self-administration of medication (sam) policy … · 2019. 3. 10. · 2 policy title...

SELF-ADMINISTRATION OF MEDICATION (SAM) POLICY

NOVEMBER 2018

This policy partially supersedes previous policies for self-medication in collaboration with the pharmacist

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Policy title Self-administration of medication

Policy reference

PHA15

Policy category Clinical

Relevant to All staff supporting patients to self-administer medicines

Date published November 2018

Implementation date

November 2018

Date last reviewed

November 2018

Next review date

November 2021

Policy lead Lucy Reeves, Chief Pharmacist

Contact details Email: [email protected] Telephone: 0203 317 7169

Accountable director

Vincent Kirchner, Medical Director

Approved by: Drugs and Therapeutic Committee

Ratified by: Quality Committee

Document history

Date Version Summary of amendments

Apr 1995 1 New policy

Mar 2002 2 Updates

Aug 2006 3 Updates

Dec 2015 4 Rewritten

Nov 2018 5 Updated

Membership of the policy development/ review team

Beverly Boateng, Clinical Pharmacist, Audrey Coker, Lead Pharmacist for Clinical Services, Simon Peel, Lead Nurse for Medicines Management.

Consultation

Chief Pharmacist, Lead Pharmacists, Team Managers

mailto:[email protected]

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Contents

1 Policy statement 4

2 Executive summary 4

3 Duties and responsibilities 4

4 Definitions 5

5 Levels of self-medication 6

6 Assessment and care planning 9

7 Management of incidents and errors 11

8 Physical assistance with self-medication 11

9 Dissemination and implementation arrangements 12

10 Training requirements 12

11 Monitoring and audit arrangements 12

12 Review of the policy 14

13 References 14

14 Associated documents 14

Appendix 1: Equality Impact Assessment 16

Appendix 2: Self-administration of medicines risk self-assessment and 17

Consent form

Appendix 3: Record for patient filling adherence aid finger or an adherence 19

aid

Appendix 4: MAR Chart 20

Appendix 5: Monitoring concordance for patients chart 21

Appendix 6: Self-medication concordance sheet – levels 1 and 2 22

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1. Policy statement

Supporting patients to self-administer their medicines is to help to promote recovery, through the development of skills and knowledge required to manage treatment. Supervised self-administration is a core function of services across the rehabilitation pathway, and trust services in the Community e.g.:

Inpatient rehabilitation wards

Community rehabilitation units

Supported housing projects

Acute day units

Crisis houses

Crisis teams/home treatment teams

Assertive outreach teams

SAM involves a multidisciplinary approach and emphasises the need for better management

of patients’ medication between hospital and community settings. This policy does not apply

to patients living at home in the Community and taking their medicines independently.

Implementation of this policy supports assurance of compliance with Regulation 13 of the Care Quality Commission (CQC) Essential Standards: Management of medicines, by ensuring that patients have their medicines when they need them, in a safe way, and understand the purpose of their medicines.

2. Executive summary

Aims of the policy:

To establish a standardised approach for assessing the patient’s ability to self-administer medicines safely

To define the different levels of the self-administration process

To define the responsibilities of each member of the multidisciplinary team in the self-administration process

Scope This policy applies if self-administration of medicines is supervised by staff employed by C&I. There are no exceptions to the policy in the trust services. Staff must use this policy when planning care that involves supervising patients self-administering medicines, in accordance with the scope of practice appropriate to their role. The policy must be read in conjunction with the medicines management policy and any standard operating protocol specific to the service.

3. Duties and responsibilities

Service managers are responsible for ensuring:

policies are adhered to within their service areas

staff are trained and competent within their services to practice in accordance with their role

staff are supported to work within, and not exceed, their sphere of competence

http://www.candi.nhs.uk/sites/default/files/Medicines%20Management%20Policy_PHA02_Jan%202017.pdf

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Ward, Team and House managers are responsible for deciding whether self-administration of medicines can be safely practised within the services. They are also responsible for ensuring that bedside lockers are available (if applicable) and for ensuring nursing staff and other members of staff are trained in the use of this policy. Doctors are responsible for prescribing (for patients) to comply with this policy and for communicating any changes in medication to the patient, nurse, pharmacist and team members as appropriate.

