Managers, Seniors & Support Workers Medicines Management Training Day for Managers, Seniors & Support Workers

Why are you here? Revised Medicines Management Guidance implemented by SBC. Significant change to current practice – Service users will now be assessed for the medication support they require. Support Staff will be administering a range of medicines from original packaging. Training required to meet Care Inspectorate Guidance.

So-why do we need training? To learn the right way to administer medicines To be in line with the new Medicine Management Guidance Build confidence Equity of access So questions can be answered

Today Four modules: Policy & Guidance Medicines and their use Monitoring & Supporting use Medicine & Older people

Competency A multiple choice questionnaire will be part of your training to test your knowledge and understanding. During this training A Competency Assessment will be carried out by your supervisor. In your place of work at a later stage. Your Line Manager must advise you before you can start administering Medicines.

Medicines Management Policy and Guidance

Session 1 Policy on medicines Medicines and the law Medication Assessment and levels of support Self administration Administration of medicines Awareness of MDS systems MAR charts and record keeping Medication Errors Session 1 Evaluation Exercise

National Care Standards Standards for each Registered Service Area: Care at Home Care Homes Support Services (Day Services) Standards make reference to what service users should expect from services - includes support with medication (Workbook Appendix 1) Page 71 of workbook

Scottish Social Services Council Codes of Practice Codes of practice for social service workers and employers of social service workers describing the standards and conduct of practice within which they should work. Pg 75 of workbook

Activity 1 Page 6 of workbook

The Law The law states that anyone can administer a medicine to another person if that is in accordance with the directions of a prescriber. (The Medicines Act 1968)

On whose authority am I giving this medicine Prescription written Pharmacist dispenses prescription Support worker administers prescription On whose authority am I giving this medicine Support worker picks up prescription Support worker writes in support plan A Medicines Administration Record Card produced by the dispensing pharmacy is NOT an authority to administer. The Support worker needs to be aware of a valid prescription, that is, the best way to be sure is to see and sign the prescription when it is picked up and to document this in the Service user’s support plan. What about medicines that the service user or their family purchase for them? – If they are not prescribed they may not legally be administered. There is nothing stopping the service user having help to take these on their own authority, but they are not legally allowed to be ‘given’. The Care Commission and the Scottish Borders Council are still in discussion about the precise way this will work but we hope it will be as detailed on the slide and simply be an entry in the support plan.

Authority to Administer Medicines A Medicines Administration Record Chart is NOT an authority to administer. A Palliative Care Medicines chart signed by a Doctor is an authority to administer. Sign the prescription (look at both sides) when it is picked up and to document this in the Service user’s support plan. If they are not prescribed they may not legally be administered. Document medication on delivery to service user.

Medicine Management Guidance In place to promote the safety and wellbeing of the service users and ensure safe practices of all support staff . All support staff must be aware and understand their role and responsibilities while working with medicines.

Activity 2 Page 8 of workbook

Procedure for Service User Medicines Management See Guidelines Appendix 1 Appendix 2 Appendix 3, 4, 5

Administration Levels (Full Details in Workbook) (See Appendix 2 of guidelines) Assessed at Level 1 – Service Users will retain full control of their medication. Assessed at Level 2 – Service Users will maintain overall responsibility but will require assistance with prompts to take their medicines and collection of prescriptions.

Support Worker Tasks at Level 2 Reminding the patient to take medicines– prompting Confirm the reading of labels. Provide assistance with opening medication packaging Performing and interpreting blood glucose monitoring. Order repeat prescriptions from the medical practice. The service user must specify the name, strength and quantity of the medicines to be ordered. Collect the prescription from the medical practice, take it to the nominated pharmacy for dispensing and collect the dispensed medications from that pharmacy.

Assessed at Level 3 Service Users are unable to manage their own medication and will require their medicines to be administered. Medicines to be administered will be listed on a specific chart “Medicines Administration Chart” (MAR). The MAR chart is provided by the Pharmacist who dispenses the medicines. The MAR chart is supplied monthly along with the supply of medicines.

Support Worker Tasks at Level 3 Only those medicine management tasks that have been agreed by the service user or his/her representative and are specified in his/her support plan may be undertaken. Support Staff can Administer those medications that are listed on the medicines administration record, including those contained in a Medicines Compliance Aid (MCA) filled by a Pharmacist or a Dispensing Doctor

Level 3 - Support Worker Tasks Care at Home Staff are not permitted to administer “as required” medication for service users assessed at Level 3. In care homes medicines that are prescribed on an ‘as and when required’ basis may be administered provided that it is listed on the medicines administration record (MAR) with full instructions as to the frequency of administration and the maximum daily dose. This should be clearly documented in the support plan.

Warfarin CARE AT HOME STAFF SHOULD NOT ADMINISTER WARFARIN In Care Homes the GP practice may give verbal instruction over the phone or in person to the Senior Support Worker on duty and they should repeat the instruction back to the GP practice to ensure clarity. This then needs to be recorded in the Social Care & Health recording notes and in the Warfarin Dose and INR Recording Form. This form should be stored along with the service users MAR record and the MAR record should read “as prescribed on WD/INR/Form”.

