Medicines ManagementTraining Day for Managers, Seniors & Support

Workers

Why are you here?

• Revised Medicines Management Guidance implemented by SBC.

• Significant change to current practice – Service users will now be assessed for the medication support they require.

Support Staff will be administering a range of medicines from original packaging.

Training required to meet Care Inspectorate Guidance.

So-why do we need training?

• To learn the right way to administer medicines

• To be in line with the new Medicine Management Guidance

• Build confidence• Equity of access• So questions can be answered

Today

• Four modules:– Policy & Guidance– Medicines and their use– Monitoring & Supporting use– Medicine & Older people

Competency

A multiple choice questionnaire will be part of

your training to test your knowledge and

understanding. During this training

• A Competency Assessment will be carried out by your supervisor. In your place of work at a later stage.

Your Line Manager must advise you before

you can start administering Medicines.

Medicines Management

Policy and Guidance

Session 1

• Policy on medicines • Medicines and the law• Medication Assessment and levels of

support• Self administration• Administration of medicines• Awareness of MDS systems• MAR charts and record keeping• Medication Errors• Session 1 Evaluation Exercise

National Care Standards

Standards for each Registered Service Area:

• Care at Home• Care Homes• Support Services (Day Services)

Standards make reference to what service users should expect from services - includes support with medication (Workbook Appendix 1)

Page 71 of workbook

Scottish Social Services Council Codes of Practice

Codes of practice for social service workers and employers of social service workers describing the standards and conduct of practice within which they should work.

Pg 75 of workbook

Activity 1

Page 6 of workbook

The Law

• The law states that anyone can administer a medicine to another person if that is in accordance with the directions of a prescriber.

(The Medicines Act 1968)

Prescription written

Pharmacist dispenses prescription

Support worker administers prescription

On whose authority am I giving this medicine

On whose authority am I giving this medicine

Support worker picks up prescription

Support worker writes in support plan

Authority to Administer Medicines

• A Medicines Administration Record Chart is NOT an authority to administer.

• A Palliative Care Medicines chart signed by a Doctor is an authority to administer.

• Sign the prescription (look at both sides) when it is picked up and to document this in the Service user’s support plan.

• If they are not prescribed they may not legally be administered.

• Document medication on delivery to service user.

Medicine Management Guidance

In place to promote the safety and wellbeing of the service users and ensure safe practices of all support staff .

All support staff must be aware and understand their role and responsibilities while working with medicines.

Activity 2

Page 8 of workbook

Procedure for Service User Medicines Management

• See Guidelines – Appendix 1– Appendix 2– Appendix 3, 4, 5

Administration Levels (Full Details in Workbook)

(See Appendix 2 of guidelines)

• Assessed at Level 1 – Service Users will retain full

control of their medication.

• Assessed at Level 2 – Service Users will maintain

overall responsibility but will require assistance

with prompts to take their medicines and

collection of prescriptions.

Support Worker Tasks at Level 2

• Reminding the patient to take medicines– prompting

• Confirm the reading of labels.• Provide assistance with opening medication

packaging Performing and interpreting blood glucose monitoring.Order repeat prescriptions from the medical practice. The service user must specify the name, strength and quantity of the medicines to be ordered.

• Collect the prescription from the medical practice, take it to the nominated pharmacy for dispensing and collect the dispensed medications from that pharmacy.

Assessed at Level 3• Service Users are unable to manage their

own medication and will require their medicines to be administered.

• Medicines to be administered will be listed on a specific chart “Medicines Administration Chart” (MAR).

• The MAR chart is provided by the Pharmacist who dispenses the medicines.

• The MAR chart is supplied monthly along with the supply of medicines.

Support Worker Tasks at Level 3

• Only those medicine management tasks that have been agreed by the service user or his/her representative and are specified in his/her support plan may be undertaken.

• Support Staff can Administer those medications that are listed on the medicines administration record, including those contained in a Medicines Compliance Aid (MCA) filled by a Pharmacist or a Dispensing Doctor

Level 3 - Support Worker Tasks

• Care at Home Staff are not permitted to administer “as required” medication for service users assessed at Level 3.

• In care homes medicines that are prescribed on an ‘as and when required’ basis may be administered provided that it is listed on the medicines administration record (MAR) with full instructions as to the frequency of administration and the maximum daily dose. This should be clearly documented in the support plan.

Warfarin• CARE AT HOME STAFF SHOULD NOT ADMINISTER

WARFARIN

• In Care Homes the GP practice may give verbal instruction over the phone or in person to the Senior Support Worker on duty and they should repeat the instruction back to the GP practice to ensure clarity. This then needs to be recorded in the Social Care & Health recording notes and in the Warfarin Dose and INR Recording Form. This form should be stored along with the service users MAR record and the MAR record should read “as prescribed on WD/INR/Form”.

Don’t Forget

• Right Person

• Right Medicine

• Right Dose

• Right Time

• Right Route

Those Assessed at Level 4

• Administration requires medical training and knowledge

Who Does What?

