Medication Policy and Procedure

Medication Policy

CONTENTS
	Policy statement
Section 1	General Principles
Section 2	Assessment of the Service Users Needs
Section 3	Consent
Section 4	Levels of support with medication
Section 5	Prescribed and non-prescribed medication
Section 6	Dispensing and storage
Section 7	Administration of medication
Section 8	Refusal to take medication
Section 9	Disposal of medication
Section 10	Medication errors
Section 11	Recording
Section 12	Medication Administration Records
Section 13	Training
Section 14	Advice to service users on medical issues

Policy Statement

Wherever possible, Service Users will be responsible for administering their own medication. When Service Users require assistance, the requirements of the following policy must be adhered to.

The aim of this policy is to promote Service User independence though it covers those situations where individuals are unable to take responsibility for administering their own medication or they require assistance which is provided by Epitome Home Care staff in the service user’s own home.

This policy and good practice guide has been developed to meet the requirements of the Mental Health Care and Treatment (Scotland) Act 2003, and the ‘Essential Standards of Quality & Safety’ and incorporates professional guidance from the Royal Pharmaceutical Society and the Care Inspectorate. The policy aims to provide guidance so that Support Workers can support Service Users safely with their medication, whilst promoting their independence and maintaining their dignity and privacy.

It is not possible to anticipate every situation that may arise when supporting service users with their medication. However, when a situation arises that has not occurred before it is important that actions are based on the principles included in this policy and appropriate advice is sought from the service user’s GP, Pharmacist or NHS Direct.

Assistance with prescribed medication, including reminders, may only be provided by Epitome Home Care staff if medications are supplied and stored in the original container (Including Monitored Dosage Systems such as blister packs) as supplied by the Pharmacist or dispensing GP / Nurse. Assistance will not be provided with prescription medication which is stored in any container filled by any other person.

Medication will not be administered without the informed written consent of the service user according to their needs as assessed and as recorded in their Support Plan. If the individual lacks capacity to give informed consent and the General Practitioner feels the medication should be given in their best interest, this decision needs to be recorded in the Medication Support Assessment.

If the individual has the capacity to give informed consent, written agreement must be obtained from them before a support worker assists with or administers any medication. If the service user can give informed consent verbally but not in writing, this should be recorded with the date, in their Support Plan. In these cases, a family member, next of kin or advocate may sign to give consent on the service user’s behalf.

Medications are used to cure or prevent disease, or to relieve symptoms, and not to punish or control behaviour.

The Principles and Aims of the Service are:

• To assist people to remain independent in their own homes

• To be responsive to their needs

• To maintain their dignity and privacy

• To support service users safely with their medication

Section 1: Good Practice Guide For Epitome Home Care Support Workers Operating In An Individual’s Home
General Principles 1.1	All medicines are potentially harmful if not used correctly, and care must be taken in their storage, administration, control and safe disposal. A medication needs and risk assessment should be carried out and made available to support staff via the Personal Support Plan.
1.2	It is the responsibility of the person carrying out the initial assessment (The Assessor) to obtain written consent where it is considered that the Service User will require any assistance with their medication and the service user has capacity.
1.3	Written, informed consent must be given by the service user if they have capacity. If the service user can give informed consent but cannot give written consent, this can be given by a family member, next of kin or advocate.
1.4	If it is not possible to obtain informed consent, in accordance with the Mental Health Care and Treatment (Scotland) Act 2003, this Act came into force in 2005 which makes provision that people whose decision making capacity is impaired by mental disorder, with the result that their health, welfare or safety or safety of others may be jeopardised by a refusal to consent to treatment which would be of benefit to them. Therefore, a GP is required to act as ‘decision maker’ in instances where medical issues are involved. A record of how and why the decision was reached must be recorded in the medication needs and risk assessment in the Support Plan. If the assessor feels that the Service User no longer has the ability to give informed consent to the prescribed medication, consideration should be given to requesting an assessment from the Health Care Professionals (HCP) for a Section 47 Certificate to be issued under the Adults with Incapacity Act, (Scotland), 2000.
1.5	Under the Adult with Incapacity Act, (Scotland), 2000 anything that is done on behalf of an adult with incapacity will have to: benefit him or her; take account of the person’s wishes and those of his or her nearest relative, carer, guardian or attorney; and achieve the desired purpose without unduly limiting the person’s freedom. Support Workers must only assist with the administration of medication (Including Controlled drugs) following authorisation by their line manager and where the need for assistance is recorded in the Support Plan / medication needs and risk assessment completed by the Assessor and the Support Worker has received the appropriate level of training.
1.6	Support Workers must report any concerns relating to a Service User’s medication to their line manager or office immediately in accordance with the Medication Policy, and the requirements of this policy and an appropriate record should be made on the Medication Administration Record and in the Communication Book.
1.7	Where a service user has responsibility for their own medicines, and the Support Worker is concerned about the service user’s ability to continue to manage their own medication; the Support Worker must report this to their line manager.
1.8	In the circumstances described in 1.7, the line manager is responsible for arranging an assessment of the service users need for assistance with their medication.
1.9	Service users have the right to expect that any assistance offered is carried out in a professional manner by properly trained and competent staff.
1.10	The policy provides guidance to staff so as to ensure that any assistance given with medication is carried out in a professional manner, within the knowledge and competence of staff and meets the aims of the service.

