication in line with the Human Medicines Regulations 2012.

Provide ongoing advice and support about a person’s medicines including

non-prescribed medication.

Complete an incident form when necessary and appropriate, e.g. where a

Domiciliary Care Agency has been informed that there is a medicine to

collect and they have not done so in an appropriate timescale.

Nursing Personnel

Nurses provide nursing and clinical care to individual Service Users, e.g. caring for

wounds, pressure sores and the change of dressings or with invasive procedure such

as injections and bladder irrigations and matters relating to feeding tubes.

During the above provision, monitor the health status of the individual and report any

change in circumstances to the GP.

Key Points

Specialist nurses, e.g. stoma nurses, palliative care nurses or

continence advisors will similarly provide nursing and clinical care

to individual Service User and support to their family.

These specialist nurses will support and educate the Service User

and carers in coping with their particular condition and assist them

in dealing with equipment or the drug treatment or therapy

necessary to the condition.


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Key Point

There may be some instances when some procedures normally

carried out by nurses can be done by carers. These are classed as

Specialised Techniques (see Section 2 – 1.3.3 of the Joint Policy)

and would require additional training, it would also be specific to

the Service User and carer. The health care practitioner would

need to train the carer to undertake the task, e.g. administering

insulin or simple wound dressing.

Activity

Discuss with your Supervisor or Line Manager, and make notes on

your role and responsibilities as a Domiciliary Care Worker.



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Activity

Who is responsible for providing general health and medical care

to a Service User?

Who obtains and records the Service User’s consent to administer

medication?

If you, as a Domiciliary Care Worker, have a concern about a

Service User’s medication:

Who do you report your concern to?

How do you report your concerns?

Do Care Providers have the responsibility to facilitate the training

of Domiciliary Care Workers and to keep records of staff training?

(Circle the correct answer) YES / NO

Can an Unpaid Carer only retain responsibility for evening

medication, where Paid Care Workers are responsible for Morning

and Lunch Time Medication?

(Circle the correct answer) YES / NO



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Independence and Choice

It is important to remember that your Service Users are individuals and should be

treated as individuals; if two people have the same diagnosis, for example, a stroke,

they will likely have very different needs. Regulation 9 of the CQC Fundamental

Standards states that “an individual must have care or treatment that is tailored to their

individual preferences”.

Some Service Users may be able to self-medicate and others may be able to

administer their own tablets but need help applying creams. Whatever the situation,

we need to be mindful that if the person can manage their medication then they

should be allowed to do so without interference, but only intervening if we feel the

person is at risk.

Privacy, Dignity and Consent

Privacy

The Domiciliary Care Worker should maintain confidentiality of Service User

information and only share information on a ‘need to know basis’, in line with data

protection legislation.

Another CQC regulation which applies to medication is dignity and respect. An

individual must be treated with dignity and respect at all times whilst receiving care

and treatment – this includes promoting privacy, treating people as individuals and

giving individuals the support they need to remain independent.

Consent

An individual (or their advocate) must give their consent before any care or

treatment is given to them and they have the right to withdraw that consent at any

time.


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Mental Capacity Act 2005

The Mental Capacity Act affects what happens with medication.

The Five Principles of the Mental Capacity Act 2005

The Mental Capacity Act is underpinned by five principles, which are explained in the Mental

Capacity Act Code of Practice. These are:

A presumption of capacity - every adult has the right to make his or her

own decisions and must be assumed to have capacity to do so unless it is

proved otherwise - you must not assume someone lacks capacity because

they have a particular medical condition or disability.

The right for individuals to be supported to make their own

decisions - a person is not to be treated as unable to make a decision unless

all practicable steps to help them do so have been taken without success.

Every effort to encourage and support people to make the decision for

themselves. If you establish lack of capacity, it is important to involve the

person as far as possible in making decisions.

Individuals must retain the right to make what might be seen as

eccentric or unwise decisions – what seems eccentric to us may feel very

different to the individual – you cannot treat someone as lacking capacity

because of this.

Best interests – everything you do for or on behalf of a person who lacks

mental capacity must be in their best interests.