Pharmacists and pharmacy technicians are responsible for following the instructions in

this policy relating to the assessment and supply of medicines for use by patients.

4. Definitions

Self-administration

The preparation and administration of medication to oneself.

Administration/use of medicines

The activities undertaken when a medicine is administered; i.e. given by introduction into the body, or by external application to the patient.

Medication Administration Record (MAR) chart

A MAR chart is a written record of medicines that have been self- administered. It is not a prescription. MAR charts must not be used to obtain medicines from the pharmacy department. The MAR chart must be written by a nurse or allied professional who have undertaken trust accredited medicines management training two-day course or a nurse or allied health professional who has successfully completed the medicines management competency framework. The Trust MAR chart is in appendix 4. Alternatively, houses may obtain preprinted MAR charts from Community Pharmacies.

Medication chart

A medication chart is a record of all medicines prescribed and administered.

Dispensing/issuing/supply

Medicines are issued to services where they will be used, or supplied direct to the patient. This includes the supply of both stock, and individually named items.

Capacity

The MCA states that a person is ‘unable to make a decision’ if they cannot do one or more of the following four things:

Understand information given to them

Retain that information sufficiently to be able to make the decision

‘Weigh up’ and evaluate the information available to make the decision

Communicate their decision verbally or by using sign language or by muscular movement, for example, blinking or squeezing a hand

See Mental Capacity Act 2005 (incorporating the deprivation of liberty safeguards) policy.

5. Levels of self-administration

5.1 Levels of self-administration There are three levels of self-administration. Each level denotes the responsibility that patients have for managing medicines. See summary of each level below. The assessment must take place on referral to the service or when the decision to start self-medication is made. Patients can be managed by using a combination of the levels according to their

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needs. For example, a patient residing in a community rehabilitation unit may independently manage the storage and self-administration of nicotine replacement therapies (level 3). However, the patient may require prompting and direct supervision of the self-administration of their antipsychotic treatment (level 1). Before initiating self-administration, an assessment of the patient’s capacity and adherence must be undertaken. The patient must be informed of the responsibility that each level holds. The levels below apply to a ward or house environment. There is no specific duration for each step of the self-administration process. The decision is dependent on the patient’s needs.

Patients should be educated about their medication and given access to written and verbal explanations of the medication by a doctor, nurse or pharmacist. The Choice and Medication link or MAPPs can be used to provide written information. An individualised patient information leaflet can be given during admission stay and/or at discharge. This leaflet can be created from the MaPPs ® (found under clinical resources on the intranet).

Summary of each level:

Level 1 - Staff led

The patient must be supervised by a staff member throughout the self-administration

process. Medicines will be stored in a central medicines cupboard or trolley, and patients

will not have independent access to them. This is usually the first level on the wards and

may be the first level in a crisis or residential house.

When administration is due, the staff member will prompt the patient that their medication

is due, and will ask if they want to take it. They will hand the medicines bag/box/blister pack

to the patient and will request him/her to:

Select correct medicine(s) from the bag/box/blister pack.

Advise the staff member the medicine, dose and number of tablets they are taking.

Count out the correct number of tablets/capsules/volume of liquid, and take the medication correctly.

Return closed item(s) to bag.

The observing staff member must check what the patient states they are taking correlates

with the record on the MAR chart (appendix 4) /medication chart before the self-

administration occurs.

• Staff led • Service user fully supervised by staff

throughout the process Level 1

• Service user initiated • Service user is expected to remember the

scheduled times to come for their medication

Level 2

• Service user led •Service user has sufficient knowledge and has demonstrated that they can be responsible for their medication in every aspect

Level 3

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The member of staff will then observe the patient preparing and taking the medication and

will intervene to prevent the patient from taking medicines incorrectly if necessary.

The member of staff will initial the MAR chart/medication chart and make an entry in the

electronic patient record and the self-medication concordance sheet (appendix 6).

The member of staff should make any further comments relevant to the self-administration.

The information must be shared with the multidisciplinary team (MDT) and any concerns

regarding a patient’s safety during self-medication must be escalated. For level 1 during

Community visits, the patient’s medicines will be kept in the team base and would be

supervised when the staff member arrives at the patient’s home. The medicine chart must

be taken to the patient’s home.

