Administration of Medicine Policy and Procedure

  1. Purpose

    1.1 This policy should be read with the Overarching Medication Policy and Procedures.

    1.2 To support and complement any locally required policies and procedures.

    1.3 To ensure service users are safeguarded by systems put in place regarding the administration of medication

    1.4 To set minimum standards of practice that must be adopted by all staff involved in the administration of medication

    1.5 The policy, associated policies and associated procedures supply to all care and any nursing working staff with Epitome Home Care Agency and should be read and n followed.

    1.6 To meet legal requirements of the regulated activities that Epitome Home care is registered to provide;

    – Data Protection Act 1998
    – Equality act 2010
    – Human rights act 1998
    – Medicines Act 1968
    – The Human Medicines Regulation 2012
    – RIDDOR
    – Adults with Incapacity(Scotland) act 2000
    – Mental health (care treatment) Scotland act,2007
    – Social Care (self-directed support) (Scotland) act 2013
    – Health (tobacco, nicotine etc. And care) (Scotland)act 2016
    – The social care and social work improvement Scotland(requirements for care services) regulations 2011
    – Social work(Scotland) act 1968
    – Medicine labelling regulations 1976
    – National health service (Scotland) regulations 2009

  2. Scope

    2.1 The following roles may be affected by this policy:

    – the registered manager
    – other management
    – care staff
    – nurse

    2.2 the following people may be affected by this policy

    – service users

    2.3 the following stakeholders may be affected by this policy

  • family
  • commissioners
  • External Health Professionals
  • Local authority
  • NHS

  1. Objectives

    3.1 all staff involved in administering medication should diligently observe the ‘6 rights of medication administration’:

  • right patients
  • right drugs
  • right dose
  • right route
  • right time
  • rights documentation

    3.2 to ensure that service users receive appropriate help and encouragement to manage their own medications independently as possible when, following assessment it has been agreed that this is needed.3.3 to reduce the risk of medication errors and incidents and to help prevent unnecessary admissions to hospital

    3.4 to ensure nurses work within the NMC code and NMC standards for medication

    3.5 to comply with National Standards and Scottish Services Council(SSSC) Codes of Conduct.

  1. Policy

    4.1 General Policy Statement

  • Epitome Home Care Agency aims to provide safe and reliable care including support, treatment and advice in relation to Medication Administration that maximises the Service User’s Choice and independence
  • Service Users will be treated as individuals and at all times due consideration will be given to their age, beliefs, opinions, experience, ability, cultural needs and any other factors important to them
  • Epitome Home Care Agency recognises the importance of staff training and supervision and will ensure that all employees involved in the administration of medication are well trained and competent to perform the activities with the remit of their roles.

    4.2 Medication Administering Principles

  • Service Users will be fully involved in the management and administration of their medication
  • Service Users will be fully involved in decisions regarding their individual medication and its purpose. The Medication Patient Information Leaflet provided by the dispensing pharmacist will be shared with them in a method which promotes their understanding.
  • Before any support with medication is provided, an assessment will be undertaken to establish the Service User’s capacity to self-manage their medication or the level of medication support in line with the Overarching Medication Policy and Procedure(SCM03)
  • Before medication is administered to any Service User, formal consent must be obtained.
  • Where a Service User is unable to give valid consent due to mental incapacity, the doctor will need to make an assessment of the Service User’s capacity to consent to treatment. If the doctor thinks the Service User cannot consent, he/she will need to complete a ‘Section 47’ Certificate. This allows the doctor and other staff to give the treatment the Service User needs. When this arises Epitome Home Care Agency and other health professionals must follow the principles of the adults with incapacity (Scotland)Act 2000 and the Code of Practice 5 of the Act
  • Medication administration must promote the Service User’s independence, choice, privacy, and dignity.
  • Medication must take account of the Service User’s cultural and religious values and beliefs
  • Medication must not be used as a form of restraint to sedate people for the convenience of staff. This is abuse and a breach of Human Rights and Epitome Home Care Agency should consider the guidance laid down by the Mental Welfare Commission for Scotland on Deprivation of Liberty
  • Medication must only be administered to the person who has been prescribed that medication
  • All care staff, including those who are not directly concerned with the administration of medicines, should be trained in the understanding of medications, the main types of medication in use, their administrative procedures, and how to look for and report possible adverse reactions, including changes which may require review of the Service User’s medication prescription.
  • Only staff who have undertaken Epitome Home Care Agency’s Medication Training Course and who have been assessed as competent should be involved in the administration of medication
  • Epitome Home Care Agency will keep an up to date list of all staff who are trained and assessed as competent to administer medicines. This list should be easily accessible.
  • Covert medication must not be given to Service User who has the capacity to consent or refusal to medical treatment. Staff should follow the Covert Medication Policy and Procedure(SCM40) .