Section 2: Assessment of Needs Of The Service User

2.1

This is a key process to identify what, if any, assistance with medication is required. A medication needs and risk assessment should be completed for every service user. This will also highlight service users whose medication needs are beyond the knowledge and competence of Epitome Home Care staff or whose needs are outside the contractual arrangements with a Local Authority. If administration assistance is to be provided following the assessment of needs, a Medication Administration Record (MAR) Form

2.1 continued		should be in place to detail any prescribed medicines that the service user uses.
2.2	When carrying out the assessment, particular care should be taken if any of the following high-risk factors apply:
	a) b) c) d) e) f) g) h)		Health would deteriorate rapidly without medication Communication difficulties Long term conditions, e.g. diabetes, epilepsy People who have problems understanding the need for, or how to take their medicines and who may have difficulty with memory. People who have poor vision People are known to self-harm People are known to misuse substances, including alcohol
2.3	The Quality monitoring Officer, Service Manager, Coordinator or other designated competent person is to carry out this assessment in discussion with the service user and where appropriate, their family carers and or GP and by following the guidance given in this policy. The assessment is subject to six monthly reviews or earlier as the service user’s needs or condition changes or following reports of concerns from Support Workers.
2.4	Where clarification or advice and assistance on any aspect of the assessment is required, guidance can be obtained from the Pharmacist, GP, District Nurse or NHS 24. Level 4 support can only be provided where a Health Professional has assisted in the assessment of needs. Details of sources of advice must be recorded on the service user’s record all staff involved in the support of the service user should be informed.
2.5	The assessment should identify who will have responsibility for the following, particularly where multiple agencies are contracted to provide services; Is the prescription up to date? Who will request repeat prescriptions from the pharmacy? Who will collect prescriptions from the pharmacy? Who will return unwanted / unused / expired medications to the pharmacy? What would happen if the service user took too much medication? What would happen if they didn’t take enough? What would happen if they were taken at the wrong time of day? Are there risks from the service user having access to their medication or is a medication safe advisable? Are there risks to the support worker? (Some medicines such as Methotrexate need special care to protect the person who is giving the medicines. The likely outcome of the assessment will be one of the following: i) Ability to self-medicate without assistance The Service User will retain maximum control of their medication, thus preserving their independence and choice. This should be encouraged wherever possible. Wherever it is practical, family members should be encouraged to assist the service user with their medication if required.

2.5 continued

ii) Ability to self-medicate with the use of administration / compliance aids

Service Users will retain maximum control of their medication by using aids to administration to enable them to self-medicate. Under the Disability Discrimination Act (DDA) 1995, pharmacists are required to make “reasonable adjustments” to their services to enable people with a disability to access them. With regard to the supply of medicines this means that if a person falls within the scope of the Act, they may need extra help to take their medicines, for example non-child-resistant-container tops, large print labels or Monitored Dosage Systems (Blister packs). It is important that the needs of the service user are addressed and the most suitable reasonable adjustments to meet these needs are made.

iii) Assistance Required – Level 2 / Level 3 / Level 4

Staff must only assist with medication as part of an agreed written support plan which will indicate the level of support required. The Service User must agree and give their consent to assistance being given with regard to the following:

Prescribed medication (Including Controlled Drugs) must be in the original packaging as dispensed and labelled by the Pharmacist, this may on occasions include Monitored Dosage Systems E.g. Blister Packs.
Non prescribed medications, General Sales List medications / homely remedies must be stored in the original container– guidance must be sought from the Pharmacist and recorded in the support plan before assistance can be provided.

iv) Complex Clinical / Invasive Procedures required

Any invasive medication procedure should only be performed by qualified Health professionals with the appropriate knowledge and skills, and will usually fall outside of the remit of Domiciliary Care, examples are injections, removal of stitches, insertion of catheters, changing of dressings, wound care, administration of eye drops for the first 7 days after an eye operation.

The results of this assessment must be recorded and made available to all staff who will be involved in the support of the Service User.

2.6

Support Workers should advise their line manager immediately of any changes in the medication needs of the service user and these should be taken into account when reviewing the assessment.

2.7

Service users who have been discharged from hospital may have medication that differs from those retained in the home prior to admission. The Manager / Coordinator / Senior Support Worker should provide additional support to support workers when this occurs, and a review of the medication needs, and risk assessment should take place. Where Monitored Dosage Systems are in use these will need to be repackaged by the Pharmacist if there any changes.

Section 3: Consent (See also section 1 – General Principles)
3.1	It is the responsibility of the Assessor to obtain informed, written consent from the service user if they require assistance with their medication. If the service user has the Mental capacity to give verbal consent but not written consent, their family member, next of kin or advocate can give written consent on their behalf. If the service user lacks capacity, consent should be obtained from the GP (See also 1.4) and in conjunction with the person authorised to act in their best interests under the Adults with Incapacity Act, (Scotland), 2000. e.g. with Lasting power of Attorney for Welfare. A record of this should be kept in the support plan. This step should also be taken, if a Service User who previously could give informed consent no longer can give consent even with all practicable assistance and again this should be recorded on the support plan.
3.2	Written consent for any assistance with medication must be obtained before a support worker may provide any support.
3.3	Details of consent must be kept on the service user’s file and any support with medication including consent, must be reviewed as part of the six-monthly review of the support plan and medication needs and risk assessment.
3.4	Verbal consent should be obtained at each occasion of assistance or administration of medication.
3.5	Service users have the right to refuse medication, and where consent is refused or withdrawn, medication must not be administered by Epitome Home Care staff, but this should be reported immediately to the coordinator and recorded in the communication book and MAR chart if Level 3 for medication.
3.6	If the service user refuses to consent to assistance with medication, which may place the Service User at risk, the refusal should be reported to the service user’s GP or other member of the Primary Care Team and appropriate records kept.
3.7	The support worker must contact their line manager immediately for advice in the event of a service user, who has previously given consent, refusing to take prescribed medication and the appropriate records should be made. The line manager should contact the GP or Pharmacist for guidance and record any information given.