The least restrictive intervention - anything done for or on behalf of

people without capacity should be an option that would cause less restriction

to the person’s basic rights - as long as it is still in their best interests.


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Administration of Medication

What tells a Domiciliary Care Worker how to administer

medication?

The Care and Support Plan sets out the help care workers give to a Service

User, including help with administering medications. Care Workers can only

administer medication to a Service User if it is written in the Care and Support Plan.

The Care and Support Plan may require the Worker to administer some or all of the

Service Users medication. For Example, a Worker may be required to administer

only a Service User’s creams / ointments whilst the Service User is able to

administer their own oral medication, such as; tablets or liquids.

Key Points

If you have a concern about a Service Users ability to handle their

own medication you should report this to your Line Manager and

make a note in the daily diary sheets.

The Label contains lots of important information for the care worker. The

information on the label should be the same as the information on the domMAR

label for each item.

Key Points

There is only one exception and this is the date the medicine was

dispensed. This date can sometimes differ by a few days and this is

down to the dispensing process. If the dates differ by more than 5

days then you should contact your line manager before

administering the medication)


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The Service User may be well informed about their medication as they may have

been taking it for quite some time, however Care Workers should ensure they have

also read the medication label and Care and Support plan to confirm the information

the Service User has given them.

The Patient Information Leaflets (PIL) can be found in original medication

boxes or attached to the side of the medication bottles. It is important to read the

Patient Information leaflets when you are administering new medications for the first

time as they contain information on how to administer the medicine, possible side

effects, storage requirements, contra- indications etc.

The Domiciliary Care Worker’s Supervisor or Line Manager – if you are

still unsure how to administer a medication it is important that you contact your

Supervisor or Line Manager, who may than contact the Pharmacy or Doctor for

further advice.

The Joint Policy “Administering Medication Safely in the Domiciliary Care Sector” – this

explains how care workers are allowed to administer medication in Domiciliary

Care.

Directions on how

to use the medicine

10ml Chloramphenicol Eye drops

One drop to the left eye four times a day

Store in a Fridge

Mr Eryc Example 1-01-2010 Patients /

Service Users

Quantity, Name of

Medicine, Formulation

Warnings or

special

requirements

Date medicine was

dispensed


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Barriers to Taking Medication

The following are some of the key factors you will be aware of that can impact on an

individual being either willing or able to take their medication:

Illness Stigma

Immobility Poor literacy skills

Poor dexterity Language barrier

Poor eyesight Learning Disability

Poor living conditions Lack of understanding

Choice Individual values

Views of others Poor communication

Side effects The timing of the medication

Taking multiple medications Swallowing difficulties

Forgetfulness/Confusion Nausea

Fear/anxiety Taste

Delirium Fear/anxiety

Changes in colour Changes in shape

The Different Forms of Medication

The following are some of the forms of medication you will be familiar with. The

bold print highlights some of the invasive forms of medication you are not allowed to

administer without additional training as they are Specialised Techniques and should

be individualised to specific Service Users.

Tablets Patches

Liquids Nebules

Creams/ointments/lotions Preventer inhalers

Ear drops Suppositories

Eye drops Injections

Eye ointments Mouthwashes

Nasal drops Throat sprays

Nasal sprays Pessaries

The above list is not exhaustive. Domiciliary Care Workers are not allowed to

administer invasive forms of medication, examples are noted above in bold, without


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undertaking additional Specialised Techniques (Level 3 Training), individualised to

specific Service Users.

Administering of Medication

Care Workers can only administer medication from original boxes and bottles

prepared by the Pharmacy or Dispensing Practice and must record the

administration on a Domiciliary Medication Administration Record.

The reason being that should a medication be refused, spat out or dropped then it

may not be easily recognisable by the Care Worker and hence lead to errors in

documentation and confusion for the care worker.

Key Point

Under the Joint Policy:

Care Workers are not allowed to administer medication

from a Monitored Dosage System.

The 7 Rights of Administration

Administering medication is all about common sense and remembering the 7 Rights

of Administration. These are:

The right Service User receives

The right medicine

At the right dose

Via the right route

At the right time

With the right documentation

And the right to refuse.


