medication policy and procedures
TRANSCRIPT
MEDICATION POLICY AND PROCEDURES
Version Number Issue 1
Date Revision Complete September 2013
Policy Owner Care & Support
Author Lesley Carnegie, Business Improvement Manager
Reason for Revision Updated following a good practice review carried out by
the Business Improvement Manager, supported by Care
Service Managers and frontline staff (see Appendix 1).
Data Protection
Equalities Impact
Assessment
Is it required? Yes/No
Proof Read Yes
Date Approved September 2013
Approved by Housing & Care Committee
Next Review Due September 2015
Audience – Training and
Awareness Method
Effective Date
Internal References
External References N/A
Comments
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Medication Policy & Procedures
Introduction
Blackwood believes that service users have the right to manage their own medication within a setting that is safe and supportive.
This policy and procedures provide a framework to positively encourage service users to manage their medication and to ensure systems are in place to assist those who require support to do so. The aim is to provide personalised support, acknowledging the individual’s rights in accordance with the National Care Standards.
Legislation places a duty on Blackwood to comply with recognised best practice to promote the safety and wellbeing of service users and employees, including medication management. Our policy and procedures ensure that these requirements are met.
Contents
Medication Policy 2
Medication Procedures 4
Related Policies & Guidance 9
Legislation 10
Appendix 1 – Good Practice Review of Medication 11
Appendix 2 – Weekly Medication Audit template 16
Appendix 3 – Self Medication Assessment template 17
Appendix 4 – Body Map template 19
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Medication Policy
1. Purpose
1.1 The purpose of this policy is to ensure that Blackwood establishes a consistent approach to ensuring safe and secure practices for the storage, administration and recording of medication.
2. Care Homes and Care at Home
2.1 This policy and its accompanying procedures are most relevant to care homes, where medication is ordered centrally and managed by staff. Certain elements are also important for care at homes services, where staff assist some service users with administering medication.
2.2 Where appropriate it is noted in the policy and procedures when a different approach is required for care homes and care at home services.
3. Responsibilities
3.1 It is the responsibility of the Care Service Managers to ensure the principles and scope of the policy are followed by the staff within their service.
3.2 Any serious breaches of the policy or related procedures will be reported to the relevant Regional Manager, and where appropriate to the local Social Work department and the Care Inspectorate.
4. Self-Medication
4.1 An appropriate risk assessment will be completed to determine whether service users are able to manage their own medication. This risk assessment will consider the individual’s state of physical and mental health and their own wishes, as well as practicalities around storage and disposal of medical equipment.
4.2 Where service users are independent with regards to managing their medication, staff will maintain a flexible service including information, education and support at an appropriate level, taking into account the changing needs of the service user.
5. Support to Manage and Administer Medication
5.1 Service users who require support to manage their medication will have a support plan in place that will include details of their expectations and those of staff in encouraging effective management of medication.
5.2 Where staff have responsibility for the actual administration of medication, the procedures accompanying this policy must be followed.
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6. Training
6.1 Blackwood staff are not permitted to administer medication if they have not had accredited training. The SVQ unit covering the skills needed to ‘Administer Medication to Individuals’ is widely used, and an SVQ compliant e-learning option is now being promoted (e-learning.cornerstone.org.uk).
6.2 Whilst awaiting accredited training, new staff will work in pairs alongside a more experienced colleague. This will continue during their six month probationary period. All new staff will also receive detailed induction training before starting work.
6.3 This training will be refreshed annually and accurate training records will be held for every member of staff.
7. Quality Assurance
7.1 Each of Blackwood’s care services are required to have quality assurance arrangements in place, to ensure that medication procedures are being effectively communicated, are clearly understood by staff, and are being followed consistently.
7.2 In care homes a weekly reconciliation audit will be carried out by Care Service Managers and / or Assistant Managers using a standard template (see Appendix 2). The purpose of these audits is to review medication records and identify any errors or anomalies that have occurred.
7.3 For care at home services, Managers / Assistant Managers will carry out regular spot checks of staff visits, both announced and unannounced.
7.4 Medication management will also be regularly reviewed by the Business Improvement Manager, as part of Blackwood’s continuous improvement programme.
8. Disciplinary Procedure
8.1 Specific disciplinary procedures are used within Blackwood to ensure that any errors in the administration of medication are appropriately addressed:
If the weekly audit or spot checks carried out by management show that a record has not been signed correctly the manager will meet with the relevant staff members and explain their error. If this happens three times within six months it will result in formal counselling, as per Blackwood’s Discipline Procedure.
