1 Medicines Management Band 3 Training Medicines Management Nigel Buck Learning and Development Facilitator

2 Aim  Within your role you will play your part in the safe supply, administration, handling and storage of medicines.

3 Objectives At the end of the session you will be able to -  say what a medicine is  understand some of the legal aspects relating to medicines  state who can prescribe medicines  understand the principles of safe transport and storage of medicines

4 Objectives (continued)  Understand how to administer medications safely (including record keeping)  Understand how to support patients in their use of medicines  Know what to do if something goes wrong

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6 What medicines do  Can you name any medicines?  Do you know what they do?  How can you find out – BNF

7 BNF  British National Formulary for all medicines (current / childrens)   Contraindications  Cautions  Side Effects  Interactions

8 BNF Use the BNF find Calpol  Cautions – What are the cautions when taking Calpol?  Side Effects?  Interactions?

9 BNF Use the BNF find Nurofen  Cautions – What are the cautions when taking Nurofen?  Side Effects?  Interactions?

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11 What is a medicine? “Any substance or combination of substances  (a) presented as having properties for treating or preventing disease in human beings;  (b) ……to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis Medicines and Healthcare products Regulatory Agency MHRA Guidance Note No. 8 Revised June 2007 A GUIDE TO WHAT IS A MEDICINAL PRODUCT

12 Legal aspects  Medicines Act 1968 & Human Medicines Regs  Marketing Licence (MHRA)  The Safe and Secure Handling of Medicines 2005 (revision to the Duthie Report 1988 CD’s)  Health and Safety Regulations Policy for the supply, administration, safe handling and storage of medicines CPPG/MM01 *Registering bodies guidelines*

13 Legal aspects There are 3 classifications of medicines  GSL – (general sales list) Medicines sold in general shops as well as pharmacies  P – (pharmacy medicine) Medicines sold in pharmacies by or under the supervision of a pharmacist  POM – (prescription only medicine) Medicines only obtained on a prescription through a pharmacy  Can you name some?

14 Controlled Drugs (CD’s)  Misuse of Drugs Act 1971  Drugs liable to abuse  Controlled drugs  E.g..  Controlled Drugs Regulations 2006 – “all significant events involving CD’s should be reported to Chief Pharmacist.

15 Prescription  P.O.M. must be given as instructed by the authorised prescriber.  Changing dose or giving medicines to a different person without the prescribers permission is against the law.

16 Who can prescribe? Doctors – GMC Registered, (& Dentists GDC) Suitably trained, experienced, qualified……………………………  Independent Prescriber – Suitably trained and competent Nurses & Pharmacist- licensed medicines only (CD’s limited)  Supplementary Prescriber- needs a clinical management plan (CMP) & be a…. ……….nurses, pharmacists, physiotherapists, chiropodists/ podiatrists, radiographers or optometrists  Extended Nurse Prescriber  Limited Nurse Prescriber  Specific List Prescribers (RN prescribers)

17 What information must a prescription have?  Clearly written black ink or computer generated  Patients- full name & address  Age (by law for the under 12’s),  Date  Prescribers signature

18 What information must a prescription have? (continued) Medicine Name (Generic) Form (tablet / capsule) Strength (note liquids) Dose (best to avoid abbreviations) Frequency Route NB CD’s

19 Who can give medicines?  Section 6.2 “The law states who can prescribe medicines it allows anyone to administer them………………... provided they follow the authorised prescriber’s instruction”  Section 6.3 Non- registered healthcare professionals may only administer medicines after receiving appropriate training & assessment at local level in accordance with local guidance to a named patient only.

20 Get it Right -Checks  Right Patient (Name & D.O.B.) & prescription  Right Medication (name form strength)  Right Dose  Right Route  Right Date & Time (Last dose given?)  Right Duration (over what time)  Appropriate member of staff  Expiry Date  Drug sensitivity

21 Administration Exceptions  Saving a Life in an Emergency section 16 p27  Epinephrine – Adrenaline- Anaphylaxis policy  Verbal order section 11.5, p25 (Registered Staff)

22 Patients at high risk  Taking 4 or more medications  Post discharge from hospital  In care homes  Medicine- related problems identified  Children & Special Needs & over 75’s  Following adverse change in health  Note side effects of medication  GP Medicines review may be needed

23 Medicines & Children Children & Special Needs  Children’s metabolism – reduce drug clearance – report adverse drug reactions  Many children require medicines not specifically licensed for paediatric use or for unlicensed applications (‘Off Label’).  Writing of prescriptions –Age, Strength of capsules  Doses in children – Body Weight (Overweight / Ideal weighted dose) or Body Surface area  Children’s BNF

24 Medicines & Children  Oral Syringes  Out of reach?  Rare Conditions  Sugar Free?

25 Help with medications  Large print labels  Clic-loc tops  Reminder charts  Prompt sheets  Volumatic devices  Medicines Information

26 Side Effects  Can you name some side effects of medications?

27 Side Effects  Over Sedation  Medication interaction  D&V  Dehydration  Constipation

28 Sedation  Keep to regular bedtimes - don't sleep or doze during the day.  Hidden Caffeine  Have a set time for getting up in the morning.  Make sure your bed and bedroom are comfortable; not too cold or too warm.  Sleeping problems are common.

29 Falls  What medicines could contribute to the risk of falls?

30 Analgesics - Painkillers Constipation Many stronger painkillers such as co-codamol (eg Solpadol, co-dydramol, and morphine (eg MST) cause constipation as a side effect, so a laxative may also be needed.

31 Analgesics continued  Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) -ibuprofen (eg Brufen, Nurofen), naproxen (eg Naprosyn, Synflex) & others can cause bleeding from the stomach or bowel.  More than one NSAID should not be taken at the same time. (note cold & flu remedies)

32 Storage of Medicines  Follow manufacturers instructions  E.g. Vaccines and the cold chain +2 to +8 degrees C Keep in original containers, do not mix batches Expiry dates do not over order Lockable cupboards Check them in and store them Patients medication is the patients property

33 Documentation  Record at the time of administration  Sign to say it has been given  “R” refused  “O” omitted  Note CD’s  When things go wrong..

34 Disposal of Medication  P.29 section 21.  In general return to pharmacist Not the domestic sewage system

35 Administration  P22 section  Only Following training & Assessment- HCA working with an individualized planned package of care…naming both the patient & the HCA.  Routes of administration

36 The Gut A&P

37 Bristol Stool Chart

38 Eye Drop administration

39 Eye infections

40 P.E.G. Tube  Percutaneous Endoscopic Gastrostomy Tube  P.26 & separate policy

41 When things go wrong  Prevention- follow the policy  Prevention- are you competent?  Prevention- Get it right checks  Trust’s Incident Reporting Policy and Procedure  Notify supervising staff / line manager  Community Pharmacist  GP - prescriber  Medicines manufacturer e.g. loss of refrigeration