This governs the manufacture and supply of medicines. This requires that the local pharmacist or dispensing doctor is responsible for supplying medication. He or she can only do this on the receipt of a prescription from an authorised person e.g. a doctor. According to the law (The Medicines Act 1968) medicines can be given by a third party, e.g. a suitably trained care worker, to the person that they were intended for when this is strictly in accordance with the directions that the prescriber has given. The Misuse of Drugs Act 1971 and Amendments 1985, 2001
This controls dangerous or otherwise harmful drugs designated as Controlled drugs. (CD) The main purpose of this act is to prevent the misuse of controlled drugs. Some CD’s are prescribed drugs used to treat severe pain. Some people abuse them by taking them when there is no clinical reason. The purpose of the legislation impacts on care homes by requiring special arrangements for storage, administration, records and disposal. The misuse of drugs (Safe custody) Amendment Regulation 2007 This specifies how controlled drugs are stored and is referred to in the Standards for care homes. Controlled drugs must be kept in a Controlled drugs cabinet that complies with these regulations. The regulations specify the quality, construction, method of fixing and lock and key for the cupboard. The safer management of controlled drugs (2006)
This specifies how controlled drugs are stored, administered and disposed of. Controlled drugs must be kept in a controlled drugs cabinet that complies with these regulations. Records must be made for all controlled drugs transactions. Care Home Regulations 2001
Regulation 13 states that a registered provider must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This applies to all medicines including controlled drugs. Health & Safety at Work Act 1974
To maintain safety for all in the workplace your employer must ensure that anyone administering medication has attended the appropriate training. The risks associated with the handling or administration of any medicine should be assessed for both staff and patients. Control of Substances Hazardous to Health Regulations 2002 (COSHH) The law requires employers to control exposure to hazardous substances for both employees and others who may be exposed and to ensure employees and properly informed, trained and supervised. Care Standards Act 2000
Regulates and inspects services used by people for care services, provides guidance and information. The Act, has a major impact on the quality of care provided to children and vulnerable adults, and could make the system of regulation and inspection of care in particular simpler, more transparent and navigable. All care including that provided by local authorities falls within the scope of the Act. Its key provisions are: * The creation of a National Care Standards Commission (NCSC) for England to undertake the regulation of care. * The creation of a General Social Care Council (GSCC) for England and a Care Council for Wales to register social workers, regulate the training of the social care workforce and raise standards in social care through the production of codes of conduct and the maintained of a register of social care staff Access to Health Records Act 1990
The act defines who can see medical records. The individual can see his or her own records, but nobody else can except with the individuals permission. This includes next of kin and friends.
Data Protection Act 1998
The Act applies to any organisation that keeps personal records on a computer to register as a data user and they must comply with specific regulations. They must be secure, allow the individual to have access to their records, record only relevant information, only be used for its stated purpose. Hazardous Waste Regulation 2005
Dispensed medication for individual service users either at home or in a care setting can be described as household waste or is covered by the Hazardous Waste Regulations 2005. These medications can be returned to the dispensing pharmacist for disposal. However, care situations that provide nursing care not covered by this legislation and must make their own arrangements for the disposal of unwanted medicine through a licensed waste management company. There should be a written policy in place which describes the local procedure for recording of unwanted medication to be returned to the pharmacist. All medication should be recorded and signed for by the receiving pharmacist and a copy kept by the organisation.
National Minimum Standards
* Standards 9.5 and 20.7 states that controlled drugs should be kept in a designated CD cupboard until staff are responsible for giving them to people. * Standards 9.7 and 20.9 Controlled drugs should be given by care workers who have been trained and designated to do so. Another trained and designated member of staff should witness this process. * Standards 9.8 and 20.11 care homes should keep additional records of receipt administration and disposal of controlled drugs in a register. Working in line with your organisation’s policies and procedures enable you to work in line with best practice and the law (legislation). There must be a policy at your work place for the receipt, recording, storage, handling, administration and disposal of medicines. Check your policies and procedures file which should list the procedures relating to administration of medication with regards to your job role. 2.1
Common side effects from medicines
All medicines can potentially cause side effects or adverse reactions and these can vary from person to person. Side effects may be minor or extreme enough to be life threatening. Common side effects include: rashes, stiffness, breathing difficulties, shaking, swelling, headaches, nausea, drowsiness, vomiting, constipation, diarrhoea, weight gain. Side effects can either present as one symptom or as a combination of symptoms. Staff must monitor all medication given and record and adverse reactions in the service users care/support plans. The service users GP must be contacted and the medication stopped until informed otherwise. All medication should come with a description leaflet, which lists possible side effects.