Level 2 – Patient initiated

The patient will be informed of self - administration times. The patient is expected to come

and ask for medication at the scheduled time(s). The staff member will hand the

medicines bag/box/blister pack to the patient, and will request they:

Select correct item(s) from own bag/box. Advise the staff member the medicine, dose and number of tablets they are

taking. Count out the correct number of tablets/capsules/volume of liquid, and take

the medication correctly. Return closed item(s)

Initially, the member of staff will not remind the patient when to take their medication. If

he/she forgets to ask for the medication and 30 minutes have elapsed, then he/she must be

reminded. The reminder must be recorded in the progress notes and discussed within the

MDT.

The member of staff will observe the patient preparing and taking the medication and will

intervene to prevent the patient from taking medicines incorrectly if necessary.

The member of staff will initial the MAR chart (appendix 4)/medication chart; make an entry in the electronic patient record and the self-medication concordance sheet (appendix 6). The member of staff should make any further comments relevant to the self-administration.

Records in the electronic patient record: If the patient asked for the medicines Identified what medicines he/she was taking The patient read the instructions correctly If the patient prepared the medicines correctly If the patient self-administered medication correctly Any prompting or intervention provided

Records in the electronic patient record: If the patient asked for medicines Identified what medicines he/she was taking The patient read the instructions correctly If the patient prepared the medicines correctly If the patient self-administered medication correctly Any prompting or intervention provided.

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This information must be shared with the multidisciplinary team (MDT) and any concerns

regarding a patient’s safety during self-medication must be escalated.

In the community, patients will keep medicines at home. He/she will be supervised when the

staff member arrives at the patient’s home or the patient comes to the team base. The

medicine chart must be brought with the staff member.

Level 3 – Patient led - The patient will have sufficient knowledge about their medicines and

be able to handle their medicines safely, taking the correct dose at the right time without

direct supervision from staff.

The patient takes their medicines correctly with minimum intervention from staff.

The patient will ensure the medicines are kept locked in the bedside locker/cabinet.

The staff member in charge must hold a duplicate key (but routine concordance

checks must be done in collaboration with the patient)

Monitoring of concordance must be completed at least twice weekly using the form in

appendix 5. It may be completed more frequently if clinically indicated (e.g. every 48

hours for patients taking clozapine).

Controlled drugs must be retained by staff in a controlled drugs cupboard and will be

monitored as level 2.

The level of self-medication must be recorded in the patient’s care plan and on the MAR

chart/medication chart.

In the Community, patients will take medicines independently.

Level 1, 2 or 3

For patients on wards, the pharmacists can either:-

a. Ask the medical staff to write an electronic leave prescription for dispensing or

b. Complete a ward sheet with the patient name, medicines and dosage instructions for

dispensing.

5.2 Self-administration in bedded services (wards, crisis houses, assisted accommodation projects)

Wards and assisted accommodation projects are able to support service across different

phases of self-medication in accordance with patient needs, provided appropriate storage is

available and staff can manage any risks.

Wards use medication charts rather than MAR charts to record self-administration. The

medication chart must be annotated with the level of self-medication carried out. Self-

medication will only be supervised and signed for by a nurse or trained member of staff.

The crisis house must use a MAR chart to record the observation of self-administration. The

MAR chart must be written by a doctor or a trained member of staff. If medication is required

from the pharmacy department, then a medication chart must be written. The contents of the

medication chart and MAR chart must match. A doctor or trained staff members must

update the MAR chart.

Concordance must be recorded in the electronic patient records. For patients at level 3,

tablet counts can be done using appendix 5 - monitoring concordance for patients.

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5.3 Self-administration in community teams (crisis teams, home treatment teams, assertive outreach teams)

Teams in the Community who supervise the self-administration of medicines must use the

appropriate section of the crisis team medication charts to record each supervised self-

administration.

Some patients treated by these services may require this level of direct supervision during

self-administration. The patients may retain their own medicines at home. Patients are not

be required to lock the medicines in their own homes. The patients must be encouraged to

keep medicines safely from children and pets. Advice must be documented in the care plan.

Concordance must be recorded in the electronic patient records.