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Before Administering Medication

Before administering medication, always:

Ask the Service User if they are ready to take their medication.

Check that Service User name is correct on domMAR.

Check that Service User name is correct on containers.

Wash and dry hands.

Get together any equipment needed to help with medication.

Ask Service User to sit upright - the Service User should be in sitting upright

before help with oral medication is given. If this is not possible then the

carer must report this to their Supervisor or Line Manager who can ask

advice from the Service User’s GP, Community Pharmacist or PCT Medicines

Management Team.)

Refusal of Medication

What happens if the Service User does not want to take their Medication?

If a Service User does not want to take their medication, even after encouragement,

then their refusal must be recorded on the medication administration record as a

refusal. In addition, you should also inform your Supervisor or Line Manager

Try and find out why they do not want their medication but under no

circumstances should a Service User be forced to take their medication and

medication should not be given covertly, except where a Best Interest Meeting has

been held.

Sometimes a person may refuse their medication because they are simply not ready

to take it and if approached again later in the Domiciliary Care Workers visit are

then happy to take their medication. Consider aspects about barriers to taking

medicines.

Covert Medication

This is the “hiding of medication from individuals in food or drink in order that the

medication can be given without the person’s knowledge or consent”.

This is quite different to just mixing with food to aid swallowing:

There may be a different procedure for each medication.

It would need to be reviewed regularly.


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The Domiciliary Care Worker should ensure the legal framework is in place

before administering as if it is not then this potentially ‘deception’ and there

is the potential for assault.

Key Point

Covert medication would only be needed in cases where, without

the medication, there would be a serious risk to the person’s

health and only after a Best Interests Meeting has taken place.

Key Point

There is the potential for assault and also possible problems with

the medication, for example, stopping it working or altering the

release.

When Required Medication (PRN)

The prescriber must:

Give the reason why the medication is needed, for example, for pain relief,

anxiety, etc.

Always state the maximum does in 24 hours.

Avoid giving a choice of dose (for example, 1 or 2), if possible.

The use of PRN as a direction should only be used when there is no alternative. The

Service User’s Care and Support Plan will give details of the PRN medication. This

medication should be recorded on the DomMAR when ‘not required’ as ‘N’.

If a choice of dose is given (e.g. 1 or 2 tablets or 5ml or 10ml) then the carer would

need to indicate the dose administered on the domMAR.


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What to do if you have concerns about the administration of

medication

You should also make a note in the diary sheets and on the domMAR what your

concern was and the answer your line manager gave you.

Key Point

Any concerns about the administration of medication should be fed

back to your Supervisor / Line Manager before you administer the

Service User’s medication.

Non-Prescribed Medications

If Service User asks for support with non-prescribed medication refer to your

Supervisor or Line Manager who will give guidance as to your services /

organisations procedures for this.

Any procedures need to include contact with GP or Pharmacist to ensure non-

prescribed medications are safe to be taken with the individual’s prescribed

medication and robust procedures and guidance will be in place for staff to follow.

Robust procedures and guidance must be in place in your organisation for staff to

follow and this must be audited regularly.


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Recording Medication Administration

Care Workers must keep a record of the administration of medication to Service

Users.

The Domiciliary Medication Administration Record (domMAR) is used to

record the administration of Medication to Service Users by Care Workers working

for or on behalf of the Council. The domMAR is prepared by Community

Pharmacies, Dispensing Practices and Hospitals under an Enhanced Service provided

by NHS ERY.

How does a Service User get a DomMAR?

Adult Services Community Wellbeing Teams or Community Support Services

Assessment Officers / Team Leaders use the Fullers Assessment tool during the

Service User’s assessment of need and if medication administration is required

complete the domMAR request form and send to the Service Users normal

pharmacy.

Community Pharmacies, Dispensing Practices and Hospitals prepare DomMARs via

an NHS Enhanced Service – under the Standard Operating procedures. Duplicate

prescription labels are applied to the domMAR and are made tamper evident at the

time of dispensing the prescription. Community Pharmacies, Dispensing Practices

and Hospitals cannot give out copy labels.

Key Point

Community Pharmacies, Dispensing Practices and Hospitals can

only provide the domMAR once they have received the domMAR

request form.