These should be retained for future reference. If medication for service users come in MDS packs then the pharmacist should be contacted for information on all medication dispensed in this manner. Older people are particularly susceptible to reacting adversely to medication and are often already taking many different types of medication. Staff should be particularly vigilant with older people. Common adverse reaction symptoms in older people are: restlessness, falls, confusion, drowsiness, depression, constipation, incontinence, and Parkinson’s symptoms. Policies and procedures should be put in place locally, describing the steps to be followed in the event of an adverse reaction to a medicine, whether minor or life threatening.
Common types of medication
Types of medication Function Antibiotics To fight infection Analgesics To relieve pain Anti-histamines To relieve allergy symptoms Antacids For digestion Anticoagulants To prevent blood clots Psychotropic medicines which interact with the nervous system Diuretics Used to get rid of excess fluid Laxatives To alleviate constipation Hormones E.g. steroids or insulin Cytotoxic medicines to treat some forms of cancer
Medication Common side effects Hypnotics and sedatives –Temazepam and Nitrazepam Causes drowsiness in the morning Antibiotics such as Erythromycin and Amoxicillin Nausea and vomiting, diarrhoea and skin rashes. Analgesics
Strong painkillers such as codeine and morphine Nausea and vomiting, drowsiness, confusion and constipation. Antidepressants such as Amitriptyline becoming sleepy and confused.
Some medication which demands the measurement of specific physiological measurements are as follow: Insulin (blood glucose testing) to ensure the blood glucose is not too high (which prevents healing and increases the risk of damage to the nerve endings among many other effects) or too low (could induce a loss of consciousness for example) and warfarin (a blood thinner) which requires the blood to be checked regularly to monitor how effective the drug is i.e. is it preventing the blood being too “thin” (which could cause an internal bleed) or under anti-coagulated leaving the patient at
risk of blood clots. There is also Digoxin. The pulse should be recorded prior to administration of the drug.
Also a test is used to monitor the concentration of the drug in the blood. The dose of digoxin prescribed may be adjusted depending on the level measured. A doctor may order one or more digoxin tests when a person begins treatment to determine if the initial dosage is within therapeutic range and then order it at regular intervals to ensure that the therapeutic level is maintained. Apart from the administration of insulin you may not be expected to have a full knowledge of the others above or to take out the clinical activities but there should be an awareness of the reasons for clinical monitoring and to ensure that these take place as directed by a clinician.
The individuals you work with may experience unwanted or adverse effects after the administration of medication and you need to recognise this and take action. Adverse effects could be: * Anaphylactic shock – occurs sometimes after the use of an antibiotic. * Swelling of body parts, skin changes, breathing difficulties etc. If you observe any adverse changes you need to follow the laid down procedures at your workplace which you need to write out to support your answer of the appropriate action to take. * Inform the manager and seek professional help immediately. * Observe the individual
* Document all adverse reactions and action taken
* Treat the symptoms following clinical advice.
* Record the medicine and reaction in the care plan and MAR chart.
* Inform the individual’s own doctor and the pharmacist as soon as possible.
* Oral – by mouth, tablets and syrups
* Aural – ear drops
* Rectal – suppositories
* Vaginal – tablets, creams
* Sublingual – under tongue
* Nasogastric – via a nasogastric tube
* Buccal – between the lips and gums
* Inhaled – into lungs via inhaler or nebuliser
* Ocular/ophthalmic – eye drops
* Nasal – sprays, drops
* Topical – skin creams
* Intra venous – directly or via a drip into a vein
* Intramuscular – injection into muscle
* Subcutaneous – injection into subcutaneous layer of skin
* Transdermal – injection under top layer of skin, patches e.g. HRT
* Peg – Percutaneous Endoscopic Gastrostomy – medicines are introduced via a PEG tube which has been inserted directly into the service users stomach.