If the wrong medication has been given or medication is missed, this will immediately result in formal counselling.
8.2 Any disciplinary action will be taken by managers with appropriate support from HR. It is recognised that errors may indicate a training need that needs to be addressed, and if so this training will be provided.
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Medication Procedures
1. Self-Medication
1.1 A detailed risk assessment will be completed to determine whether service users are able to manage their own medication (see Appendix 3). The assessment and its outcome will be clearly recorded in the individual’s support plan. This will be considered during six-monthly reviews to ensure their needs have not changed.
1.2 Where service users in care homes manage their own medication, individual locked cupboards will be provided in the person’s room so that medicines can be stored safely. Service users within the community will be given advice on safe storage of their medicines.
1.3 The service user’s GP will be asked where necessary to prescribe self-medicating medicines in smaller unit containers.
1.4 For insulin-dependent service users an individual sharps container will be provided by the community nurses. The container will be disposed of in accordance with the local procedure for disposal of sharps.
2. Prescriptions & Supplies
2.1 Supply of medicines to service users will be on prescription of a doctor (or dentist) unless the medicine is an over the counter medication.
2.2 Medicines supplied for a service user are the property of that individual. They will only be administered to the person for whom they have been prescribed, labelled and supplied. This principle applies to all prescribed items, such as dressings, surgical sundries and nutritional supplements.
2.3 Medication received from the dispensing pharmacist will vary, some pharmacies use blister packs with a 28-day supply while others use packs for each individual week. In all cases these packs will clearly state the name of the service user and the medication strength and dosage it contains.
2.4 Supplementary short courses, such as antibiotics, will be sent separately in their own bottle or phial from the pharmacist. Again these will be clearly labelled.
2.5 Where relevant, Blackwood’s services will keep copies or scans of original NHS prescriptions before they are sent to the pharmacy. Once delivered, all medication will be checked against the original copies by the Service Manager, Assistant Manager or Duty Officer to ensure that quantities and instructions are as directed by the GP. Similar checks and records will be in place for medicines carried over from month to month.
2.6 Labelling and changes to medication will not be altered unless it is on the instruction of the prescribing GP and should be carried out by the pharmacist. The packs will be returned to the pharmacist for the changes to be made and appropriate labels attached. Labels on creams and eye drops etc. will be on the container itself and on the outside box.
2.7 Advice will always be sought from the pharmacist or GP before over the counter medicines are purchased, as these may interfere with prescribed medications.
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3. Storing Medical Supplies
3.1 Within care homes, medicines are stored individually in each service user’s room or in the office, in a secure, lockable cupboard where they will not be subject to extremes of temperature. Medicine cupboards will be kept locked at all times except when medicine is being issued.
3.2 Items that require to be refrigerated (stored between 2° and 8° C) will be kept in a lockable medicine refrigerator. This refrigerator is located in the office and is solely used for storage of medicines. The temperature will be monitored daily and recorded. If the temperature falls outside the normal range this must be reported to the relevant Property Assistant and a repair requested. Regular defrosting and cleaning of the appliance is also required.
3.3 Details of who holds keys to each cupboard are kept in the individuals support plan / risk assessment. The cupboard and refrigerator keys should not be held as part of the master system and access restricted to authorised members of staff only.
3.4 When oxygen has been prescribed for a service user it will be stored in their own room and relevant safety advice, and appropriate safety notices displayed. A risk assessment will also be completed. All rooms where oxygen is in use will display the statutory warning notices: “Compressed Gas / Oxygen: No Smoking, No Naked Flames”.
4. Administration by Staff
4.1 Only appropriately trained members of staff will administer medication, as per the Blackwood Medication Policy.
4.2 Staff in Blackwood’s care homes will work in pairs wherever possible. They will work together throughout the entire process and have joint responsibility for any errors. If medication needs to be administered by an individual working alone, this will only be the Service Manager, Assistant Manager or Duty Officer.
4.3 The arrangements for care at home services mean medication will often be administered by an individual member of staff.
4.4 All members of staff will comply with the following process:
Identify the service user.
Check that the medicine has not already been administered.
Check the particular dose and method of administration.
Administer the medicine.
Enter the administration in the appropriate record sheet.