Section 4: Levels of Support with Medication (Appendix 3 Guidance for staff)

4.1

General support needs should be identified at the Medication Needs & Risk Assessment and recorded in the person’s care plan. If any support is to be provided, a Medication Administration Record should be completed and included in the care plan. Care staff will be required to maintain ongoing records in the comments book and on the Medication Administration Record.

4.2

Level 1: Self Medication

Service users are capable of following their own medication regimen or receive assistance from a family member or health care professional.

4.2 continued	Level 2: General Support also called Assisting with Medicine General support is given when the person still retains responsibility for their own medication. In these circumstances the support worker will always be working under the direction of the person receiving care. When included as a requirement in the support plan, the support given may include some or all of the following: Requesting repeat prescriptions from the GP / Pharmacy Collecting medicines from the community pharmacy/dispensing GP surgery (ID may be required, and support workers may be required to sign for receipt of medications by the Pharmacist). Medication received should be checked that it matches the medication and dosage prescribed and is listed on the appropriate documentation. Disposing of unwanted, discontinued, unused or out of date medicines safely by returning them to the supplying pharmacy (When requested by the Service User or with their consent and when this is a requirement in the Support Plan) completion of a returned medication form and a signature should be obtained from the Pharmacist and a record made in the Communication book and Medication Administration Record so that medication audits will be accurate. Giving reminders to the service user to take their medicines. Manipulation of a container, for example opening a bottle of liquid medication or popping tablets out of a blister pack at the request of the person and when the support worker has not been required to select the medication. Purchasing General Sales List medicines and homely remedies on behalf of the service user is not allowed by a staff member of Epitome Home Care. Applying cream – toiletry moisturisers may be applied if written in the support plan and the skin is intact, for example; Dove, Johnson’s, Nivea. (Whether obtained on prescription or bought, products holding a Product License Number (PL) such as E45, Aqueous cream etc are only to be applied by medication trained staff as these are licensed medications.)
4.3	Adults can retain independence by using medication and compliance aids including Monitored Dosage Systems. These should be considered if packs and bottles are difficult to open or if the person has difficulty remembering whether he or she has taken medicines. (See also 2.5 ii)
4.4	The service user may qualify to receive medications in a monitored dosage system or compliance aid from a community pharmacist if they meet criteria under the Disability Discrimination Act 1995. No assistance can be given if the service user or their family member fill a Dosette Box or compliance aid themselves – this is called secondary dispensing and is unsafe.
4.5	Level 3 Administering Medication The service user needs full assistance with their medication regimen.

4.6	The need for medication to be administered by Support Workers should be identified in the medication needs and risk assessment and recorded in the Service User’s support plan. The communication book, support plan and medication administration record (MAR) should be checked before any assistance with medication. Appropriate records should be completed at every visit.
4.7	The initial medication needs, and risk assessment may identify that the Service User is unable to take responsibility for their medicines. This may be due to impaired cognitive ability but can also result from a physical disability. Whatever the level of support provided; the support worker should aim to promote the service user to be as independent as possible.
4.8	The Service User must agree to have the support worker administer their medication and consent should be documented in the Support Plan. In addition, on each occasion of assistance or administration, verbal consent should be obtained.
4.9	Epitome Home Care workers should only administer prescribed medication from the original container, dispensed and labelled by a pharmacist or dispensing GP. This includes pharmacy filled monitored dosage systems and compliance aids.
4.10	Administration of medication may include some or all of the following: When regular reminders are required – more than 3 per week may indicate that the service user is not able to manage their medications safely themselves. Where prompts to take medication are required as the service user would not take the medications otherwise. When the service user is unable to pick up the medication themselves or place oral medication into their mouths. When the support worker selects and prepares medicines for immediate administration When the support worker selects and measures a dose of liquid medication When the support worker applies a cream/ointment; inserts drops to ear, nose or eye; or administers inhaled medication Administer controlled drugs.
4.11	Only support workers who have completed Medication Training and have been assessed as being competent will be assigned to Service Users who require Level 2 or Level 3 assistance with their medicines. Support Workers who are not confident, can refuse to administer medication if they feel they have not received adequate training and do not feel competent to do so.
4.12	Level 4: Administering medication by specialist techniques. If following an assessment by a healthcare professional and it is included in the Support Plan as an identified need and a medication needs and risk assessment has been carried out, an Epitome Home Care worker may be asked to administer medication by a specialist technique including: Medication by prefilled pen (Not needles / syringes) e.g. Insulin Blood sugar testing e.g. for a person with diabetes Administration through a Percutaneous Endoscopic Gastrostomy (PEG) Applying Transdermal patches

4.13

If the task is to be delegated to the Epitome Home Care worker, the worker must have already received medication training. A healthcare professional must train the support worker on a service user by service user basis and be satisfied that they are competent to carry out the task. The details of the training should be recorded on the support workers file and a list of trained support workers should be retained in the service user’s file and notes made on both staff members and service users computer record.