6.0 Assessment and Care planning Inclusion and exclusion criteria

To introduce the self-medication programme, the following criteria must be considered:

Table 1: Criteria for self-medication

Inclusion

criteria

Patients who are on a stable medicine regime

Patients who are expected to remain on the ward/unit for at least 7 days or

have been admitted to a crisis house

Capable of understanding the purpose of the medication, remembering the

directions for use and agreeing to take the medication prescribed.

Exclusion

criteria

Patients who are confused or who have an unstable mental state

Patient deemed unable to participate due to lack of capacity* as defined under the Mental Capacity Act (2005)

Patients on an unstable medicines regime

Patients at risk of self-harm

Patients who do not self-administer when they are not in hospital, e.g. carers

administer their medication

6.2 Risk assessment An appropriately skilled registered nurse or trained member of staff must carry out an individual risk assessment to determine how much support a patient needs to self-administer their medicines. For assisted accommodation and crisis houses, this must ideally occur prior to transfer into the service. Risk assessment must consider the following items, and a management plan addressing these must be recorded within the ‘evidence of risk of harm from others’ section of the risk assessment in the electronic patient record (see Risk and Safeguarding section):

Patient choice re: self-administration and their consent to engage in the process.

If self-administration will be a risk to the patient or to other residents/carers (for example, could leaving a medicine in their home pose a risk to another person)?

If the patient can take the correct doses of their own medicines at the right time and in the right way (for example, do they have the mental capacity and manual dexterity to self-administer)?

The frequency of the assessment based upon individual patient need.

How the medicines will be stored.

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The responsibilities of the care home/crisis team/crisis house/assisted accommodation staff (as applicable).

See appendix 2. If the formulation of the risk assessment exceeds the sphere of knowledge of the nurse, additional input must be sought from colleagues e.g. the pharmacist, RMO, or Trust Mental Capacity Lead. For patients who lack the manual dexterity to administer medicines themselves (with or without adherence aids), support from occupation therapy colleagues in the assessment process must be sought if available.

If a patient does not have capacity, a best interest’s decision must be taken. The MDT retains ownership of responsibility for making best interests decision, however the membership of the group taking a best interests decision must be proportionate to the level of restriction placed on the patient. For example, it may be appropriate for a decision regarding supervision of self-administration for a patient who has fluctuating capacity to be taken by a single registered healthcare professional. However, a decision to transfer the patient to a registered care facility would be taken in conjunction with other professionals and a representative for the patient.

NB Certain medicines may not be suitable for self-administration (level 3)

Controlled Drugs (Schedule 2 and 3) – in accordance with the Controlled drugs policy

Injections (unless the patient is self-administering their medicines at home e.g. insulin)

Once only doses Variable doses

Some “When required” medication

Patients at level 1 or 2 may have controlled drugs provided there is a controlled drug

cupboard. Level 3 patients’ controlled drugs will be monitored at level 2.

Medication supply for SAM

Wards and certain crisis houses (Daleham (House) Crisis House and Rivers

Crisis House):

- Routine medicine prescriptions must be requested from GP surgery. For medicines

initiated or changed by the medical team, a supply can be requested either via a TTA

or a pharmacist writing an order with a ward sheet.

- For level 1 & 2, a month’s supply will be provided for medication suitable for

inclusion.

- For level 3, four batches of 7 days will be supplied. The patient will have

responsibility for one batch at a time, unless otherwise agreed by the

multidisciplinary team and documented.

Community teams and Crisis teams:

- Medicines must be requested as defined in the policy/procedure for each service.

This may be via GP/community pharmacy, with the use of pre-packs or by using the

trust pharmacy service.

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Patients wanting to hold ‘as required’ medicines.

Patients may hold the following medicines provided there is a locked cupboard/bedroom or

they are holding it on their person There must also be a documented patient specific risk

assessment documented in Carenotes:-

Drops

Sprays

Inhalers

Creams

Ointments

NRT products

Environmental factors

For patients considered to be appropriate for level 3 self-administration, a lockable

medicines cupboard must be securely located within the patient’s bedroom. The patient

must be able to lock the bedroom.

Duplicate keys are available for both locker and bedroom drawer, in case of loss by

patient.