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Mid-Month Medications

Key Point

If a prescription is given mid-month, then the domMAR should

be taken to the Pharmacy/ Dispensing Practice with the

prescription to obtain the medication and update the

domMAR.

If this is not possible the pharmacy may provide a second

domMAR and it should be labelled 2 of 2 to indicate this is a

second chart.

If this is not possible then the carer may be directed to

handwrite the medication onto the chart following a safe

procedure.

If it is necessary for care workers to do this you would be

directed to do so by the Supervisor / Line Manager.

Information

It is not permitted for Community Pharmacies or Dispensing

Practice to issue copy labels for a medication for a care

worker to apply to a domMAR.

Hand-Writing Charts

This may be necessary due to:

New mid-month medication where there is no other option

Change in dose following hospital discharge

Hand-Writing Charts – Process

The following applies when hand writing a chart:

Confirm the need for a hand-written chart with the Supervisor / Line-

Manager.

The Supervisor / Line-Manager will direct only trained carers to handwrite

the chart.


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Copy exactly the medication labelled by the pharmacy including any warnings,

such as;. take after food, store in the fridge, etc.

Use 2 spaces on the DomMAR if needed (but hatch out one of them so that

administration can only be recorded the once).

Write in black ink and initial the domMAR.

The next carer going in will need to check entry and initial.

Some organisation allow their carers to send a photograph of the entry to be signed

off in the office.


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General Procedures for the Administration of Medication

You will already be familiar with the followings generic procedures for administration

but they will act as an aide-memoire for you when out working in the community.

Specific information on the administration of a medication can be found in its

Patient Information Leaflet.

Oral Tablets and Liquids

1. Medications should be handled as little as possible.

2. Measure out correct amount of liquid or remove tablets from a bottle or

pushing out of a foil (blister) strip onto a small plate for the Service User to

access.

3. Dispersible or soluble tablets should be placed in a suitable amount of water

according to the Patient Information Leaflet.

4. Administer medication to the Service User as laid out in the Support Plan.

5. As each medication is administered it should be recorded on the domMAR.

Buccal Tablets

1. Read the patient information leaflet for specific information about

administration.

2. If the Service User suffers from a dry mouth, ask the Service User to moisten

the area where the tablet is to be placed with their tongue or a little water

before they apply the tablet.

3. The tablet should be placed high up between the upper lip and the gum, to

either side of the front teeth.

4. The tablet should not be placed under the tongue, chewed or swallowed

Sublingual Tablets

1. Read the Patient Information Leaflet for specific information about

administration

2. If the Service User suffers from a dry mouth, ask the Service User to moisten

the area where the tablet is to be placed with their tongue or a little water

before they apply the tablet.

3. The tablet should be placed under the tongue.


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Ear Drops

1. Ask the Service User to put their head to one side - left hand side if drops

are to go in right ear or right hand side if drops are to go in left ear

2. Shake the container gently and remove container top

3. Place the number of drops stated on the label into the ear canal – squeeze

the container gently if needed.

4. Ask the Service User to keep head to one side for 2 minutes to allow the

drops to get into the ear.

5. Wipe the end of the nozzle with a clean tissue, replace top and store

container upright.

6. Repeat steps 2 to 4 for the other ear if asked for on the label.

Ear Drops should not be used longer that directed by the Doctor and should be

disposed of four weeks after opening, as they may become contaminated.

Eye Drops

1. Ask Service User to put their head back slightly

2. Shake the container gently and remove container top

3. Gently pull lower eyelid downwards and outwards

4. Place one drop in the space between the lid and the eye. Squeeze the

container gently if needed. Do not let the dropper touch the eye.

5. Ask the Service User to close their eye for 1 – 2 minutes to allow the eye

drops to be absorbed.

6. Repeat in the other eye if stated on the label.

7. Replace the top and store container upright.

8. If there are two or more different types of eye drops to be given at the same

time, wait 5 minutes before giving the next type of eye drops.

Eye drops should not be used longer than directed by the Doctor and should be

disposed of four weeks after opening, as they may become contaminated. (Eye drops

may also come in Minims which are single dose vials).


