Transcript Medication Management

Sunshine Care Training
Sarah Yorwerth & Tara Hollinshead
MOST IMPORTANT
It is an Organisational requirement that
you check the Care Plan of every client
on every visit
There are 8 core principles that apply to any care setting or service that might be involved in
the handling and administration of medicines and drugs on behalf of service users.
People who use social care services have freedom of choice in relation to their provider of
pharmaceutical care and services including dispensed medicines.
Medication is used
to cure/prevent
disease.
Care staff
preserve
dignity and
privacy.
Medication is
accessible and
disposed of
correctly
Care staff know
about medication,
and keep records
Care staff are
competent
Access to
Pharmacy
advice
Stored
safely
Legislation
Handling medicines in accordance with all legal requirements and professional
guidelines including:
Medicines Act 1968
Misuse of Drugs Act 1971
Misuse of Drugs (Safe Custody) Regulations 1973
Safer Management of Controlled Drugs Regulations 2006
Health and Social Care Act 2008; (Regulated Activities) Regulations 2010
Care Quality Commission: Essential Standards of quality and safety March
2010
Controlled Drugs (Supervision of Management and Use) Regulations 2013
Guidelines of the Royal Pharmaceutical Society and other relevant
professional guidance (such as the Nursing and Midwifery Council
standards).
Self Medicating
For client’s who are self medicating we DO NOT
Need to record anything to do with medication
on their report sheets
Check the care plan it should read self
medicating
Level 1: Category 1
Self-Administering Service Users.
Helping the Service User to order and collect prescriptions under the direction of the
Service User. Giving advice on safe storage.
On medication, requires help ordering and collecting prescriptions and advice on safe storage.
Tasks to be Included:
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Ensuring safe and secure storage of medicines in the Service User’s home;
Prompting or helping Service User to order prescriptions;
Prompting or helping Service User to collect prescriptions;
Note and record any change in Service Users ability to manage their
medication.
Level 1: Category 2.
General Support- Working under direction of the Service User.
CQC guidance adds that a persistent need to remind a service user to take their medication might
indicate that they do not have the ability to take responsibility for their own medicines at this level
and might need more support.
Many service users requiring this level of support will use compliance aids.
Tasks to be Included:
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Ensuring safe and secure storage of medicines in the Service User’s home;
Prompting or helping Service User to order prescriptions;
Prompting or helping Service User to collect prescriptions;
Note and record any change in Service Users ability to manage their medication.
Level 2: Category 3.
Administering Medication
Requires supervision with Self-administration or total medication management which
may include some direct administration.
If an adult is unable to communication informed consent, the prescribed must indicate formally
that the treatment in the best interests of the individual. This must be documented and recorded.
Tasks to be Included:
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Ensuring safe and secure storage of medicines in the Service User’s home;
Ordering Prescriptions, collection or delivery of medicines.
Supervise self administration or directly administer.
Select and prepare dose of medication.
Record administration of prescribed medicines on Daily Report Sheet.
Level 2: Category 3.
Permanent/regular
medication recorded here.
Clear information/direction
how medication is given.
Any changes to
medication must be
report to office, a new list
will need to be
completed and old sent
to office.
No editing/adaptations
to list permitted.
List must be reviewed weekly
be the keyworker.
It must be reported if this is
not happening.
Any changes must be
reported to office and a new
sheet completed,
implementing the change.
Every Delivery of medication
should be checked, and
signed by the Care Worker
present.
Level 3: Category 4.
Administering Medication by Specialised Techniques.
It will include more complex tasks, some may be invasive.
Total medication management which may include some direct administration and invasive
procedures.
The care worker MUST receive extensive training by a Health Care Professional and signed off as
competent with the task.
Tasks may Include: (will be applicable to the needs of the Service User)
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Administration of Auto-Injector (Epi-Pen)
Insulin Pens.
Vaginal/ rectal creams.
Suppositories/ Enemas.
Intra musclar/ Intravenous/subcutaneous injections.
Pessaries.
PEG feeding.
What is a drug?
A medicine or other substance which
has a physiological effect when
ingested or otherwise introduced into
the body.
What makes a drug become a
medicine?
A drug becomes a medicine when it is
used
in the treatment or prevention of a
disease
Interlinked areas of law
Duty to
employer
Duty under
statutory
law
Duty under civil
law
Duty to profession
Legal categories of Medicines
• GSL – General Sales List, can be bought
anywhere, supermarket, garage. Can
only be sold in limited quantities.
• P – Pharmacy Only Medicines, can be
bought from chemist without prescription
– but only if pharmacist is in attendance.
• POM – Prescription Only Medicines, only
supplied on prescription signed by
doctor, dentist or registered nurse
prescribing practitioners.
• Controlled drugs – These prescriptions
are normally written in the doctor’s
own handwriting
• Complementary medicines – vitamins
etc
• Homeopathic medicines – natural
products
The Journey of a Prescription
• Prepared instruction from a doctor to a
pharmacist to supply the medicine to the
named patient
• Care homes often have different
mechanisms for obtaining supplies of
medicines, usually explained within the
individual local policies and procedures
• All prescribed medication from the GP
will be written on a FP10 prescription form
Prescriptions
• May be hand written or
computer generated.