    4.3 Levels of Medication SupportEpitome Home Care Agency is responsible for assessing and agreeing on the level of medication support required as detailed in the Overarching Medication Policy and Procedure(SCM03) and ensuring that the appropriate record keeping and training needs are met. The Service User’s Personal Plan will require review as needs change. Involvement with the wider multi-disciplinary team may be required to ensure that the Service User’s independence, needs and expectations are met.

    In addition to self-managed, there are three levels when support is required with Medication Administration:

  • Level 1– General support or assisting with medicine
  • Level 2-Administering medication
  • Level 3-Administering medication in specialist areas after receiving them further training

    4.4 The 6 Rights of Medication Administration

    The following 6 rights of Medication Administration must be applied where the Service User requires assistance (Levels 1, 2 or 3);RIGHT PERSON–  the identity of the Service User must be confirmed and checked with the name on the Service User’s Medication Administration Record(MAR), the pharmacy label on the medication and by asking the Service User to confirm their name. Any allergies should be notedRIGHT DRUG- The name, form and strength of the medication must be checked during the administration process, i.e. the pharmacy label on the medication should be compared with the MAR chart, before it is placed with the Service User and before documenting and signing on the MAR chart. The MAR chart is NOT a prescription sheet. It is a document used to record administration of medicines. The NHS prescription or a written “direction” from the prescriber is the authority for the career to administer medicines. Any document used to record administration of medicines to Service Users should reflect the prescriber’s instructions.  Therefore, The Agency should keep copies or scans of the original NHS prescriptions where possible and when pharmacy printed MAR charts are not available.

    RIGHT DOSE- The dose medication must be administered in accordance with the prescriber’s instructions. Again, the MAR chart and pharmacy label should be checked. If there is any discrepancy between the dose on the MAR chart and then stated on the label, advice must be obtained from the supervisor /GP before the medication is given.

    RIGHT ROUTE-  Each medication must be administered in its prescribed form, i.e. tablet, capsule, patch, inhaler, etc. and by the prescribed route, i.e. oral, sublingual, topical, etc.

    RIGHT TIME- Medication should be given at the time indicated on the MAR chart. If medication is administered more than one hour either side of the time stated, advice may need to be sought from the Registered Manager/GP before the medication is administered.

    RIGHT DOCUMENTATION- The documentation for the medication should clearly reflect the Service User’s name, the name of the ordered medication, date, time, dose, route and frequency of administration. Each medication chart must be signed immediately after administration of the drug. Where a Service User refuses, the correct code should be entered on the MAR chart, a note made on daily record sheet, and  the supervisor informed. The service User should never be forced to take their medication and has a Right to Refuse. 

  1. Procedure

    5.1 Wash and thoroughly dry hands ad assemble any equipment that may be required, e.g. medicine spoons, table cutter. Any liquid medication must be measured into a clearly graduated and marked medication pot or by using an appropriately sized syringe which clearly identifies individual millilitre markings.5.2 Where specialised clinical administration is required, undertake precautions and infection control procedures are required

    5.3 Check the Service User’s identity and allergy status- 6 Rights of Medication Administration

    5.4 Check the Service User consents to have their medication. Where a Service User lacks capacity, check that a Section 47 certificate has been completed.