Room temperatures must be monitored each day if the patient has a medicine locker.

There must a trust approved room temperature record sheet in the rooms.

6.3 Review

Review of capacity, risk, and consent must be an on-going process during a treatment episode/admission. The risk assessment/care plan must be updated in response to:

Deterioration in mental state

Changes in medication

After a self-administration error

Withdrawal of consent

Review of treatment via CPA or other care review

In wards and in community rehabilitation, the multidisciplinary team in line with their treatment review schedule must review the unit’s progress against the self-administration pathway. This must be aligned with 6 monthly CPA cycles at a minimum. Risk assessment and care plans must be updated.

7. Management of errors and incidents

Errors must be clinically managed in accordance with the protocols for managing medication

incidents described within local SOPs. This will usually include:

Escalation to Prescriber/GP and Trust pharmacy during working hours

Escalation to duty doctor and on call pharmacy out of hours

All errors/incidents related to the self-administration of medicines must be reported using

Datix online incident reporting.

8. Physical assistance with self-administration

Patients who require assistance with preparing medicines for self-administration (for example a patient whose hands shake and require help with pressing out the tablets into a pot) must have:

The capacity to have made the decision to self-administer the medicines

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Requested for assistance from staff in supporting them to remove the medicines from the packaging

A blister packs/adherence aid may be used if a decision is made by the MDT. If the person is an inpatient, the ward pharmacist must be consulted as part of the decision-making process. The GP surgery must be contacted to check if a referral for a blister pack will be made on discharge. Refer to appendix 2.

In residential and crisis houses, arrangements for patients away from the home are as follows: When the patient needs to take their medicines away from the home, the original dispensed supply should accompany the patient. If possible, for a short-term leave, the original supply should be sent with the patient, provided it can be returned. If a return of the medicines is uncertain, a prescription for the short-term leave period should be requested from the GP. The prescription should be sent to the Community Pharmacy. Alternatively, if the patient is on leave for one day, the patient can transfer the medicines into a adherence aid finger. This must supervised by the nurses or accredited members of staff. The supervision must be documented on the designated form (appendix 3).

If a patient wishes to keep their medicines in an adherence aid, the Community Pharmacist must be contacted to request the medicines are dispensed in it. The adherence aids must be purchased.

If the community pharmacists cannot provide this service and the patient still wishes to use adherence aids, they must fill the boxes under a supervision of nurse or an accredited member of staff. Advice must be obtained from the Trust pharmacist or Community Pharmacist as to the stability of the medicines in adherence aids. The MAR chart and labels on the dispensed medicines must be used as reference sources by the staff member during the supervision. The patient under supervision by the member of staff must complete the adherence aid label. The staff member must not fill the adherence aid on the patient’s behalf. Once completed, the member of staff must record the observation in appendix 3 and in the electronic patient record.

See the Trust medicines management policy for more information.

9. Dissemination and implementation arrangements

The policy will be circulated to divisional directors, service managers and team managers for dissemination. The lead nurse for medicines management, mental capacity act lead, and lead pharmacists will be available to support services in its implementation.

10. Training requirements

For training requirements please refer to the Trust’s Mandatory Training Policy (Intranet) and Learning and Development Guide (Intranet).

Staff involved in supervised self-administration of medicines is required to participate in

training and competence assessment processes pertaining to these interventions.

11. Monitoring and audit arrangements

Nurses based within services are expected to lead on the local monitoring and audit of processes around the management of medicines, with additional support from the pharmacy department as required.

The criteria below must be checked on a weekly basis by the manager or designated nurse. The service manager will monitor results of the audit checks. Required actions will be identified and completed in specified time frames.

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MAR chart checks

Any entries on MAR chart are signed and dated by the staff member supervising self-administration

Medicines administration is recorded or reason for not administering (by code) on the

MAR. There are no blank spaces on at due times for administration.

Patients on level 3 of self-administration have had their concordance recorded in the concordance sheet in appendix 5 at a frequency determined by the multidisciplinary team or at a minimum of weekly checks.

Medicines (expiry, storage, disposal) checks

All medicines administered are in date.

All medicines are stored appropriately in locked medicines cupboard, CD cupboard or medicines fridge.

