Medicine Matters

Training programme in medicine management for carers

Introduction

Medicine must be taken by:  Right person  Right dose  Right time  Right way

Learning Objectives

        Understand carers role Understand good practice Understand problems Understand and follow instructions Understand and follow additional instructions Identify side effects Record Know where to get help

Errors happen when

 Lack of understanding of purpose and use  Believing more is better  Physical impairment  Confusion  Forgetfulness  Side effects unpleasant  Unhelpful comments

Errors continued

 Failure to get the medicine  Poor storage  Old medicines

Roles & Responsibilities

 Only trained carers can assist with medication  Only when authorised by managers  Consent from service user  Only those medications which have been prescribed with specific instructions

Needs assessment

 The level of help needed will be assessed by GP practice  Sometimes in consultation with home care managers

Level 1 user

 Can take full responsibility for her/his own medication

Level 2 user

 Assistance with ordering, collection and disposal  Confirming reading of medicine label  Opening containers or strip packages

Level 3 user

 Needs assistance with administration of oral dose medicine, some topical preparations and other types of medication where approved, e.g. eye drops

Taking the medicine what next?

 Swallow  Stomach  Intestine  Blood  Eliminated Amount of medicine eliminated = amount of medicine absorbed

Types of medications

 How many can you think of?

Pills & capsules powders Liquids Patches Creams Drops Gels Sprays Inhaled Intravenous Subcutaneous Pessaries, suppositories.

Help is permitted with

   Tablets Liquids Creams     Drops* Gels* Sprays* Pessaries micro enemas* *with advice from primary health care team

Help is not permitted with

 Intravenous medication  Subcutaneous medication  Diabetes testing

Risk Factors

 What can go wrong?

Forgetting to take it Taking too much, too little Taking wrong one Taking someone else’s

Risk factors

 People factors Sensory Impairment Dementia Physical disability

Risk factors

 Medication factors Unclear instructions Pills look alike Packaging hard to open

Ordering & Collecting Medication

Level 2 user  Must request the carer to order  Must indicate what medicine, the strength and quantity.

Level 3 user  Only medicines listed on the chart may be ordered

Storage of medication

General  Safe  Cool & dry out of sun  Original containers  Some in fridge

Storage of medicines to be administered by carer

 Keep together in sealed container labelled  Chart to be kept in care plan or alongside  Look for special storage instructions  Medicine in fridge to be kept separate from food  Oral medicine separate from external

Disposal of medication

 Never throw into public waste system  List unwanted medicine on disposal form signed by client  Return to pharmacy  Get signature

Dispensing Labels

 How to take the medicine what would you expect to find?

Date of dispensing What is it and how much is there - strength Name DOB Pharmacy address Dosage amount When to take How to take Storage instructions * Expiry date may be on but is not a legal requiremnet

Additional instructions

 Swallow whole Do not crush  Take before or on empty stomach 30 minutes  Take after food 30 minutes  Take regularly complete course Same times

Additional instructions

 Take with or after food During meal  Do not take indigestion remedies at same time Minimum of 30 minutes preferably 2 hours  Dissolve or mix with water Ensure fully dissolved

Additional instructions

  Allow to dissolve under tongue Take with plenty of water Glassful  Apply sparingly No coating on skin about fingertip to cover size of a hand  Rinse mouth after use E.g. steroid inhalers may cause thrush  Shake the bottle Do it thoroughly

Ambiguous instructions or none!

 When (or as) required  As directed  As before  No instructions Do not administer unless the instructions are clear

Side effects

 List as many as you can think of Nausea - stomach upset Tiredness Motor function affected – dizzy – unsteady Hallucination paranoia Leg cramps Skin itching, skin pallor

Side effects

Rashes Headaches Confusion Constipation – diarrhoea Restlessness Mood changes General aches and pains

Over the counter medicines

List the types that client may buy or you may be asked to buy for them  Pain killers      Indigestion remedies Cold remedies including vapour rubs e.g. Vick Anti histamines Laxatives Vitamin supplements

Over the counter medicines

   Homeopathic medicines Cough medicine Rub ins e.g. rheumatism     Steroid nasal sprays Eye nose and ear drops Herbal remedies Antiseptics Check with pharmacist before buying OTC remedies

Documentation

 Must be completed before assistance can be given  Self medication assessment  Medication permission (level 3) SHCO  Medication chart (level 3) GP team

Documentation

 To be completed by carer  Medication administration chart (level 3)  Medicines disposal chart

Documentation emergencies

 Emergency procedures form GP team  Action on reverse of medication chart GP team  Administration on reverse of medication administration record

Administration Practice

All Formulations  Clean and tidy space  Wash hands  Check medicine has not been given  Select medicine to be given  For each item, read the label, compare with medication chart  Assemble medicines to be administered.

Administration Practice

 Put medicine packages back into containers  Administer  Complete the administration record sheet  Wash your hands

Administration Practice

Solid oral dose formulations (pills and capsules)  Transfer the correct number of units into a clean container without touching them  Prepare a drink of cold water  Ensure client is upright and comfortable  Hand the client the container and drink

Administration Practice

 Ask client to take a sip of drink then place medicine on the middle of the tongue and swallow with remaining drink chin slightly down  Ensure dose had been swallowed  Encourage client to finish drink  If client cannot take medicine themselves use a spoon not your hands

Administration Practice

Liquid oral dose formulations  Shake the bottle  Measure the correct dose  Offer medicine to client  If using oral dose syringe expel liquid to the middle of tongue NOT back of throat  Clean the bottle with damp tissue before replacing lid

Administration Practice

Soluble dispersible formulations  Measure dose from original container  Place in a third of tumbler of cold water  Swirl the solution gently in the glass to ensure adequate mixing  Hand to client and offer drink afterwards

Administration Practice

Sublingual formulations  Place tablet under the tongue and leave to dissolve Buccal formulations  Place the tablet high up between the upper lip and the gum on either side of the front teeth and leave to dissolve

Administration Practice

Topical (external) preparations  Use only as instructed  Apply only where prescribed  Smallest quantity that will easily rub in  Use only for as long as stated  Return partly used tubes  Wear disposable gloves

Administration Practice

 Transfer the quantity needed to a gloves  Gently rub into the skin  Dispose of gloves in a sealed polythene bag and place in general waste container

Administration Practice

Eye Ear & Nose preparations  When approval has been given for carers to administer these s/he MUST be given a practical demonstration by the community nurse  Good practice guidance is in packs

Good Practice Points

 Clean, tidy and systematic work reduces risk of errors  Good hygiene practice at all time never touch medication with your hands  Seek advice if in doubt  Never administer unless competent to do so  Always read the label, read what is written not what you expect to be there