• Usually written for 28 days or
multiples of for continuous
treatment.
• Should be reviewed at least
annually, but if taking more
than four types of
medication, 6 monthly.
What should be on the prescription?
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Name of patient
Address
Age/date of birth
Name of medicine
Strength/dose of medicine
Quantity to be supplied
Date
Doctor’s name and address
IT MUST BE SIGNED
Names of Medication
All medicines have two names
Generic name
chemical composition, e.g. Paracetamol
Brand name
given by the manufacturer, e.g. Panadol
A medicine can have many brand names but will only have
one generic name, however sometimes generic medicines
made by different manufacturers can look different.
Prescriptions will usually be written as the generic name.
Abbreviations
Abbrev.
Meaning
Latin (or New Latin) origin
a.c.
q.o.d
a.m.
b.i.d. (or bid)
gtt.
h.
h.s.
o.d.
o.s.
o.u.
p.c.
p.m.
p.o. or po
p.r. or pr
Before meals
Every other day
Morning
Twice a day/daily
Drop(s)
Hour
At bedtime
Right eye
Left eye
Both eyes
After food
Afternoon
Orally
Rectally
ante cibum
quaque otra die
ante meridiem
bis in die
gutta(e)
hora
hora somni
oculus dexter
oculus sinister
oculus uterque
post cibum
post meridiem
per os
per rectum
p.r.n.
q.
q.2.h.
q.4.h.
q.6.h.
q.8.h.
q.d. or qd
q.i.d
q.h.
q.s.
Rx or ℞
Sig. or S.
Stat.
t.i.d. or tid
u.d.
as needed
every
Every two hours
Every four hours
Every six hours
Every eight hours
Every day/daily
Four times a day
Every hour, hourly
A sufficient quantity
prescription
directions
Immediately, with no
delay
Three times a day
As directed
pro re nata
quaque
quaque secunda hora
quaque quarta hora
quaque sexta hora
quaque octava hora
quaque die
quater in die
quaque hora
quantum sufficiat
recipe
signa
statim
ter in die
ut dictum
Routes for Medication.
Term
What it means?
Buccal
Between cheek and gum
Sublingual
Under the tongue
Topical
On skin
Oral (p.o)
Per Oral
Transdermal
Patch form
Intra Aural
In Ears
Intra Ocular
In eyes
Intra Nasal
In nose
IM (Intra Muscular)
Injection in muscle
IV (Intra Venous)
Injection in vein
Subcutaneous
Injection in fatty tissue
GI
Gastro Intestinal
NG
Naso Gastric
General considerations for
storage
All medication should be stored correctly in
accordance with the practitioner’s instruction
and per Risk Assessment.
Medication may be locked and have restricted
access if it is assessed the Service User could be
at risk.
Some medications may need to be kept at a
lower temperature e.g. Refrigerator.
Out of Date medication must be returned the
pharmacist.
Five R’s
Right
service
user
Right
Medicine
Right
Route
Right
Dose
Right
Time
Royal College of General
Practitioners
• Elderly patients must be treated with
dignity and respect. They should not be
forced to take medication against their will.
If they have swallowing difficulties the most
suitable preparation of the drug should be
used – usually in the liquid form if available.
If a person has difficulties, they, or a carer,
should contact the prescribing doctor.
Consent
• All service users have the right of refusal and
should consent to the administering of
medication.
• Have the right to information about the
medication being administered.
• Service users’ beliefs and views are a key
influence on whether , when and how they
take their medicines.
Crushing medication
• This should not be routine practice and as stated above it is
preferable to use a product in the way it was licensed to be used.
The prescriber should take responsibility for using a medicine in a
manner that is outside its licence and should specify the exact
directions on the prescription, e.g. “crush, mix with water and
administer”. These instructions should be added to the dispensing
label.
• Altering the form of medicine must only be undertaken under the
guidance of an authorised prescriber.
• A written direction to crush or disperse tablets or to open capsules
should be documented in the patient’s care plan (where care staff
are involved in administration.)
• A pharmacist or Medicines Information service should be referred
to and every effort must be made to ensure Health and Safety
guidance is followed.
Crushing NMC
• The NMC gives advice on crushing
medication in its Standards for Medicines
Management 2010 and says
“Medicinal products should not routinely be
crushed unless a pharmacist advises that the
medication is not compromised by crushing,
and crushing has been determined to be within
the patient’s best interest.”
Covert Administration
Staff MUST NOT disguise medication and administer to
Service User’s without their knowledge.
Only Service User’s detained under section 3 under the
Mental Health Act can legally be given medication
against their will.
With Service User consent, making the medication more
palatable by taking it with food or drink is not the same as
disguising. This consent must be in writing and confirmed
by the Prescriber.
Crushing or Covert medication should only take place with
written consent from the GP and appropriate recorded on
the care plan.
Controlled drugs
Prompt 9B of CQC Essential Standards state that clear
procedures must be in place.
Controlled drugs are those that have been agreed as
potentially addictive or dangerous thus requires
special provisions.