Fridge temperature is monitored daily and appropriate action taken where temperature has deviated outside 2-8°C.

All rooms where medicines are stored are temperature monitored daily and

appropriate action taken where temperature has deviated above 25°C.

Nursing staff must also complete weekly checks to verify the quantity of each medicine. This is to ensure that medicines are appropriately used.

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AUDIT AND MONITORING/GOVERNANCE

12. Review of the policy

November 2021 or earlier should practice change.

13. References

This policy has been developed in accordance with the following NICE guidelines

SC1 - managing medicines in care homes (2014)

CG76 – Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence (2009)

NG5 – Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (2015)

14. Associated documents

Medicines Management Policy

Patients own drugs policy

Medication optimisation policy

Controlled Drugs Policy and Procedures

Standard Operating Procedure (SOP) for Medicines

Management in Crisis Houses


Management in Community Rehabilitation Units


Management in Hanley Gardens and Caledonian Road

Medicines management procedure for SAMH Home Treatment

Team Medicines Management Procedure

Medicines Management Procedure for Crisis Teams

Elements to be monitored

Lead How Trust will monitor compliance

Frequency Reporting

Acting on recommendations and Lead(s)

Change in practice and lessons to be shared

MAR chart and concordance for level 3

Manager of the service

Audit /

Pharmacy checks

Weekly / monthly

Divisional quality forums

Required actions will be identified and completed in a specified timeframe

Required changes to practice will be identified and implemented within a specific time frame. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders

Medicine storage, expiry, disposal


Audit /

Pharmacy checks

Weekly / monthly


Controlled Drugs

Manager of the service / Lead Pharmacist

Audit /

Pharmacy checks

Weekly / monthly

(quarterly trust CD audit)


DTC

Self-administration assessments


Audit Quarterly Divisional quality forums

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Appendix 1

Equality Impact Assessment Tool

Yes/No Comments

1. Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race No

Ethnic origins (including gypsies and travellers) No

Nationality No

Gender No

Culture No

Religion or belief No

Sexual orientation including lesbian, gay and bisexual people

No

Age No

Disability - learning disabilities, physical disability, sensory impairment and mental health problems

No

2. Is there any evidence that some groups are affected differently?

No

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

N/A

4. Is the impact of the policy/guidance likely to be negative?

No

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving the policy/guidance without the impact?

N/A

7. Can we reduce the impact by taking different action?

N/A

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Appendix 2: SELF-ADMINISTRATION OF

MEDICINES RISK ASSESSMENT AND CONSENT FORM

1. Introduction 1.1. Patients with difficulty remembering to take their medicines should be considered for

a medication reminder (produced from MAPPs) as a first option. 1.2 The tool below must be used to assess the patient’s needs. 1.3 Medication adherence aids are devices designed to help patients to take their

medication. They may be helpful in assisting patients who are motivated to take their medication, but sometimes forget. They are of no value in patients where non- adherence is intentional.

1.4 If a medication compliance aid is required, a blister pack or alternative compliance aid must be considered. This can be obtained by contacting the GP surgery. The GP surgery will make a referral to the chosen Community Pharmacy. The Community Pharmacy will make an assessment as to whether a blister pack is appropriate. Once accepted, blister packs will be provided. For inpatients, the ward pharmacist must be contacted. As part of the assessment for inpatients, the ward staff must contact the GP surgery to check if a referral to the Community Pharmacy can be made on discharge.

Tool for assessing patients for managing their medicines

Patient Name NHS Number

Ward Date of Birth

Risk Level of Risk Comments/adjustments

Patient’s mental state is unstable and/or confused (unaware of time and space)

Is there any history of alcohol/drug abuse

Is there any history of overdose, accidental or intentional

Patient has history of non-compliance to medication leading to relapse or risk of relapse

Yes/No

Is the patient currently able to manage medicines?

If Yes , no further assessment required

Is the patient motivated to commence self-medication

If Yes, consider the options below

Is the patient able to manage medication with a reminder card from MAPPs)?


Does the patient require counselling with an interpreter to ensure information isunderstood?

If Yes, organise an interpreter and reassess if the patient can then manage medicines.

Could the medication regimen be simplified? If yes contact the prescriber.