Using a few of the different routes of administration highlight the materials or equipments involved. For example * A service user who has a severe chest condition may require a nebulizer. This devise pumps air through a mask/mouthpiece that contains the medicine in a chamber. The medicine is converted into a fine mist and the service user inhales the medicine. * Oral administration – spoon, pill pot, water, gloves
* Topical administration – gloves to avoid cross contamination and potential harm to yourself.
An example of this would be what to do when you make an error in administration of medication. Anyone can make a mistake but it is important that you report the incident immediately to your manager to avoid any damage or deterioration to the health of the individual. Your workplace should have a policy in place of what to do when an error in administration has been made and why. Read and summarise. If you have administered medicine to an individual and they develop an adverse effect which you are not competent to handle you need to report following the procedures at your workplace. Medication errors happen, but you should report errors immediately. An error in the administration of a medicine can be at best inconvenient or at worst fatal. Common medication errors include; –
* Under administration
* Over administration
* Incorrect medication
* Incorrect prescription
* Non administration
* Non recording
* Administration of wrong medicine to wrong service user
* Administration at wrong time.
When any error in administering medication occurs, the local procedure must be followed immediately and should include the following steps:- * Report immediately to your line manager and follow directions given * Report immediately to the prescriber/GP/pharmacist and follow directions given * If serious error is made the service user may need hospital treatment * Document error fully
All incidents should be fully investigated, the results documented and every possible action taken to prevent the mistake happening again. If serious negligence or an attempt to cover up the mistake is discovered, this should be treated as a disciplinary offence. Failure to record medication errors is a Registration Offence for qualified staff and should be reported to the NMC. The Care Commission and CQC also require to be notified of medication errors.
Even if an individual wishes to self administer their medication it is still necessary to maintain a record of their current medication as stated in the National minimum standards which states “ The service user, following assessment as able to self administer medication, has a lockable space in which to store medication, to which suitably trained, designated care staff may have access with the service users permission” It is necessary to confirm that the individual actually takes the medication because you are required to complete the MAR (Medicines Administration record) accurately. If the individual passed the medication to another individual, that person could become seriously ill as could the person who the medication was intended for. You are responsible for the administration and its accuracy and it is your duty of care to protect individuals from harm.
Special arrangements apply to the disposal of Controlled Drugs (CD’s) in care homes registered to provide nursing care in England and Wales: * If supplied for a named person: denature CDs using a kit designed for this purpose and then consign to a licensed waste disposal company * If supplied as a ‘stock’ for the care home (nursing) : an authorised person must witness the disposal. For all other social care settings, the CDs should be returned to the pharmacist or dispensing doctor who supplied them at the earliest opportunity for safe denaturing and disposal. When CDs are returned for disposal, a record of the return should be made in the CD record book. It is good practice to obtain a signature for receipt from the pharmacist or dispensing doctor. Handling non prescribed controlled drugs and their disposal
Sometimes people bring illicit substances into care homes. The care setting should take advice from local police and if necessary the Serious and Organised Crime Agency concerning appropriate procedures for dealing with this. Homecare providers should devise policies and procedures in relation to service users using illicit drugs. This may include a requirement for care workers to vacate the premises if a service user is smoking, consuming or injecting illegal substances. Legal advice should be sought in situations where care workers may be at risk of aiding and abetting a service user to perform an illegal act.
DISPOSAL OF MEDICINES
All care settings should have a written policy for the safe disposal of surplus, unwanted or expired medicines. When care staff are responsible for the disposal, a complete record of medicines should be made The normal method for disposing of medicines should be by returning them to the supplier. The supplier can then ensure that these medicines are disposed of in accordance with current waste regulations. In England, care homes (nursing) must not return medicines to a community pharmacist but use a licensed waste management company. Additional advice is provided by CQC in safe disposal of waste medicines from care homes (nursing).
The situations when medicines might need to be disposed of include: * A person’s treatment has changed or is discontinued – the remaining supplies of it should be disposed of safely (with the persons consent) * A person transfers to another care service – they should take all of their medicines with them, unless they agree to dispose of any that are no longer needed * A person dies. The person’s medicines should be kept for seven days, in case the Coroner’s Office, Procurator Fiscal (in Scotland) or courts ask for them * The medicine reaches its expiry date. Some medicine expiry dates are shortened when the product has been opened and is in use, for example, eye drops. When applicable, this sis stated in the product information leaflet (PIL). All disposals of medicines must be clearly documented.