• Relevant training done by all support workers

• Assessment of need – by care manager/Parmacist

• Support plan – added to by everyone• Consent – from the service user or their

legal representative www.sehd.scot.nhs.uk/mels/HDL2006_34.pdf

• Medication Administration Record (MAR) Chart – pharmacist produces

• Medicines Administration Record (MAR) Chart – support worker writes on it

Check the serviceUser’s support plan

And Medicines Administration Record Chart

or Kardex and get allThe medicines ready

Level 2/ 3 Service user

Sitting up preferablyWash hands

Offer a glass of waterMeasure and

Give dose(s)

Put medicine away, check if

They need ordered

Sign medicinesAdministration

Record if level 3order

SUPPORT WORKER’S RESPONSIBILITY

Check Identity

Service user is assessed by Support manager

For level of medicines administration needed

Level 1,2,3, or 4 agreed

Support plan writtenDetailing Support level

And Community Pharmacy address

Support workerchecks the serviceUser’s support plan

And Medicines AdministrationRecord Chart

CARE MANAGER’S RESPONSIBILITY

Community Pharmacist asked for MAR chart, if level 3

All instructions will Need to be very

Clear on the MARSo they will be

understood

Remember Consent

Administration of MedicinesPreparation is important

Wash hands,

MAR chart, - look at the time of day it is

Medicines – select the ones needed

Administer, remember to offer a drink

Record – exactly what you administered and when

Put away – making sure that those needed are ordered

Wash hands – washing hands is the thing that has been shown to reduce transfer of infection the most.

Important points to note

• If you are unsure about the service user’s identity or there is a discrepancy with medicines or the instruction is not clear then do not administer - contact your line manager immediately.

. Do not handle medication: disposable gloves should be worn as an extra precaution when administering cytotoxic medication.

• Push tablets out of blister packs directly into a medicine pot or other receptacle used for this purpose.

• You must not administer medicines which are not prescribed on the MAR chart.

• You must report immediately if medication that should have been administered previously has been missed by another worker.

• You must report immediately if when administering you notice a missing signature on the MAR

What Does a Medicines Administration Record Chart

look like?1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Paracetamol 500mg Tablets

Take two four times a day

B JS

IG JO

L JS

1

T JS

IL

N IG JO

Aspirin Dispersible 75mg Tablets

Take one in the morning

B JS

IG JO

L

T

N

Lisinopril 20mg Tablets

Take one in the morning

B JS

IG JO

L

T

N

B

L

T

N

This is what some

Of the Medicines Administration records look like.

Others will be similar.

Activity 3

Page 19-22 of workbook

Administering Tablets or Capsules

• Tap from the container, or pop out of the blister, into a lid or small cup or the service user’s hand

• Should not be touched by your bare hands

• Service user should be offered a half glass of cool, but not too cold, water to help with swallowing

SOLUBLE/DISPERSIBLE ORAL FORMULATIONS

• Take the dose from its original container • place in a third of a tumbler of cold water

and allow to dissolve • swirl the solution gently in the glass to

ensure adequate mixing • hand to the client to drink and offer a drink

after the dose has been taken • SUBLINGUAL FORMULATIONS - under tongue• BUCCAL FORMULATIONS – between

cheek and upper teeth

LIQUID ORAL DOSE FORMULATIONS

Only one liquid bottle should be open at any one time.

§ shake the bottle§ measure the correct dose – How? § offer the medicine to the patient§ when using an oral dose syringe empty the

syringe slowly onto the tongue, or towards the cheek

AVOID ‘SQUIRTING’ INTO THE BACK OF THE THROAT

§ clean the neck of the bottle with a clean damp tissue before replacing the cap

TOPICAL (EXTERNAL) FORMULATIONS

• use only as often as instructed • apply only to the areas of the skin for

which it has been prescribed -support plan

• use the smallest quantity that will easily rub into the skin

• use only for as long as instructed and return partly used tubes to the Community Pharmacy for safe disposal at the end of the treatment period

APPLICATION OF EXTERNAL PREPARATIONS

• Look at Patient Information Leaflet (PIL)• wear disposable gloves • Transfer quantity required to gauze or

clean tissue and re-seal tube• Apply to affected area rubbing in if needed• Dispose of gauze and gloves in sealed

polythene bag in the general waste.

EYE PREPARATIONS, Drops

• Tilt the head back and gently pull down the lower lid asking the client to look up

• Bring the dropper close to the eye• Gently squeeze the dropper allowing the

prescribed number of drops to be placed inside the lower lid

• Ask the client to close the eye and then blot away any excess solution with clean cotton wool

• Replace the cap on the container immediately after use

• May Cause blurred vision – falls risk

Eye Ointments:

• Tilt head back • Gently pull down lower lid• Apply half an inch of ointment• Ask service user to close eye and blink

several times• May cause blurred vision – falls risk• Replace cap immediately after use• Expiry of eye products

Ear Preparations

• Tilt head to one side• Place prescribed number of drops/

applications in the ear• Keep head tilted for several minutes• Have cotton wool or tissue to absorb

any run off

Nasal Drops

• Ask client to blow nose• Tilt head back or ask client to lie down• Ask service user to breath through

mouth• Place prescribed number of drops in

nose• Ask service user to keep head back or

remain lying down for several minutes• Tasting the drops is no cause for

concern

Activity 4

Page 19, 23-25 of workbook

Mistake? What do you do?

• Anyone can make a mistake• Reporting - no blame culture, near misses• Documentation• Learning from Audit• Wrong drug• Wrong dose• Wrong strength• Wrong time

Activities 5,6 & 7

Page 19, 26-28 & 29-30 of workbook

Alcohol & medicine

What do you do?

MCQ’s