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Eye Ointment

1. Ask Service User to put their head back slightly

2. Remove container top.

3. Gently pull lower eyelid downwards and outwards

4. Place about ½ cm e.g. in the space between the lid and the eye. Do not let

the container touch the eye.

5. Ask the Service User to blink a few times to allow the ointment to work all

over the eye.

6. Repeat in the other eye if stated on the label.

7. Replace the top.

Nasal Drops

1. Ask Service User to gently blow their nose and then to tip their head

backwards slightly.

2. Shake the container gently and remove container top.

3. Ask the Service User to close one nostril by gently pressing their finger

against it.

4. Place the number of drops stated on the label into the open nostril.

5. Ask the Service User to sniff gently to allow the drops get into the nostrils.

6. Repeat in the other nostril if stated on the label.

7. Wipe the nozzle with a clean tissue, replace top and store container upright.

Nasal Sprays

1. If the spray is being used for the first time press spray several times into the

air until an even spray is seen.

2. Ask Service User to gently blow their nose and then to tip their head

forwards slightly.

3. Shake the container gently and remove container top.

4. Keep the container upright, hold the container so that your thumb is

underneath the container and your middle and fore finger are either side of

the nozzle.

5. Ask the Service User to close one nostril by gently pressing their finger

against it.

6. Keep container upright and insert tip of nozzle into open nostril then spray

once.

7. Repeat another spray and in other nostril if stated on the label


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Creams, Ointments and Lotions

In this section we are talking about Creams, Ointments and Lotions that are being

prescribed for a medical condition and not being used as part of the daily personnel

care for example moisturisers.

1. Check that the label states where the cream or ointment has to be applied

and how often.

2. Put on plastic disposable gloves if provided by your employer.

3. Shake container gently if needed and remove top from the container

4. Gently rub in the cream, ointment or lotion as stated on the label.

5. Replace cap and store as stated on the label.

6. Wash and dry hands.

To ensure that creams, ointments and Lotions appear on the domMAR they must be

prescribed every month. Whilst every effort is made to ensure quantities prescribed

are adequate for 28 days there is the possibility that some excess creams, ointments

and lotions, if this is the case contact your line manager.

Patches

1. Check that skin is clean and dry before applying patch.

If the skin does need to be cleaned, wash with water only and dry thoroughly.

Do not apply a patch straight after a bath or shower, wait until the skin is

cool and dry.

2. Tear the pack open with your fingers along one edge and remove patch. Do

not throw way the opened pack as this can be then be used when disposing

of the patch that you remove from the Service User’s skin.

3. Remove used patch from skin and place in opened pack.

4. Peel the backing off the new patch.

5. Place the patch (sticky side to the Service User’s skin) onto the skin with the

palm of your hand and hold for 30 seconds making sure it sticks well to the

skin.

6. Throw away used patch.

7. Wash and dry hands.

8. If a patch falls off the skin before a change is due follow steps 1 to 8 and

record in diary sheets and contact your line manager


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Mouthwashes

1. Some mouthwashes cannot be swallowed. If this is the case the label will

state ‘FOR EXTERNAL USE ONLY’ or ‘DO NOT SWALLOW’.

2. Get a container ready for the Service User to spit the used mouthwash into.

3. Pour out the required amount of mouthwash to be used.

4. Pass this onto the Service User and ask them to rinse around their mouth for

about a minute.

5. The Service User should then spit out the mouthwash into a container.

6. If the Service User complains that the mouthwash is stinging their mouth

then you can add an equal volume of water.

Throat Sprays

1. Pull out the spray tube in accordance with the directions in the Patient

Information Leaflet.

2. Hold the container in your hand and put fore finger on the top.

3. If the spray is being used for the first time press spray several times into the

air until an even spray is seen.

4. Ask the Service User where their mouth or throat is sore and spray at that

area.

5. Repeat for how many sprays are needed.

6. Wipe tube with a clean tissue.

7. Push spray tube back in and store container upright.

Nebules

1. Hole the nebule upright and twist off the top.

2. Pour the contents of the nebule into the container.

3. Ask the Service User to place mask on face.

4. Switch on the nebuliser.

5. When all of the liquid has been used (after about 5 minutes) switch off the

nebuliser.