4.14

Support workers can refuse to assist with the administration of medication by

specialist techniques if they do not feel competent to do so.

Section 5: Prescribed / Non-Prescribed Medication & Controlled Drugs
Prescribed medication	5.1	Support Workers who have had the appropriate training may assist a Service User to take medication which has been prescribed by the Service User’s doctor, dentist or other appropriate prescriber responsible for aspects of the Service User’s support.
	5.2	Support Workers who have undertaken the appropriate training on the administration of medicines may provide assistance with the following Medication taken by mouth (oral preparations) e.g. tablets, capsules and oral liquids Inhaled Medication Medication applied by instillation to ears /eyes / nose Medication applied externally (topically) to the skin e.g. ointments, creams, lotions, patches
	5.3	Assistance with inhaled devices must only be given by Support Workers who have received instructions on the use of the particular device and if required, after receiving specific recorded training from a nurse or other qualified health professional. Any such training should be recorded on the Training Record and a copy should be retained in the staff file and notes made on both staff members and service users computer record.
	5.4	Support Workers must not offer advice on any prescribed or non-prescribed medicines and remedies. It may be Dangerous to Do So the Service User may be allergic to the treatment or be taking other medicine that may result in harm.
	5.5	Where a support worker suspects that a service user is experiencing adverse side effects from a prescribed course of treatment, they must not recommend that the service user discontinues the treatment. Advice should be sought from the GP.

Controlled drugs (CD’s)	5.6	The Misuse of Drugs Act Regulations 2001(as amended) governs how Controlled Drugs are stored, produced, prescribed and supplied. Examples of Controlled Drugs are Morphine, Fentanyl and Methylphenidate. These additional controls are in place to prevent Controlled Drugs being misused, causing harm or being obtained illegally. The regulations do apply to every social care service and they do not apply when a service user looks after and takes their own medicines.
	5.7	CD’s are prescribed and dispensed in the same way as other medicines for service user’s living in their own homes though extra time should be allowed when requesting and collecting prescriptions for CD’s. Support workers may be asked for identification before being allowed to collect CD’s from the Pharmacy. Where possible it would be advisable for an arrangement to be made where the Pharmacy delivers CD’s directly to the service user.
	5.8	Once CD’s have left the pharmacy they are administered like any other medication in Domiciliary Care and no witness is required.
	5.9	CD’s in domestic properties do not have to be kept in a locked container nor is a separate ledger kept. They should be added to the Medication Administration Record along with any other medications.
	5.10	Some Local Authorities do not permit Domiciliary Support Staff to administer Controlled drugs so the area contract should be checked before agreeing to provide support with CD’s. This includes Fentanyl patches which require the member of staff to have further Level 4 training by a healthcare professional.
	5.11	Controlled Drugs (CDs) that are no longer required should be returned to the pharmacist who supplied them at the earliest opportunity for safe denaturing and disposal. The support worker should obtain consent from the Service User and / or when this is a requirement in the Support Plan. A completion of a returned medication form and a signature should be obtained from the Pharmacist and a record made in the Communication book and Medication Administration Record (MAR) so that medication audits will be accurate.

Non-prescribed medicines and remedies

5.12

When Support Workers are asked by the Service User to assist with the administration of non-prescribed medication or to purchase a non-prescribed medicine, they must:

Refer the Service User to seek advice from their GP or Pharmacist and
Seek advice from their line manager, who will take further advice from the Service User’s GP or Pharmacist before assistance can be given.

The pharmacist will require information about the service user’s prescribed medication in order to determine if it is safe for the Service User to take the non-prescribed medication. This course of action must be followed in all circumstances whether a support worker is responsible for assisting the Service User or where the Service User manages their own medication and any advice provided should be followed and recorded in the communication book and on the computer record.

5.13

Non-prescription medicines may only be purchased on behalf of a Service

User, where the line manager has contacted the Service User’s GP or Pharmacist to check if the medication requested is appropriate and to avoid any contra indications or interactions between medicines.

5.14

Details of any non-prescribed medication administered with the assistance of the support worker must be recorded in the Service User’s communication book.

Medications / Support which Will Not Be provided by Epitome Home Care staff:

5.15

Staff will not assist with service users’ medications in the following circumstances:

Injections, (Other than by prefilled pen)
Suppositories, Pessaries or Enemas
Any aspect of wound care – including the application of, or changing of dressings
With family or self-filled dosette boxes or compliance aids
With any medication that has been tampered with, including monitored dosage systems that have been opened, added to or medications have been removed
With any medication which is not in its original packaging or is past it’s expiry or use by date
The application of topical preparations i.e. creams, lotions if the skin is not intact and is broken
With oxygen or nebulisers
Medication will not be crushed
Medication will not be administered covertly – hidden in food except in rare exceptions where a covert administration instruction is in place and has been directed by a GP
Service users will be assisted with prescribed medication only if the label with the service user’s name, medication dosage, frequency, form and instructions is intact.

The administration of these medications is the responsibility of a health care professional (e.g. a District Nurse). If in any doubt, support workers should always contact their line manager to report concerns and record details in the daily communication book.