The Misuse of Drugs Act 1971 classifieds controlled
drugs into 5 schedules.
The Controlled Drugs (Supervision of Management
and Use) Regulation 2013 came into force with
Department of Health and replace previous
guidance and regulations.
Controlled drugs classification
Schedule
Drug
Schedule 1
Cannabis (resin), coca leaf, lysergide (LSD).
They have no recognised medicinal use
Controlled Drugs licence.
Controlled Drugs
Diamorphine (heroin), Amfetamine, Morphine,
Cociane, Pethidine, Methadone, Oxycodone.
Misuse of Drugs (safe custody) regs 1973.
Schedule 3
Barbiturates, Temazepam, Phentermine,
Pentazocine, Meprobamate, Buprenorphine.
Schedule 2
No Register
Schedule 4
Benzodiazepines (except temazepam/midazolam)
Anabolic and Androgenic Steriods.
Schedule 5
Codeine cough syrups, pholcodine, morphine.
(exempt from full control when low strengths)
Invoice.
Disposal / Ordering of
medication
Medicines belong to the Service User so must be
disposed of with prior consent.
Unused tablets must be placed in sealed
envelope and returned to pharmacy.
Complete a Disposal form and Pharmacist to sign
for.
Reasons for Disposal
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Service User refused medication
Service User no longer taking medicine
Medicine dropped on the floor
Medicine out of date.
Omitted Doses.
If you wrongly administer or omit to give a dose of medicine to a
Service User in your care, or become aware than an error has
been made, you must report to the line manager immediately.
The line manager will:
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Immediately seek Professional advice.
Enter details onto an issue log.
Inform NOK.
Report to CQC.
Types of medications
Analgesics - Painkillers
• Paracetamol
• Aspirin
• Co Dydramol
• Co Codamol
OPIODS (reduce intensity of pain signals to the brain)
• Morphine
• Diamorphine (heroin)
• Pethedine
• Fentanyl
• Oxycodone
Contd
Non Steroidal Anti Inflammatory Drugs (NSAIDS)
– for pain
 Ibuprofen
 Naproxen
 Diclofenac (Voltarol)
NSAIDs are generally prescribed for people who
have pain and inflammation - for example, if you
have pain in your joints (arthritis) or muscles (back
pain).
Although cannot be taken for people who have
stomach ulcers.
Contd
Antibiotics – For treatment of Infections
• Penicillin
• Erythromycin
• Trimethoprim
• Cephalexin
• Amoxycillin
• Tetracyclides
The main side effects for antibiotics are diahorrea,
skin rashes and some penicillin’s can cause
anaphylactic shock.
Contd
Respiratory Drugs
• Ventolin
• Salbutamol
• Atrovent
• Prednisolone
These are used to open up the
breathing tubes.
Contd
Diuretics
These drugs are designed to make the kidneys pass
more urine.
They are useful in treating high blood pressure, heart
failure and severely swollen legs.
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Frusemide
Co Amilofruse
Amiloride
Frumil
People that take certain diuretics, must increase potassium foods
within their diet.
Diuretics can cause dizziness.
Contd
Heart Drugs
Used for Atrial fibrillation or heart failure.
• Digoxin
• Lanoxin
Anti Convulsants
These are used in the control of Epilepsy
• Carbamazepine
• Phenytoin
• Phenobarbitone
• Gabapentin
• Midazolam.
Contd
Anti Depressants
These are mood altering drugs that affect brain
chemistry to relieve depression
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Amitryptilline
Dothiepine
Fluoxetine (Prozac)
Lorazepam
Diazepam
Contd
Sedatives
Reduces brain chemistry thus relieving anxiety, agitation,
and /or psychiatric disturbances, and sleeplessness.
 Temazepam
 Zopiclone
 Amitryptilline
Anti Coagulants
Used for thinning the blood
 Warfarin
 Heparin
 Aspirin
Warfarin
To prevent and treat the formation of harmful blood clots
within the body by thinning the blood and/or dissolving
clots.
• There will be given an anticoagulant record book; read this
carefully and carry it with you at all times.
• It is important to have regular blood tests to check the level of
warfarin in the blood - these blood tests are very important.
• Any changes to diet must be discussed with GP prior.
• Avoid drinking cranberry juice whilst taking warfarin.
• Only drink alcohol in moderation whilst taking warfarin.
 Check Therapy (INR) book for correct
dosage.
 DN/GP will complete this 1-week or 2weekly.
 You MUST check every time before
you administer, doses can change
within 24 hours.
 Select and prepare correct dosages.
E.g. 2mg Warfarin (2x1 mg tablets)
Contd
Anti Hypertension (reduce High Blood Pressure)
• Clonidine
• Diazoxide
• Furosemide
• Hydralazine
• Minoxidil
• Nitroprusside
• Lisinopril
Contd
Cytotoxics -All cytotoxic are anti cancer drugs,
the interfere with cell division and can kill tumours.
• Anastrozole – antibiotic for cancers
• Tamoxifen
• Letrozole
Working with cytotoxic drugs has also been associated with
negative health effects for developing fetuses including higher
incidences of spontaneous abortions, congenital malformations,
low birth weight, and infertility