4.5 Medicines will only be crushed before administering after receiving confirmation in writing from the pharmacist that this will not alter the properties of the medicine.
4.6 Medication will not be handled whilst dispensing it. Medicines can be placed in a small pot from the dispensed container to hygienically hand it to the service user.
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Medicines will never be dispensed by the designated person and then left for someone else to administer at a later date or time.
4.7 Gloves must always be used by staff when administering steroid creams and other external applications.
4.8 Body maps will be used to record instructions and administration of topical medicines. These provide a visual and easy to follow format (see Appendix 4).
4.9 Invasive procedures such as injections or suppositories are carried out by the community nurses.
5. Record Keeping
5.1 Medication Administration Records (MARs) are usually provided by the pharmacies supplying medicines for recording administration of medication in Blackwood’s care homes.
5.2 While Blackwood staff usually administer medication in pairs, there is not always space on the MAR sheet for both people to sign. When this is the case the second person will use the reverse of the MAR or an extra sheet.
5.3 For care at home, where medication is not managed centrally but is still administered for some service users, Blackwood’s services will put in place their own forms to record the necessary information. As a minimum these will include:
Service user’s name.
Medicine name, quantity, dosage, form and strength.
What the medicine is for.
Prescription instructions.
Date and time of administration.
Who administered the medication, or if it was withheld / refused.
Who witnessed this.
5.4 The member of staff will only record administration once they have confirmed that the person has taken their medicine, not when the medicine has been removed from the dispenser.
5.5 Discontinuation of medicines will, where possible, be signed on the MAR / care at home record sheet by the GP. Changes to doses will be on the instruction of the GP and carried out by a pharmacist, with a new label provided.
5.6 A record of all current medication and emergency contacts will be kept in each service user’s home so that these can be quickly passed to the hospital or paramedics should an emergency occur.
5.7 It is a legal requirement for care home records to be retained within the home even when a service user has left. It is recommended that these records are kept for a minimum of three years from the date of the last entry and should be retrievable in needed.
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5.8 Each service user’s personal support plan will also include detailed, regularly updated information relating to medication, including:
When a medicine is started.
Who prescribed it.
What it is for.
How it is administered.
How long it has to be used for.
When it should be reviewed.
6. Refusal of Medication
6.1 A service user has the right to refuse medication. The reason for refusal will be recorded for further discussion at a review – this will be recorded in a different coloured pen or in a separate column so that it is easy to see when a dose was not given.
6.2 The service user’s GP will be consulted if there is persistent refusal to accept medication.
6.3 Covert administration or administration of medicines without the knowledge of the recipient will never be carried out unless it has been decided by a multi-disciplinary team (including carers and relatives of the person) that the person will miss out on essential treatment if they do not take the medication prescribed. A full and detailed record of the reasons for this will be kept, with a review date.
7. Withholding Medication
7.1 Medication will only be withheld from a service user if there are concerns that administering medicine will mean a risk to their health, for example if the individual has been drinking alcohol and the medicine instructions warn that it should not be taken with alcohol. In these cases the staff member will inform their line manager, and the GP or other appropriate health professional will be consulted.
7.2 As with refusals, any withheld medication will be recorded in a different coloured pen / in a separate column so that it is easy to see when a dose was not given.
7.3 Any adverse reaction or suspected adverse reaction will be reported to the service user’s GP.
8. Disposal of Medicines
8.1 All medicines will be returned to the named pharmacist if they are no longer required, have not been used for three months, or have reached their expiry date.
8.2 A receipt book is used for recording returns, which is signed by the pharmacist and a senior member of staff. The information recorded will detail the following:
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Date of disposal / return to pharmacy.
Name and strength of medicine.
Quantity removed.
Service user’s name.
9. New Admissions & Those Leaving the Service
9.1 Care Service Managers / Assistant Managers will ensure that all relevant medication details and medication accompany a new service user on arrival.
9.2 Managers / Assistant Managers will ensure that the same applies when the person leaves the service. If medication is transferred to another care provider this should be recorded and receipted.
9.3 Following the death of a service user, medicines will be retained for seven days in case the Procurator Fiscal requires them.
10. Controlled Drugs (Class A)
10.1 Controlled drugs will be stored in a double locked cabinet only used for this purpose.
10.2 Controlled drugs will be clearly marked on all records and registers used to monitor the receipt, storage, administration and disposal of medication, as outlined above.