6. If there is more than one nebule to be given at one time put them into the

nebuliser at the same time.

7. Remove the container; wash in water and leave to dry.


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Inhalers

Key Points

Care workers can only help Service Users with Inhalers used to

prevent worsening of an existing condition.

1. Commonly known as Preventers, this type of inhaler has a

regular dosing pattern.

2. There are 2 levels of support Care Workers can be asked

to offer:

a. To remind the Service User to use the inhaler and

to pass the Service User the inhaler,

3. To administer the inhaler via a spacer for a Service User

who cannot self-administer after all options of inhaler types

have been excluded.

4. Any concerns should be fed back to your line manager.

The process for assisting the Service User with an MDI inhaler and a spacer device

for administration is as follows:

1. If spacer device requires assembling carer would do so following directions in

Patient Information Leaflet (PIL).

2. Take mouthpiece off inhaler and shake device.

3. Fit onto spacer.

4. Press down once on top of inhaler to release medication.

5. Ask Service User to breath out first.

6. Pass device to Service User to place in, or for mask-type spacers over, own

mouth (with inhaler still attached).

7. Ask Service User to take in one slow deep breath or 2-3 normal breaths to

make sure medication gets into the lungs.

8. If second dosage / puff is required wait one minute and repeat process.

9. Wash the spacer once weekly by following the directions in the PIL and

record in the support plan.


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Key Points

The Service User must be able to operate their reliever inhaler in

the absence of a carer.

If a Care Worker has any concerns over the ability of a Service

User to use their reliever inhaler they must report this concern to

the line manager.

Key Points

In an emergency situation where the Service User is

suffering breathing difficulty the Domiciliary Care Worker

should call 999 and follow the directions given.

Inform your Supervisor / Line Manager as soon as possible.

Record on the domMAR / Diary Notes as soon as possible.


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Ordering, Collecting and Disposal of Medication for a

Service User

Service Users requiring help with medication will normally have medication

prescribed over a 28 day period. The Community Pharmacy or Dispensing Practice

will try to ensure that medications are synchronised so that they are all dispensed at

the same time rather than at different times throughout the month.

These Service Users will also have a Domiciliary Medication Administration

(domMAR) record that is prepared by the Community Pharmacy or Dispensing

Practice at the time of dispensing their medication.

Key Point

The Service User’s Care and Support Plan should clearly state

whether the Care Worker is responsible for the Ordering and

Collection of Medication and domMAR for a Service User

Ordering Medication

If service / organisation are responsible for the ordering of medication for the

Service User, then it must be ordered in enough time to prevent the Service User

from running out of medication.

Doctors Surgeries generally need three working days to produce a repeat

prescription and then the Community Pharmacy or Dispensing Practice may need a

further two days to prepare the prescription and the domMAR.

The domMAR has a prompting arrow to remind care workers to reorder 14 days

before the end of the 28 day cycle.

Collecting Medications

When collecting medication, for a Service User who requires help with

administration, a domMAR should be supplied at the same time as the monthly

medication. If a domMAR is not available the Domiciliary Care Worker should first

ask the Community Pharmacy or Dispensing Practice about the domMAR and if this

does not resolve the problem contact your Supervisor / Line Manager.


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If as a Domiciliary Care Worker you are collecting medication on behalf of a Service

User who self administrates some of their medication and has some administered by

Domiciliary Care Workers then a domMAR is still required.

However if the Service User self administrates all their medication and all that the

Domiciliary Care Worker is doing is collecting the bag of medication to give to the

Service User then a domMAR is not required and the collection noted in the Diary

notes.

What about collecting new medication prescribed during the 28 day cycle?

The domMAR should be taken with the prescription to the Community Pharmacy or

Dispensing Practice to be updated at the same time as dispensing the medication.

Key Point

It is not permitted for Community Pharmacies or Dispensing

Practice to issue copy labels for a medication for a care worker to

apply to a domMAR.

Disposal

If there is an excess of medication in a Service Users home contact your Supervisor /

Line Manager to arrange disposal.