Section 6: Dispensing And Storage
6.1	The Pharmacist will supply prescribed medicines in appropriate packaging for the Service User to administer their own medication.
6.2	If the person conducting the initial assessment considers that the Service User is unable to manage medication supplied in individual bottles without assistance, with the service user’s consent they can contact the Pharmacy nominated by the Service User to discuss appropriate support options and request the pharmacist to undertake a Disability Discrimination Act assessment.
6.3	If the support worker considers that the Service User is experiencing difficulties managing their own medication due to the nature of the medicine container, they must report this to their line manager.
6.4	With the service user’s consent, the Manager / Coordinator / Senior Support Worker will contact or Service User’s GP / Pharmacist to discuss what support is needed.
6.5	The Pharmacist may advise that an auxiliary aid may be appropriate, certain aids are provided by the pharmacist free of charge if the service user falls under the Disability Discrimination Act 1995. Where this is not the case and /or where the aid is not provided free of charge the Service User or a family member may wish to fund the use of such a device.

6.6	Dispensed medication may be in appliances including monitored dosage systems, which have been assembled or supplied by a pharmacist, hospital pharmacy or dispensing GP practice. Assistance with prescribed medication, including reminders, may only be provided by Epitome Home Care staff if medications are supplied and stored in the original container (Including Monitored Dosage Systems) as supplied by the Pharmacist, dispensing GP / Nurse. Assistance will not be provided if prescribed medication is stored in any container filled by any other person.
6.7	All medication should be stored in a safe location in the Service User’s home that is accessible to adults but is out of the sight and reach of children.
6.8	Where it has been assessed that it is unsafe to leave the medicine accessible to the service user, a medicine safe may be required.
6.9	Most medications are required to be stored in a cool dry place, out of direct sunlight at room temperature and below 25˚C.
6.10	Some medication requires refrigerated storage. It is acceptable to store medicines requiring refrigerated storage in a domestic refrigerator. However, do NOT store medicines in, or immediately adjacent to, the ice box of a refrigerator or in the freezer compartment of a combined fridge freezer. Do not store medicines adjacent to uncooked meats or other food. Store medicines if possible, in a door compartment that can be reserved for medicines.
6.11	In a person’s own home, controlled drugs do not need to be stored in a medicine safe or locked container except in the circumstances described in 6.8.
6.12	Medications such as eye drops have to be used within 28 days of opening. The date of opening should be recorded, and this should be checked to ensure they are still within date before use.
6.13	The label on the medicine or the Product Information Leaflet should indicate any special storage conditions. Storage arrangements should be noted on the Medication Needs Assessment.

Section 7: Administration of Medication

7.1

The Seven Rights should always be observed during any assistance or administration of medication;

Right person Right medicineRight doseRight timeRight route

Right to refuse Right records

A Manager or Coordinator taking on a package of care must ensure that an assessment of the Service Users medication needs is carried out usually before starting to deliver care but at the latest within 48 hours of care delivery commencing.

The Manager / Coordinator should contact the G.P./ Hospital and ask for faxed confirmation of the medication dosage and regime. It is then the Manager’s / Co-ordinator’s responsibility to ensure this information is entered fully on the Medication Administration Record chart.

7.2	Following this initial period, the Manager/ Coordinator / Senior Care Assistant or other Approved Person, may amend the Medication Administration Record to reflect prescribed changes. The Support Plan must be updated, and the office staff informed of any such changes.
7.3	A Medication Administration Record (MAR) must be maintained for each Service User who is receiving level 3 assistance with their medication from an Epitome Home Care Support worker, or where non prescribed medicines, General Sales List / homely remedies are purchased at the request of the service user and following guidance from the Pharmacist.
7.4	The Medication Administration Record must be kept in the Service User’s home in an agreed location and must be examined on each occasion that the support assistant attends the Service User’s home.
7.5	Support Workers must always check the Medication Administration Record (MAR) and communication book prior to administering any medication to ensure that the medication has not already been administered. (To ensure that the medication hasn’t been given by a family member or support worker from another agency)
7.6	Doses of liquid oral medication must be measured using a 5ml medicine spoon, or a graduated medicine measure supplied by the pharmacist. Where the Service User experiences difficulty in taking liquid medicine from a medicine spoon or measure, an oral syringe may be required. Support Workers should contact their line manager if the Service User is experiencing difficulties with liquid oral medicines.
7.7	Medication should not be handled, and solid dose forms e.g. tablets and capsules should be passed to the Service User on a spoon or in a pot. The Support Worker should wash their hands and wear disposable gloves whenever they are administering or assisting with medication.
7.8	Some medication must be dissolved or dispersed in water before administration. This will be indicated on the label.
7.9	Support Workers must wear disposable gloves and aprons when applying external medication (e.g. ointments, creams or lotions).
7.10	Always follow the dosage directions and other instructions on the medicine label.
7.11	Prescribed medication must only be administered if the container is clearly labelled with the Service Users name, the name of the drug(s), dosage and frequency.
7.12	A Service User must never be forced to take medication.
7.13	If a Service User refuses their medication this must be reported to the Coordinator promptly and recorded in the communication book and on the Medication Administration Record. If the Support Worker has concerns about the medication being refused out of office hours, they must contact the On-Call Manager for advice.
7.14	Details of the administration must be recorded in the Medication Administration Record by the Support Worker at the time the medication is administered.