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Related Policies & Guidance
Blackwood Policies & Procedures
Discipline Procedure
Whistleblowing Policy
Data Protection Policy
Accident & Incident Reporting
External Guidance & Good Practice
‘Guidance about medication personal plans, review, monitoring and record keeping in
residential care services’ (Care Inspectorate)
http://www.scswis.com/index.php?option=com_docman&task=doc_details&gid=767&Itemi
d=720
‘The Handling of Medicines in Social Care’ (Royal Pharmaceutical Society of Great Britain)
www.rpharms.com/support-pdfs/handling-medicines-socialcare-guidance.pdf
‘Commissioning care homes: common safeguarding challenges’ (Social Care Institute for
Excellence)
http://www.scie.org.uk/publications/guides/guide46/files/guide46.pdf
‘A guide to good practice in the management of controlled drugs in primary care’ (NHS)
http://www.nes.scot.nhs.uk/media/820809/20120322_a_guide_to_good_practice_in__the_
_management__of_contmarch_2012.pdf
‘Authorisation to Administer Medicines’ and ‘Maintenance of Medication Records’ (Social
Care & Social Work Improvement Scotland)
http://www.scswis.com/index.php?option=com_docman&task=cat_view&gid=330&Itemid=
720
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Legislation
A legislative duty of care is placed on Blackwood that relates to the care, safety and wellbeing of individuals receiving our services and to the safety of employees who deliver services.
Noted below are some pieces of legislation under which ‘duty of care’ falls. Examples are provided as an indicative (but not exhaustive) range of legislation that provide legal protection of individuals and employees who act to support them.
http://www.legislation.gov.uk/
Social Work (Scotland) Act 1968
Regulation of Care Act 2001
Medicines Act 1968
Medicines Labelling Regulations 1976
Controlled Drugs Act 1971
National Health Service (Scotland) Regulations 2009
Reporting of Injuries, Diseases & Dangerous Occurrence Regulations 1995
Data Protection Act 1998
Human Rights Act 1998
Health & Safety at Work Act 1974
Managing Health & Safety at Work Act 1999
Adults with Incapacity (Scotland) Act 2000
Mental Health (Scotland) Act 2003
Adult Support & Protection (Scotland) Act 2007
Equal Opportunities Act 2010
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Good Practice Review of Medication, April 2013
1. Background
Management of medication is an area of increasing importance in care inspections, with
particular attention being given to how medicines are administered, recorded and reviewed.
In Blackwood’s most recent inspection reports there are four care services where
medication is noted as a strength. However, for one service it is flagged as a Requirement –
an improvement action that must be taken, that is legally enforceable at the discretion of
the Inspectorate.
This inconsistency was also identified as an area of concern by Rebecca Shaw during Phase 1
of her whole organisation audit of Blackwood in November 2012. As part of the action plan
for this audit it was agreed that a review of medication management would be carried out.
This review was carried out during February and March 2013 by the Business Improvement
Manager. This involved site visits to care services that had received positive inspection
reports in relation to medication, meeting with management and staff to discuss current
approaches. In two of these services local improvement projects were already underway.
This report presents the key findings of the review, detailing the examples of good practice
observed during the site visits, whilst also noting best practice guidance published by
organisations such as the Care Inspectorate and Social Care Institute for Excellence.
2. Current Policy
Blackwood currently has a Medication Policy Statement that is due to be reviewed in April
2013, having last been approved in 2007. There is also a Self-Medication Policy that is
overdue for review, and a Medication Procedure that is ‘no longer controlled’ on the Master
Index. Care services have local procedures in place that are often discussed at a Regional
level to compare best practice and concerns, but are seldom shared across the whole of the
organisation.
While these policies and procedures are most relevant to care homes, where medication is
ordered centrally and managed by care staff, elements of them are also important for care
at home services where staff assist some service users with administering medication.
3. Good Practice Findings
3.1 Ordering & Receiving Medication
▫ In care homes, where all medication is ordered centrally, services should keep copies or scans of original NHS prescriptions before they are sent to the pharmacy. Once delivered, all medication should be checked against the original copies to ensure that quantities and instructions are as directed by the GP. Similar checks and records should be in place for medicines carried over from month to month, or returned unused.
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3.2 Administering Medication
▫ In Blackwood’s care homes medication is always administered by two staff. It should be emphasised that they are jointly responsible and that they must see the process through together from start to finish. Where possible the same two people should be assigned for the full day.