Carers should only dispose of medication where there is no other option - the

Service User / family should make arrangements for disposal at the pharmacy where

possible. Medicines are a Service User’s property and consent should be obtained

and recorded prior to disposal. If there is no other option, medicines to be disposed

of should be listed in the Diary Notes and taken to the local Community Pharmacy.

Key Points

Individual tablets should be placed in a small container or envelope

and clearly labelled ‘medications for return and destruction’.

The container or envelope should then be kept separate from the

medication to be administered and arrangements made to return

to the community pharmacy at the end of the month.


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If the medication is kept in safe storage then the container or

envelope should be placed in the locked box.

Key Point

If a tablet has been dropped prior to administration and disposed

of the Care Worker should administer a fresh tablet to the Service

User and then report their actions to their Supervisor / Line

Manager as this may mean that there is a shortage of medication to

complete the 28 day period.

Medicines Storage

Medications should be kept in a safe place, away from children, and should be stored

off the floor. They should be stored below 25 o C although some medications will

need to be stored in a fridge. If fridge storage is necessary it will state this on the

label. A box of medication will always have the storage temperature on it, either 2 -

8 degrees C or Below 25 degrees C. 2 - 8 degrees C would need to be stored in a

fridge.

If secure storage is required this should be stated in the Service User’s Care and

Support plan.

Key Point

Once in someone’s own home Controlled Drugs are treated the

same as any other medication.


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Medication Errors

A medication error is defined as, “a mistake made in the prescribing, dispensing,

ordering, delivery, storage or administration of medication that leads to a Service User

receiving the wrong medication, unintentionally missing a dose or being at risk of harm”.

What to do if you identify a Medication Error

If a as a Worker you are aware of having made an error in administering medication

or notices that an error has been made, e.g. by another person, the pharmacy or the

prescriber, you should report it immediately to your Supervisor / Line-Manager.

If unable to contact the manager do not delay in seeking medical advice from the

Service User’s GP / appropriate healthcare professional, such as; pharmacist or A&E.

Key Points

1. Details of the error should be recorded on the DomMAR

or in the daily diary. Medication errors must not be

treated as trivial - ALL errors must be reported.

2. Your line manager will complete an accident / incident

form.

3. The Domiciliary Care Agency must apply the harm table to

determine whether a safeguarding concern needs to be

raised and where this has serious consequences for a

Service User you must make a Safeguarding Referral.

This may also result in appropriate further training and

competence testing. It is important that all errors are recorded

and the cause investigated to learn from the incidents and prevent

a similar error happening in future.

The CQC guidance on Statutory Notifications Regulation 20 –

‘Duty of Candour’ covers any event which adversely affects the

wellbeing or safety of any Service User. It states that the service

provider must be open and transparent with individuals about their

care and treatment and if something goes wrong they must tell the

individual what has happened, provide support, apologise

(preferably in writing) and make a log of the error.


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On Completion of this Self-study Guide

Once this self-study guide has been completed Domiciliary Care Workers will be

allowed to administer medication to Service Users via the following routes:

Oral.

Ear drops.

Eye drops.

Eye Ointment.

Nasal drops and nasal sprays.

Mouthwashes and throat sprays.

Medication to be applied to the skin (e.g. creams/ointments/lotions and

transdermal patches).

Nebules .

Inhalers used to prevent worsening of an existing condition, known as

preventers but only in line with the guidance in this document and the joint

policy “Administering Medication Safely in the Domiciliary Care Sector”.

About the Appendices within this Self-Study Guide

The following items are included as appendices to this Self-Study Guide for use

reference and use as required:

1. Competency Record - Tasks in Handling Medication.

2. Competency Record - Administration Techniques.

3. Record of Refresher Sessions for Medication Training for Domiciliary Care

Workers.

4. Record of Additional Medication Training – including Specialised Techniques.


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Appendix 1 – Competency Record - Tasks in Handling

Medication

Objective Process Care

Workers

Signature

Line

Manager

Signature

Date

Order prescriptions

from the Service User’s

doctors.

Demonstrate understanding of

ordering process.

Demonstrate ability to order

prescriptions in plenty of time.

