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Medicines Management

Updated November 2019 - ECC Medicines Standards for Providers

The County Council's Adobe _PDF_file _icon _24x 24Medicines Standards for Providers is available to view in PDF format. 

 

The aim is to ensure that the Individual is able to maintain good health through receiving medication as prescribed.

The Service Provider should liaise with and engage in joint working with health services and other relevant organisations that can meet the needs of the Individual.

The Service Provider should have a clear, written medication policy and procedure in place which meets statutory and best practice requirements and is adhered to by all staff.

 

Standards

The Service has to be delivered in accordance with the Council's medication standards which can be accessed via the link above .  The standards should be used to support the requirements to follow relevant legal and best practice guidance.

There is a requirement that the Service Provider and Staff establish, document and maintain an effective system to ensure that medicines are handled in a safe and secure manner.

 

Storage

Medication should be stored in an appropriate location which can be secured. Where a lockable treatment room is not available, medication trolleys should be locked and secured to a wall when not in use.

Medication should be stored according to manufacturer's guidance and should not be exposed to extreme temperatures, as such medication stored in a treatment room/trolley or fridge should be subject to regular temperature checks. It is recommended that these are completed twice daily. Minimum and maximum temperatures should be readily available to staff in addition to escalation procedures should temperatures be out of the required range. 

A clear key holder process should be in place i.e. administering individual holds keys whilst on shift

Opening dates should be recorded for boxed and bottled medication with expiry dates monitored. 

 

Management of Stock

Processes should be in place to prevent shortfalls or overstocking of medications. There should be consideration of how best to manage this such as stock counts, regular auditing and oversight of prescriptions. 

Regular monitoring should be in place of actual medication administered; where an individual is regularly refusing medication, processes should be in place to arrange a prompt review with their doctors surgery.

Pharmacy audits and GP reviews should be completed annually or when required to support you in this area. 

A robust process should be in place for medication returns, with a returns book the usual course of action. Controlled drugs should be returned separately to other medication or should be clearly identified within the returns process. 

 

Homely Remedies and PRN (when required) Medication

Medication policies should include the processes to be followed by staff for both homely remedies and PRN medication. Such policies should align to the guidelines of your local Clinical Commissioning Group.  

A protocol should be in place for each individual and for each homely remedy or PRN medication in use. Protocols in place should include the following minimum information:

  • Resident name
  • Medication, strength, dose, route of administration and frequency
  • Maximum dosage in a defined period
  • Reason for medication and expected outcome
  • Signs and symptoms displayed by individual if individual is unable to ask for medication
  • In what instances the medication should be reviewed 

An administration log should be in place for homely remedies and PRN medication and should include the following information:

  • Resident name
  • Medication and amount administered
  • Time and date of administration
  • Reason for administration
  • Stock balance 

 

Covert Medication

Covertly medicating should be a last resort and should only be considered once all other options have been exhausted. The decision to covertly administer medication must be done using a multidisciplinary approach and should involve the GP, pharmacist, individual where possible and those with a vested interest in their care such as next of kin or advocates.

The GP will be responsible for the final decision and as a part of that process will complete a capacity assessment. The Pharmacist will also be involved and will give advice on whether the medication can be crushed or dissolved as an example and how the medication is best administered.

Clear care plans should be in place once the decision to covertly administer has been made with copies of all relevant documentation retained on file.

Staff should also be aware of decisions made and their responsibilities for administration. 

The decision should be reviewed regularly or as and when there has been a change.

 

Controlled Drugs

Controlled drugs should be stored within a lockable controlled drugs cabinet. 

The controlled drugs book should be carefully completed ensuring:

  • The index is up to date and corresponds with pages in use
  • Two staff signatures for receipt, administration and auditing
  • Time and date of administration as well as current balance and  remaining balance completed
  • New stock received and auditing should be easily identifiable

 

Patches

Patch application records should be in place for those in receipt of transdermal patches; it is also recommended that these are used for those individuals who require Parkinson's patches.

Body Map charts are a good way of recoding application and removal and ensure rotation of sites is appropriately captured.

This supports a more robust auditing process. 

 

Topical Medications

A protocol and/or body map should be in place to identify the following:

  • Resident name
  • Medication, area of application and frequency
  • Maximum dosage in a defined period, if the medication is a steroid or pain gel as an example
  • Reason for topical medicine and expected outcome
  • Signs and symptoms displayed by individual if individual is unable to ask for medication
  • Pack opening date

Applications should be recorded on the MAR chart or separate application record. 

 

Compliance Aids

Each patient's needs must be assessed on an individual basis and any intervention must be tailored to the patient's specific requirements.

The use of MCAs must be made when an assessment by a health professional (for example, a pharmacist) has been carried out and a specific need has been identified to support medicines adherence following ECC standards and NICE guidance.

 

Medication Administration Record (MAR) Charts

MAR charts will usually be provided by the Pharmacy however, there will be occasions where handwritten records are necessary. The following should be considered when reviewing medication administration records:

  • A profile sheet is in place for each person and includes; a photo of true likeness with the individuals consent, the individual's name, room, GP, D.O.B, allergy status and how they prefer to take their medication. 
  • The MAR chart in place should include the individual's details; including full name, date of birth, address and weight (for frail older residents), GP and allergy status. 
  • All medication should be listed on the MAR and include; the name, strength, form, dose, timing and frequency and route of administration. It should also identify any special instructions such as with food and any maximum dosages.
  •  There should be the ability to record the carried forward and quantities received, signed in by two members of staff 
  • A guide is in place to identify when and which codes are to be used, with space for administrating staff to record additional information as required
  • An up to date staff signature sheet in place

 

Medication Policy

A medication policy should be in place and cover the procedures and processes for medication management. It is important that any policy implemented is reflective of actual processes in place. Policies should cover areas such as; ordering and returns, storage, administration, self-management, refusals, homely remedies, PRN, covert administration and warfarin as examples. Please note this list is not exhaustive. 

 

Training and Competency

Staff with responsibility for administration of medication should be appropriately trained by an accredited trainer to do so i.e. trained to a minimum of level 2 which has been refreshed regularly; although, it is recommended that all staff complete awareness training. 

Competency assessments should be completed for all staff and should incorporate observation as well as discussion. Competency assessments should be completed at least annually or as the need arises. 

 

Medication Audits

Auditing is an important part of medication management and should be completed regularly for both medication and controlled drugs. Audits should incorporate; stock counts, accuracy of recording and whether there are any gaps, training and competency and storage as example. This list is not exhaustive and it is recommended that you review the NICE guidelines for management of medicines appropriate to your field. 

It is important that any shortfalls are followed up and action plans are implemented to resolve issues identified and to prevent them from reoccurring. It is also important that any trends or themes are analysed and learning is shared

 

Incidents

There must be a clear incident reporting system which does not ignore errors but encourages a culture that allows Staff to report incidents and learn from them.

 

Last Updated: 11 November 2019

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