▫ The introduction of body maps in one of our care homes has been highlighted by the Care Inspectorate as an example of best practice. These maps are used to record instructions for application of topical medicines in a more visual and easy to follow format. The forms were provided by one of our medication suppliers (Boots) when they were asked to suggest ways the service could improve.
3.3 Recording Administration
▫ Medication Administration Records (MARs), usually provided by the pharmacies supplying medicines, are used to record administration of medicines in our care homes. This is in line with Care Inspectorate guidance.
▫ For care at home, where medication is not managed centrally but is still administered for some service users, services have put in place their own forms to record the necessary information. As a minimum these should include the date, time, medicine name, prescription instructions, who administered the medication or if it was withheld/declined, and who witnessed this.
▫ While Blackwood staff always administer medication in pairs, there is not always space on the MAR sheet for both people to sign, because the boxes are too small. The Care Inspectorate advises that when this is the case, the second person should use the reverse of the MAR or an extra sheet.
▫ If medicine is refused or not given for a specific reason, the Care Inspectorate recommends that staff record this with a different coloured pen so that it is easy to see when a dose was not given.
▫ The care worker should record administration once they have confirmed that the person has taken their medicine, not when the medicine has been removed from the dispenser.
3.4 Personal Plans
▫ Several of our inspection reports highlight person centred planning as a key strength. This includes the risk assessments carried out for all service users to determine whether they are able to manage their own medication and to identify any risks related to ‘over the counter’ medication.
▫ Blackwood’s policy is to encourage those who are able to manage their own medication to do so, whilst providing suitable advice or support to those who need it. This is in line with National Care Standards documentation.
▫ To fully meet the Care Inspectorate’s guidance, it is important that personal plans include detailed information relating to medication such as when a medicine is started, who prescribed it, what it is for, how it is administered, how long it has to be used for, and when it should be reviewed. Plans should be regularly updated to reflect any changes.
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3.5 Partnership Working
▫ The Care Inspectorate looks for evidence of good relationships and positive dialogue between care services and health professionals such as GPs and district nurses. Care staff responsible for managing a service user’s medication should be in contact with the GPs who carry out medication reviews to obtain details of any changes and to share any concerns.
▫ Relationships with the pharmacies that supply medication are also important, particularly for care homes. There are good examples of Blackwood’s services making the most of these companies and the services they provide, such as Boots and Central Pharmacy, who both provide medication, documentation and training, but also offer excellent additional advice and assistance when requested.
3.6 Duty Manager Audits
▫ While monthly medication reconciliation audits are in place across Blackwood’s care homes, a small number have increased the frequency to weekly and are reporting significant improvements as a result. A standard template has been created by these services.
▫ Two of our care services have developed local disciplinary procedures in relation to medication. If the weekly audit shows that a record has not been signed correctly the manager will meet with the relevant staff members and give a verbal warning. If this happens three times within six months it will result in a formal disciplinary. If the wrong medication has been given or medication is missed, this will immediately result in a disciplinary.
4. Recommendations
4.1 Review of Policies & Procedures
It is critical that the current Blackwood policies and procedures are reviewed. These
documents are statutory requirements and are requested in tender submissions so need to
be in place and up to date.
It would be beneficial to consolidate the current documents into a single comprehensive
policy statement that includes key procedures, whilst still allowing for some flexibility at a
local level. This policy should cover requirements for both care homes and care at home
services.
It is recommended that a draft document is pulled together by the Business Improvement
Manager, based on the current policies and procedures and the contents of this report. This
document should then be reviewed by a group of staff/managers from across Blackwood’s
care services/Regions, facilitated by the Business Improvement Manager in a focus group
format.
The new policy should include the adoption of some of the good practice examples
described above as standard practice across Blackwood, including the use of body maps and
increasing the frequency of medication audits to weekly. It should formalise the approaches
that have been adopted locally and provide detailed guidelines for staff.
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4.2 Staff Training
It is recommended that staff are not allowed to medicate at all if they have not had
accredited training. There is an SVQ unit covering the skills needed to ‘Administer
Medication to Individuals’. However, other available options such as the free training
offered by our supplier pharmacies and e-learning options should also be considered.
This training should be regularly refreshed and staff should be able to demonstrate that they
are competent in this area of practice. Any mistakes identified during the weekly audits
may indicate that there is a training need, so this should be considered by the manager.