Arrange collection of

prescription from the

doctor’s to the

pharmacy.


collection services offered by

pharmacies.

Demonstrate understanding of the

importance of using the same

pharmacy for all prescriptions.

Collect prepared

medication and

Domiciliary Medication

Administration record

chart (DomMAR) from

the pharmacy.


importance of DomMAR for

recording help with medication.

Demonstrate understanding of the

importance of collecting the

medication and domMAR in good

time so that medication does not

run out.

Store medication

appropriately at the

Service User’s home.

Demonstrate that medication is

stored correctly.

Check fridge items are stored

correctly.

Recognise when it is

necessary to contact the

care workers line

manager about

medication

Demonstrate knowledge of

procedure to be follow when care

worker has a concern about a

Service User’s medication.

Demonstrate the ability to give a

line manager clear information

about a concern regarding

medication.

Demonstrate the correct

documentation of concerns about

medication.

Recording accurately the

administration of

medication on the

domMAR.

Check procedure for recording

the administration of medication

On the domMAR


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Return of a completed

domMAR to Care

Provider for Storage.

Demonstrate knowledge of the

procedure for returning a

completed domMAR to the Care

Provider for Storage.

Recognising the types of

medication

administration that care

workers cannot do

without further

specialized training


types of administration techniques

that Care Workers are allowed to

perform having completed

Medication Training for

Domiciliary care Workers.

Demonstrate an understanding

that there are some Specialised

Administration Techniques that

will require further training before

a Care Worker is allowed to

perform.

Dispose of any

medication as needed

Demonstrate an understanding of

why medication may need to be

disposed of.


procedures for the disposal of

medication.

Medication Training for Domiciliary Care

Workers Completed

Date

Care Worker Name (Block Capitals)

Signature

Line Manager (Block Capitals)

Signature


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Appendix 2 – Competency Record - Administration

Techniques

Objective Process Care

Workers

Signature

Line

Manager

Signature

Date

Administering oral

medication to a Service

User.


procedure to administer tablets.


procedure to administer soluble /

dispersible tablets


procedure to administer liquids.


procedure to administer sachets.


procedure to administer buccal

tablets.


procedure to administer sublingual

tablets

Administering

medication via the eye


procedure to administer eye drops

from bottles and Minims.


procedure to administer eye

ointment.

Administering

medication via the ear


procedure to administer ear

drops.

Administering

medication via the nose


procedure to administer nose

drops.


procedure to administer nasal

sprays.

Administering

medication via the skin


procedure to administer creams.


procedure to administer

ointments.


procedure to administer lotions.


procedure to administer Patches.


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Administering

medication via

mouthwashes


procedure to administer

mouthwashes.

Administering

medication via a throat

spray


procedure to administer throat

sprays

Administering

medication from nebules


procedure to administer nebules.

Assisting to administer

medication via inhalers

Demonstrate an understanding of

the limitations for care workers to

assist to administer via inhalers.


procedure to assist to administer

medication via inhalers.

Medication Training for Domiciliary Care

Workers Completed

Date

Care Worker Name (Block Capitals)

Signature

Line Manager (Block Capitals)

Signature


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Appendix 3 – Record of Refresher Sessions for Medication

Training for Domiciliary Care Workers

Name of Care Worker:

Refresher

course due

(mm/yy)

Refresher

course

completed

(dd/mm/yy)

Course Provider / Tutor

Name and Signature

Care Workers

Signature

Line manager

Signature


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Appendix 4 – Record of Additional Medication Training –

including Specialised Techniques

Name of Care Worker:

Date Title

Description of Training and Objective

Trainers name Qualification

Observation of Practice

Trainer

Signature

and Date

Care

Worker

Signature

and Date

Line

Manager

Signature

and Date

Date Title

Description of Training and Objective

Trainers name Qualification

Observation of Practice

Trainer

Signature

and Date

Care

Worker

Signature

and Date

Line

Manager

Signature

and Date


(Version 1.0 – 03/2020) - 51 -


© 2020 – East Riding Social Care Academy (East Riding of Yorkshire Council)

All rights reserved. No part of this document may be reproduced, distributed, or transmitted in any

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without the prior written permission of the copyright holder.

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