    5.5  Check against the Medical Administration Record chart (MAR), Personal Plan and Risk assessment that the medication has not been changed and confirm which medicines are due, noting any time-sensitive medication

    5.6 Check the physical state of the medicines, including the expiry date and labelling and that they have been suitably stored. If the medicines label and MAR chart do not appear to match, then advice should be sought from the manager before administration

    5.7 Check the required dose and any special instructions on the dispensing label (e.g. not to be given with milk or antacids or to be taken with food, etc.) and take appropriate action.

    5.8 Contact the manager if there are concerns that the dose has already been given by somebody else.

    5.9 Ensure that the Service User is either in a standing position or sitting upright. Staff should not attempt to assist the medication or someone who is in a prone position. Medicines should be swallowed with a lot water, e.g. 100-150ml of water or at least half a glass.

    5.10 Check that the medication has been taken

    5.11 For applications of creams and ointments, disposable powder free gloves must be worn, removed when the activity is completed and hands washed.

    5.12 Record on the MAR chart that the medicine has been given or that it has been offered and refused. If medication is refused, complete the daily record chart and report to the manager.

    5.13 Return the medicines to safe storage place as identified on the risk assessment.

    5.14 Return the MAR chart to the Service User’s agreed storage area.

    5.15 Remove any apron and wash hands.

    5.16 Administration Do’s and Don’ts

  • Do only administer medication if you have been trained and assessed as competent to do so
  • Don’t take medication from its original container and give it to another member of staff to give the Service User as the person checking the right dose for the right person must also witness the person taking the medication and must be sure that the medicine has been taken properly by the Service User
  • Do make sure medication is given at the time agreed on the Personal Plan and the MAR chart. The timing of medication administration can be crucial and adherence to medical prescription instructions must be followed. This must be clearly indicated in the medical Personal Plan and in the medication administration record.
  • Don’t leave out medication for the Service User to take at a later time.
  • Do make sure that medicines are given only to the Service User for whom they are prescribed, following the prescription instructions.
  • Do give medicines from the container in which they are supplied. Medication doses should not be put out in advance (potted up) as this can lead to errors and accidents.
  • Do check where the Service User’s medication is stored before starting medication administration
  • Do always check the medication and MAR chart, don’t rely on memory
  • Do always ask the Service User if they want to take their medication before removing it from the pack. If they refuse to take the medication try again a little later. The refusal must be documented and the GP or pharmacist must be telephoned for advise
  • If the tablets or capsules are in a monitored dosage pack, do open the appropriate section and empty the tablets/capsules into a medicine pot and hand it directly to the Service User
  • Do transfer the medication from the bottle or pack into a medication pot and give this directly to the Service User
  • Don’t handle medication but transfer to the medication pot and give this directly to the Service User
  • Do wear disposable plastic gloves where drugs are risk assessed as harmful when handled. This may also apply where the Service User is unable to handle medication and they require extra support, although the handling of drugs should be avoided and medication spoons used to aid administration where difficulties are identified. Where administration by specialised technique is required the use of PPE may be required
  • Do have copies of the up to date blood test results as medication doses may change as a result of the blood test result
  • Do make sure any Variable dose or PRN medication is given as indicated in the Personal Plan following the As Required Medication Policy and Procedure (SCM41)
  • Do not use part-used medication that has been dispensed for an individual
  • In a multi-occupancy setting, do make sure that where several Users have the same medication, the medication is only administered from the container marked with the Service User’s name. This must be clearly accounted for in the drug stock audit
  • Do seek advice if a Service User cannot swallow their medication. Advice must be obtained from a health care professional and alternative liquid medication may be able to be prescribed. Medication should not be crushed or split without prior approval from the prescriber as this may affect the way medicines work and can be potentially harmful to the Service User
  • Do report any concerns and log any incidents, errors or omissions in line with the Medication Errors and Near Misses Policy and Procedure(SCM38)
  • Do mark any medication that has a short shelf life opening with the date after which it should not be used on the container
  • Do hand over all information regarding changes to medications administration to The Agency, and ensure they have received and understood the message