7.15	Assistance with prescribed medication, including reminders, may only be provided by Epitome Home Care staff if medications are supplied and stored in the original container (Including Monitored Dosage Systems) as supplied by the Pharmacist or dispensing GP / Nurse. Assistance will not be provided if prescribed medication is stored in any container filled by any other person.
7.16	If the label becomes detached from the container, is illegible, or has been altered, medication must not be administered. Advice should be sought from the line manager who should seek further advice where necessary. Out of normal working hours advice can be sought from the On-Call Manager. The person on call can contact the G.P. Out of Hours Health Service provision, Pharmacist if available and also NHS 24. Details should be recorded on the Medication Administration Record and in the communication book.
7.17	All medicines have an expiry or use-by date, however, not all will have this displayed on the dispensing container. It is important that all medication is current. Expiry dates should be checked, especially eye drops which have a life span of 28 days from being opened. If there is no date, then clarification must be sought from the pharmacy/ dispensing surgery.
7.18	The Support Worker must inform their line manager about any medication that is past the expiry date. The line manager must contact the Service User’s doctor to ascertain if the medication is still required in which case the doctor will be requested to issue a new prescription. The Support Worker must enter the details on the Service User’s Medication Administration Record (MAR) and in the communication book. The expired medication should be returned to the pharmacy with the Service User’s consent after completing
7.19	If medication is labelled with imprecise or ambiguous directions e.g. ‘take as directed’, ‘take as before’, ‘apply to the affected part’, the Care Assistant must seek clarification from their line manager who must contact the GP practice or pharmacy for clarification about any requirements before administering.
7.20	Most medication will be prescribed for administration on a regular basis. Some treatments may be prescribed on an ‘as required’ (PRN) basis. The service user will generally take the lead regarding how much medicine to take in these cased but if they are unable to, it is essential that the Care Assistant has sufficient information in order to determine if a dose being requested by the Service User is appropriate. If in doubt the Care Assistant must contact their line manager who must contact the GP practice or pharmacy for clarification.
7.21	Some medication is prescribed on a reducing or variable dosage regime. (See Appendix 5) Guidance for variable dose medicines.

7.22	Medicines should improve the way people feel but they can also produce side effects. Common side effects include; (This list is not exhaustive) Nausea Vomiting Diarrhoea Rashes Headaches Constipation Mood swings
7.23	If care workers suspect that a service user is experiencing adverse side effects from their medication, they should make a note of the symptoms in the comments book and report their concern to their line manager. Advice should be sought from the service user’s GP or the Pharmacist. If out of hours, NHS Direct can be contacted. The advice given should be recorded by the care worker in the comments book and notes made on Cold Harbour. If the service user becomes unwell or experiences breathing difficulties, emergency services should be called immediately. Care workers Must Not; Advise service users to discontinue their medication. Give the service user any advice without first seeking guidance from a health professional. Recommend any other medicines to treat the symptoms without first seeking advice from a doctor or pharmacist
7.24	Medication should never be crushed. Crushing changes, the characteristics of the medication and it may cause harm if not taken in the form it is dispensed. If the service user has difficulty swallowing medication a liquid alternative may be available, advice should be sought from the pharmacist. Only tablets with a break line should be cut.
7.25	Some medicines need to be given at specific times for example: Before, with or after food – the absence / presence of food in the stomach can affect how the medicine works and may cause unwanted effects Some illness can only be controlled with very precise dose timings, e.g. some medicines for Parkinson’s disease have to be taken five times during the day, some people’s fits are only controlled if they take their medicines at set times.
7.26	According to the law (The Medicines Act 1968) Medicines can be given by the 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. Medicines that have been prescribed and dispensed for one person should not, under any circumstances, be given to another person or used for a purpose that is different from the one they were prescribed for. E.g.., In domiciliary; if it has been agreed with the patients and it is in the care plan, doses can be left out of that individual to take at a later time, e.g. Sleeping tablet.

7.27	Medicines must be given from the container they were supplied in. This means that generally, doses of medicine must not be put out in advance of administration. This is secondary dispensing and can lead to accidental mix ups and errors. Leaving out doses of medications for service users to take later should be avoided and is unsafe practice. However, in exceptional circumstances, and to enable a service user’s independence, if it is agreed in the care plan and is risk assessed and considered safe, doses can be left out for an individual to take at a later time, e.g. a sleeping tablet to be taken with a bedtime drink. Managers, wherever possible should seek alternative solutions where possible.
7.28	Consideration should be given to maintaining the service user’s privacy, dignity & respect when administering medication. Some people may wish to take their medicine in private. Some people may be embarrassed if a member of the opposite sex gives medicine to them because of cultural or religious beliefs. It is important to find out the service user’s preferences.
7.29	Planned audits should be carried out by Senior Care Assistants / Coordinators / Managers and the number of doses received, administered and remaining established. Documentation should be checked for accuracy and investigations should take place if any errors or mistakes come to light.

Section 8: Refusal to Take Medication
8.1	The service user has the right to refuse to take medication and should never be forced to take it. Care assistants should try to establish the reason for the refusal. The care assistant should wait a short time and offer the medication again.
8.2	If a Service User refuses their medication or does not take their medication, the Care Assistant should inform their line manager who should seek advice immediately from the Service User’s GP practice – advice given should be recorded. Refusals should be recorded on the Medication Administration Record and in the Comments book.
8.3	If the care manager has concerns about a service user not taking their medication, a best interest meeting should be held with all representatives involved in their care. A decision to administer medication covertly may be taken if recommended by the service user’s GP and this should be recorded and held in the branch and not detailed in the care plan.