Consideration should also be given to whether Blackwood’s disciplinary procedure is used
more actively in relation to medication errors, though it is important that staff feel they are
able to report any mistakes and are not tempted to cover them up.
4.3 Sharing Best Practice
To be able to avoid inconsistencies between Blackwood’s services, and to optimise our Care
Inspectorate grades across the board, any best practice obtained from inspectors, published
guidance or local pharmacies needs to be shared between all services and Regions.
It would be beneficial to review and re-launch the Learning Points template, as this does not
seem to be used effectively for this purpose.
Sharing best practice is also part of the Business Improvement Manager’s role, and other
methods of coordinating and encouraging this will be looked at over the next few months.
4.4 Quality Assurance
It is important that the new medication policy is quality checked to ensure it is clear and
easily understood, has been effectively communicated, is being consistently implemented,
and is regularly reviewed.
The Business Improvement Manager will be introducing internal Improvement Reviews over
the next six months, and as part of this it is proposed that any new policy is reviewed six
months following its approval. If the medication policy is revised in May/June 2013 it will
therefore be subject to a review in November/December.
Individual care services are also required to have their own quality assurance arrangements
in place, so the Business Improvement Manager will be working with managers to develop a
checklist and templates for this purpose. It is recommended that medication is included in
this checklist.
5. Other Considerations
It was noted during Rebecca Shaw’s audit that a similar review may be required for staff
handling money on behalf of care home residents. Several of the above recommendations
can also be applied to this procedure, for example staff always working in pairs, recording
transactions on a standard template, and managers carrying out reconciliation audits on a
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weekly basis. It is suggested that this report is referred to when the Financial Procedure for
Service Users Monies is reviewed (due in September 2013).
6. Further Reading
Guidance about medication personal plans, review, monitoring and record keeping in
residential care services, Care Inspectorate, 2012
http://www.scswis.com/index.php?option=com_docman&task=doc_details&gid=767&Itemid=720
The Handling of Medicines in Social Care, Royal Pharmaceutical Society of Great Britain,
2007
www.rpharms.com/support-pdfs/handling-medicines-socialcare-guidance.pdf
Commissioning care homes: common safeguarding challenges, Social Care Institute for
Excellence, 2012
http://www.scie.org.uk/publications/guides/guide46/files/guide46.pdf
A guide to good practice in the management of controlled drugs in primary care – Scotland,
NHS, 2012
http://www.nes.scot.nhs.uk/media/820809/20120322_a_guide_to_good_practice_in__the__manage
ment__of_contmarch_2012.pdf
Lesley Carnegie
Business Improvement Manager
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Weekly Medication Audit
Name of Care Service
Date……………………………
Service user
name &
property
number
Assistance required /
Med made available /
Fully independent
Name of Duty
Manager and
colleague auditing
Note of any errors
made Action taken
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Blackwood
RESIDENT/TENANT SELF-MEDICATION ASSESSMENT
FORM No:
MRA 1
ISSUE No: 1
ISSUE Date:
NAME: ADDRESS: GP:
MEDICATION
1. …………………………………………………………. 2. ………………………………………………………….
3. …………………………………………………………. 4. ………………………………………………………….
5. ………………………………………………………… 6. ………………………………………………………….
7. …………………………………………………………. 8. ………………………………………………………….
RISK ELEMENT
Assessed by:
Date:
Verified by:
Date:
1 Resident/tenant understands the
purpose of the medication, and when to
take it.
2 Resident/tenant understands that the
medication must not be given to others.
3 Resident/tenant understands why the
medication needs to be locked away
when not in use.
4 Resident/tenant knows where the keys
are kept.
5 Resident/tenant is able to open the
medication containers.
6 Resident/tenant is able to use inhalers.
7 Resident/tenant is able to use eye drops.
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8 Resident/tenant is able to read and
understand the instructions relating to
the medication.
9 Resident/tenant is able to self-inject
safely. (if applicable.)
10 Resident/tenant understands the need
to dispose of needles safely in sharps
containers. (if applicable)
Resident/tenant signature-------------------------------------------------------------------------------------------------
Manager’s signature-------------------------------------------------------------------------------------------------------
Keyworker signature-------------------------------------------------------------------------------------------------------
Date:---------------------------------------------------------------------------------------------------------
Review date:------------------------------------------------------------------------------------------------
SUMMARY AND AGREED ACTION.
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