    5.17 Splitting Medication
  • Where it is necessary to split a tablet to provide the required prescribed dose, the supplying pharmacy should be asked to supply the medication as split tablets in an appropriate container
  • Where the pharmacist refuses to supply split medication, a tablet cutter should be used
  • Where the tablet is provided in a manufacturer’s blister pack, after splitting, the remaining tablet must be disposed of because it cannot be stored correctly until the next required dose
  • Disposal should be in line with the Safe Disposal of Medication Policy and Procedure (SCM31)
  • Staff responsible for ordering medication should ensure there are sufficient quantities of medication
  • Staff should be aware that splitting medication is a last resort as splitting can result in differences in medication fragments altering the therapeutic dose5.18 Crushing Medication
  • Crushing medication may alter the way in which a medicine is absorbed and its effect on the body
  • Crushing medication invalidates a product licence so crushing medication should always be authorised by the prescriber
  • Where it has been assessed with the prescriber that crushing medication is in the Service User’s best interest, advice from a pharmacist should be sought
  • Alternatives such as the availability of liquids or other forms of medicines should be discussed
  • Written authorisation from the prescriber for each medicine that needs to be crushed, and the period the authorisation applies, must be recorded and retained with the Service User’s medication records
  • Where staff are required to give crushed medication via specialised technique, such as via a PEG Tube, they should only administer when trained and assessed as competent to do so5.19 Timing of Medicines Administration
  • The times of administering medication are essential and there are often set times
  • It is important to know if the medication is required to be taken a specified number of hours apart, as taking some medications too closely together can result in toxicity
  • Medication errors related to the time given often occur as a result of rota scheduling calls too close together; it is important to document clearly that medications have been given
  • No double doses should ever be given, e.g. if a Serve User refuses one dose do not give two doses the next time around. The refusal should be recorded on the MAR chart
  • Staff responsible for administration of medication should be made aware of any sensitive medication5.20 Anti-Psychotic Medication
  • Prior to antipsychotic medication being prescribed, Epitome Home Care Agency should ensure that a holistic assessment of the Service User’s Health, behaviour and personality is conducted. This should be used to develop an individual Personal Plan that helps staff to develop interventions tailored to the Service User’s Preferences, such as activities that are based on an individual’s hobbies and interests
  • It is possible that these types of medication may need more frequent monitoring and it must be ensured that the prescriber is consulted to determine this. It is recommended that this is reviewed every 3 months
  • There are serious concerns over the widespread prescribing of anti-psychotic medication over long periods of time and therefore Epitome Home Care Agency must prompt a review if necessary. The GP will any potential side effects and where to report any concerns they have
  • Directions for administrating anti-psychotic medication must be full and complete and Carers must understand when it is necessary to administer the medication

  1. Definitions

    6.1 Covert Administration

    This is the term used when medications are hidden and given without the consent of the Service User6.2 PEG

    Percutaneous Endoscopic Gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient’s stomach through the abdominal wall, most commonly to prvode a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation)

    6.3 MDT

    Multi-disciplinary team

    6.4 PPE

    Personal Protective Equipment is equipment that will protect the user against health or safety risks at work. It can include items such as gloves, eye protection, disposable aprons

    6.5 Variable Dose

    Medications are sometimes prescribed to allow variable dose amounts to be administered, up to a maximum total dose in a dose interval. This is specified in the fields “dose” and “frequency” for PRN medications in the medication chart

    6.6 The right of Medication Administration

    A mnemonic to remember this is Patients Do Drugs Round The Day

  • Right Patients
  • Right Drugs
  • Right Dose
  • Right Route
  • Right Time
  • Right DocumentationThese 6 Rights vary in definition – This policy uses Right Documentation because of the high rate of errors associated with documentation but refers to the Right to Refuse.