Section 9: Disposal of Medication

9.1

The situations when medicines might need to be disposed of include:

• A person’s treatment is changed or discontinued — the remaining supplies of it should be disposed of safely (with the person’s 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 service user dies, their medicines should remain in their home 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 is stated in the product information leaflet (PIL).

9.2	The disposal of medicines is regulated by law in order to protect the environment. Medicines should never be disposed of into the sewage system or with household waste. If medicines are put out with normal rubbish, the service user may get hold of them and if placed in a land-fill site, they could fall into the wrong hands and someone, possibly a child, could be harmed.
9.3	Unused, out of date medication, or medication no longer required, must be returned to the pharmacy where this is a requirement of the care plan, with the Service User’s consent. Where there is no informal carer (e.g. a family member) who can be responsible for the return of medicines no longer required, the care assistant must obtain the approval of their line manager to return the medicines to the pharmacy. Details of returned medicines must be recorded on the Medication Administration Record (MAR) and comments book and a receipt must be obtained from the pharmacy.
9.4	A single spoilt or refused dose should not be returned to the original container nor offered again to the Service User. An appropriate record should be entered on the Medication Administration Record. Spoilt or refused doses should be stored safely in a labelled container out of the reach of the service user until returned to the pharmacy and a receipt obtained. If this becomes problematic, the Care Assistant should contact their line manager who will seek advice from the Service User’s GP as a reassessment of support may be required.
9.5	Controlled Drugs (CDs) should be returned to the pharmacist or dispensing doctor who supplied them at the earliest opportunity for safe denaturing and disposal. The care assistant should obtain a receipt from the pharmacist or dispensing doctor as proof of the return of the drugs and a record made on the Medication Administration Record and in the comment book.
9.6	If the service user has needles, lancets or syringes, a sharps disposal box should be requested from the GP and returned to the GP surgery when full.

Section 10: Medication Errors

10.1

Errors can occur in the prescribing, dispensing or administration of medicines. Most medication errors do not harm the individual although errors can have serious consequences. It is important that errors are recorded, and the cause investigated so that lessons can be learnt from the incident to prevent a similar error happening in the future.

Examples of administration errors are:

• Wrong dose is given, too much, too little

• Medication is not given or taken

• Medication is given to the wrong person, at the wrong time

10.2

Care assistants must immediately report any error or incident in the administration of medicines to the Care Coordinator or Manager. The service user’s GP should be contacted immediately for advice in case any emergency action is required. The care coordinator should log the error on Form DC 080 Medication Error Record Form (Appendix 6). If the service user consents, the Service User’s next of kin should be informed.

10.3

Care Coordinators/ Managers should investigate all reports of errors and decide whether they need to provide further training to an individual or if they need to review existing procedures. The Compliance and Contracts Manager should be informed immediately of serious incidents as a Safeguarding referral to the Local Authority may be required.

Section 11: Recording
11.1	It is important to record what you do when you do it. Do not write the record before you administer medicine, the service user may refuse the medication, but the record would show they have taken it.
11.2	From your records, everyone involved in the service user’s care should be able to understand exactly what you have done, and all medications should be accounted for.
11.3	Records should be legible, up to date and completed in black ink, dated and signed to show who has made the record.
11.4	The Care Assistant must record that a dose has been taken by entering their initials and the required code in the appropriate box on the Medication Administration
11.5	If a Service User refuses their medication or does not take their medication for any reason – including refusing or running out of medication, the Care Assistant should record the appropriate code – NT for Not Taken or D for Discontinued with their initials on the Medication Administration Record. Details of all support provided with medications should also be recorded in the comments book. The office should be notified immediately if medication isn’t taken.
11.6	Non-administration of prescribed medication due to incorrect medicines or lack of medicines should be reported immediately to the Care Coordinator and the Next of Kin notified so that the correct medications are obtained. If the service user has no next of kin, the coordinator should contact the service user’s GP / out of hours doctor to obtain a prescription wherever possible. Details should be recorded in the Comments book and an Incident Report Form completed.
11.7	Where a Service User lacks capacity and refuses their medication, this must be reported immediately to the line manager, who in turn, will contact appropriate medical staff for advice as to any potential adverse effects. A record should be made on the Medication Administration Record Chart and in the Comments book and any advice issued followed.
11.8	A single spoilt or refused dose should not be returned to the container nor offered again to the Service User. Record appropriately and store safely until it can be returned to the Pharmacy. The Care Assistant should contact their line manager who will seek advice from the Service User’s GP when medication is refused.
11.9	If a medication is labelled ‘PRN’ (Pro Re Nata) or Take as or when required, the care worker should record on the Medication Administration Record the number taken with their initials at each administration. See 7.20 and Appendix 5 Medication instructions – Variable dose.

Section 12: Medication Administration Records
12.1	The current Medication Administration Record should be kept in the Service User’s home. Completed Medication Administration Record (MAR) charts must be sent to the office and checked by the coordinator before being stored in the Service User’s file.