If Yes, review with the prescriber before completing the assessment

Can the patient manage with opening child-resistant closures foil?


Can the patient manage by opening ordinary (non-CRC) screw lids?

If Yes , contact Community Pharmacist

Does the patient have any difficulty reading the label on their medication packet?

If Yes, ascertain the difficulty and contact the Community Pharmacist e.g. to check if larger labels are possible.

Is the patient not able to manage, but here are systems at home which are satisfactory?


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Are you confident that any assistance provider e.g. carer, friend or relative is competent to order, collect, supervise self-administration of medicines?


Is the patient residing in/to be discharged to a nursing home?


Is a specific community pharmacy used / to be used for obtaining medication? If so, give details below). Name, address, telephone

Name: Address: Telephone number:

If the patient is confused by the number of medicines taken and it is felt that a compliance aid would relieve this confusion in which case record reasons below. The GP must be asked to make a referral to the Community Pharmacist for a compliance aid assessment.

Will the GP make a referral to the Community Pharmacy for a blister pack?

If Yes, request a referral.

If an adherence aid is preferred by a patient, the Community Pharmacist must be asked to fill the box. A patient may fill one day’s supply of medication in an adherence aid finger under supervision of an accredited nurse or a clinical support worker.

The adherence aids may need to be provided to the Community Pharmacy.

If the patient prefers to fill the adherence aid, he/she must undertake this task under the supervision of an accredited nurse or a clinical support worker.

The member of staff can only supervise the patient.

Additional Comments Risk Levels High (H) Unlikely to succeed with self-administration Medium (M) Likely to be successful with high levels of support Low (L) Likely to be successful with support None (N) Likely to be successful with the program

Consent Section

Name Signature Date

Consultant

Nurse

Pharmacist

Level to enter: MDT approved: Yes / No Consent completed: Yes / No

Consent

The self-administration scheme has been explained to me and I am willing to take part. I understand that I can withdraw my consent at any time. I understand that if the staff decides that I should stop the self-administration programme I will be informed. Patient signature

Date:

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Appendix 3: Record for patient filling the adherence aid finger or an adherence aid Patient Name: Age: Ward/Service: Electronic patient record no. Date Medicine Medicine chart checked

by a nurse of a clinical practitioner (signature)

Medicine added correctly to the adherence aid finger by patient. Checked by nurse or clinical practitioner (signature)

Appendix 4: MEDICINES ADMINISTRATION RECORD (MAR) FOR PRESCRIBED REGULAR MEDICINES AND WHEN REQUIRED MEDICATION

PATIENT NAME: ALLERGIES: DATE OF BIRTH: LEVEL OF SELF MEDICATION:

DATE (Month/Year)

MEDICINE DOSE AND FREQUENCY:

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

19 20 21 22 23 24 25 26 27 28 29 30 31

Morning

Lunch

Tea

Night Pharmacy: Count

Record date(s) & Quantity(s) received with 2 signatures

Qty(s) returned/destroyed & signature:

Morning

Lunch

Tea




Morning

Lunch

Tea




Morning

Lunch

Tea




Morning

Lunch

Tea




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Entry Codes: Initials = supervised medicine given, D = medicine declined, SA = self-medication (not observed), O = medicine omitted, N = not available, F = any other reason record in notes.

Appendix 5 - monitoring concordance for patients

SELF-MEDICATION CONCORDANCE CHECKS

NAME OF PATIENT:

DATE CHART STARTED:

Medicine/dose/freq Date of check

No of tablets counted

No of tablets that should be left















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Appendix 6 – self-medication concordance sheet – levels 1 and 2

SELF-MEDICATION CONCORDANCE SHEET – levels 1 AND 2

Dates

Week

Date MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

B L T N B L T N B L T N B L T N B L T N B L T N B L T N

Did person ask for

medicine

Read instructions

correctly

Takes medicines correctly

Comments (give date)

Week

Date MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Did person ask for

medicine

Read instructions

correctly

Takes medicines correctly

Comments (give date)

Y- Yes; D- Declined; B- Breakfast; L- Lunch; T – Tea; N - Night

22

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self-administration of medication (sam) policy … · 2019. 3. 10. · 2 policy title...

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