12.2	When any level of support with medication is provided, Care Assistants should maintain the appropriate records.
12.3	All medications including prescribed and non-prescribed medications should be recorded on the Medication Administration Record.
12.4	An approved person will usually complete the Medication details on a Medication Administration Record, but care staff should update these ongoing as required and add any additional medications such as a prescribed course of antibiotics or homely remedies / General Sales List items.

Section 13:Training

13.1

A medication training programme is in place for all Homecare Support care staff.

13.2

Level 1 Medication Training is incorporated into the Level 2 training delivered in house by Trainers who are trained to train in Medications for all new care staff during their induction period and which meets the requirements of the Common Induction Standards 2017. This training provides staff with the underpinning knowledge that will contribute towards the appropriate unit in the Level 2 Health & Social Care Diploma. Staff who have satisfactorily completed the Level 2 training can also provide Level 1: General Support also called Assisting with Medicine. Care staff will be aware following this training of the requirements and limits of their role in supporting a Service User with their medication. Competence is assessed by a written test and practical activities during the training and by Senior Care Assistants / Coordinators / Managers conducting staff spot checks / medication observations on the job using the Medication Observation Record Form.

The objectives of the Level 1 training are:

Develop awareness of the legislation and the requirements of Homecare Support’s policy regarding assisting service users with their medication
Demonstrate an understanding of what staff can and cannot do at this point in their training
Be aware of, and demonstrate competence in recording on all relevant documentation when providing any level of support to a service user with their medication
Know how to report a concern or medication error

The following topics are covered; See Level 2 training for content.

13.3	Level 2 Administration of Medication Training is provided in house by Trainers who are trained to train in Medications during the Induction Training Course attended by all new care staff. Care Assistants required to assist Service Users who are unable to take responsibility for their medication must attend and satisfactorily complete Level 2 training. Care staff will be aware, following this training of the requirements and limits of their role in supporting a Service User with their medication. Competence is assessed by a written test and practical sessions in training and by Seniors / Coordinators / Managers conducting staff spot checks / assessments on the job using the Medication Observation of Competency Form. The objectives of this training are; To promote the service user’s independence and to only provide the level of assistance that is required. To be aware of legislation and regulations for the safe handling of medications To understand the different levels of support To remind, prompt, assist or administer medicines safely and effectively To understand which tasks care assistants can and cannot undertake To be aware of the side effects of medicines and what to do if they suspect a service user is experiencing adverse side effects What to do if the service user refuses to take their medication Reporting Medication Errors Recording – Medication Administration Records and Comments books Who to contact with concerns? The following topics are covered in Level 2 training; Homecare Support Medication Policy Outcome of the Medication Needs & Risk Assessment Consent General Principles of support with medication Levels of support Medications which must not be administered by care staff Use of Medications Aids The use of Compliance Aids & Monitored Dosage Systems DVD – includes Classification of Medication, Form, Route & Purpose of Medications General Sales List Medications – when we can assist and when we can’t Contra indications – Recognising & reporting side effects Covert administration Crushing tablets Importance of dose timings Considerations before any assistance is provided Hand hygiene, use of gloves, aprons Administering eye, ear and nose drops, inhalers, creams Measuring liquid medications What to do with spoilt doses Refusals – service users right, reporting & recording The 7 rights – aim to reduce the risk of medication errors Safe storage and disposal of medications Medication errors – reporting Completing the MAR & comments book Reporting concerns Should staff members fail the Level 2 training Assessment they will be able to attend a further two times only.
13.4	Level 3 Administration by specialist technique training will be arranged on a case by case basis to meet the needs of a service user requiring this level of support and where it is permitted within Homecare Support’s contract agreement with the Local Authority. Care Assistants who have satisfactorily completed Level 2 training will receive training for Level 3 techniques by an appropriately qualified Health Care Professional who will assess the care assistant’s competence and record this on the Training Record Level 3 Specialist Techniques Form.
13.5	Level 3 support will only be provided where it is agreed and recorded in the service user’s Care Plan and will be subject to regular review.
13.6	Medication Needs Assessment training and Assessment of staff competence training will be provided for Senior Care Assistants, Care Coordinators, Managers and Quality Monitoring Officers.
13.7	Ongoing assessments of staff competence on the job will take place during regular spot checks and each member of staff will be required to sit a written test annually and to attend a refresher course every two years.
13.8	Staff who do not meet the requirements of the Level 2 assessment will be permitted to re sit a total of 3 times. After this, if they still do not meet the required level of competence, they will be unable to assist service users at all with their medication.

Section 14: Advice to Service Users On Medical Issues
14.1	It is the responsibility of the prescriber to explain the reason for the treatment and the likely effects (including side effects) of any medication prescribed to their patient.
14.2	The prescriber makes a judgement on whether to explain to a patient the nature of an illness and the implications of any treatment. The judgement will be respected by Homecare Support staff.
14.3	Care Assistants MUST NOT discuss or disclose a Service User’s medical history or treatment to a relative or lay person. Any questions must be re-directed to the Service User, the Service User’s medical practitioner, or the Care Assistant’s line manager.
14.4	Homecare Support staff must not advise service users on any prescribed or non-prescribed medications – guidance should always be sought from a Pharmacist or GP.

There May Be Occasions When Situations Arise Which Are Not Covered in This Guidance. Care Staff Should Always Raise Concerns with Their Line Manager.

Medication Policy and Procedure

Level 1: Self Medication

General support is given when the person still retains responsibility for their own medication. In these circumstances the support worker will always be working under the direction of the person receiving care.