Don’t Forget Right Person Right Medicine Right Dose Right Time Right Route

Those Assessed at Level 4 Administration requires medical training and knowledge

Who Does What? Relevant training done by all support workers Assessment of need – by care manager/Parmacist Support plan – added to by everyone Consent – from the service user or their legal representative www.sehd.scot.nhs.uk/mels/HDL2006_34.pdf Medication Administration Record (MAR) Chart – pharmacist produces Medicines Administration Record (MAR) Chart – support worker writes on it

SUPPORT WORKER’S RESPONSIBILITY Check the service User’s support plan And Medicines Administration Record Chart or Kardex and get all The medicines ready Service user Sitting up preferably Level 2/ 3 Wash hands When the support plan indicates level 3 the medicines will need to be administered by the support worker This means that a Medicines administration record chart will need to be signed Some medications may need only level 2 support and some level 3 support, in this case the support worker need only sign for the level 3 medications. Make sure that all instructions can be understood – contact the Community Pharmacist for clarity if they are not precise. Put medicine away, check if They need ordered Check Identity Sign medicines Administration Record if level 3 Offer a glass of water Measure and Give dose(s) order

CARE MANAGER’S RESPONSIBILITY Remember Consent Service user is assessed by Support manager For level of medicines administration needed Level 1,2,3, or 4 agreed Support plan written Detailing Support level And Community Pharmacy address Community Pharmacist asked for MAR chart, if level 3 If there is an indication at the time of the care package being set up that the service user is going to need help with medication then the Support Manager will assess the service user using the form in the policy The service user’s consent will also need to be obtained This form will then form part of the support plan and be available for the support worker to see. The Support manager will need to ask the community Pharmacist if they will produce a Medicines Administration Record Chart for the Service user. The Medicines administration Record will then be used by the Support worker to record the medicines that have been administered. It is important that if any instructions are not clear the Community Pharmacist is asked about them and they are clarified. It is not suitable to have an item labelled – as required without a dosage interval and maximum quantity in 24 hours. All instructions will Need to be very Clear on the MAR So they will be understood Support worker checks the service User’s support plan And Medicines Administration Record Chart

Administration of Medicines Preparation is important Wash hands, MAR chart, - look at the time of day it is Medicines – select the ones needed Administer, remember to offer a drink Record – exactly what you administered and when Put away – making sure that those needed are ordered Wash hands – washing hands is the thing that has been shown to reduce transfer of infection the most. So you need to administer some medicines – what do you do? Preparation – if you follow a pattern there will be less likelihood of problems Get the medicines and the medicines administration record chart Wash hands Administer as on the MAR chart Record the administration Put the medicines away making sure that if ordering needs to be done it is done – never let service user run out of medicines.

Important points to note If you are unsure about the service user’s identity or there is a discrepancy with medicines or the instruction is not clear then do not administer - contact your line manager immediately. . Do not handle medication: disposable gloves should be worn as an extra precaution when administering cytotoxic medication. Push tablets out of blister packs directly into a medicine pot or other receptacle used for this purpose. You must not administer medicines which are not prescribed on the MAR chart. You must report immediately if medication that should have been administered previously has been missed by another worker. You must report immediately if when administering you notice a missing signature on the MAR

What Does a Medicines Administration Record Chart look like? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Paracetamol 500mg Tablets Take two four times a day B JS IG JO L T IL N Aspirin Dispersible 75mg Tablets Take one in the morning Lisinopril 20mg Tablets This is an example of what it might look like Usually for 31 days Has all the patient information at the top of the page Also has name and address of pharmacy it came from and the date it was issued Sometimes comes in Duplicate or triplicate Initials should be entered when the service user has taken the medication If they refuse the medicine or do not take it for some other reason there will be a key of codes to enter instead of your initials – remember to write this on the support plan too. See Lunch time on the second – code 1 – patient refused medication Get the patient’s bags and the MAR charts and get them to look at them.

Of the Medicines Administration records look like. This is what some Of the Medicines Administration records look like. Others will be similar. Hand round copies

Activity 3 Page 19-22 of workbook

Administering Tablets or Capsules Tap from the container, or pop out of the blister, into a lid or small cup or the service user’s hand Should not be touched by your bare hands Service user should be offered a half glass of cool, but not too cold, water to help with swallowing Service user’s hand is not the preferred option – WHY? – dirty You shouldn’t touch – may have dirty hands – not if you have followed procedure and washed them! may have damp hands – not properly dried after washing May absorb some medication through your skin.

SOLUBLE/DISPERSIBLE ORAL FORMULATIONS Take the dose from its original container place in a third of a tumbler of cold water and allow to dissolve swirl the solution gently in the glass to ensure adequate mixing hand to the client to drink and offer a drink after the dose has been taken SUBLINGUAL FORMULATIONS - under tongue BUCCAL FORMULATIONS – between cheek and upper teeth

LIQUID ORAL DOSE FORMULATIONS Only one liquid bottle should be open at any one time. § shake the bottle § measure the correct dose – How? § offer the medicine to the patient § when using an oral dose syringe empty the syringe slowly onto the tongue, or towards the cheek AVOID ‘SQUIRTING’ INTO THE BACK OF THE THROAT § clean the neck of the bottle with a clean damp tissue before replacing the cap

TOPICAL (EXTERNAL) FORMULATIONS use only as often as instructed apply only to the areas of the skin for which it has been prescribed -support plan use the smallest quantity that will easily rub into the skin use only for as long as instructed and return partly used tubes to the Community Pharmacy for safe disposal at the end of the treatment period

APPLICATION OF EXTERNAL PREPARATIONS Look at Patient Information Leaflet (PIL) wear disposable gloves Transfer quantity required to gauze or clean tissue and re-seal tube Apply to affected area rubbing in if needed Dispose of gauze and gloves in sealed polythene bag in the general waste.

EYE PREPARATIONS, Drops Tilt the head back and gently pull down the lower lid asking the client to look up Bring the dropper close to the eye Gently squeeze the dropper allowing the prescribed number of drops to be placed inside the lower lid Ask the client to close the eye and then blot away any excess solution with clean cotton wool Replace the cap on the container immediately after use May Cause blurred vision – falls risk

Eye Ointments: Tilt head back Gently pull down lower lid Apply half an inch of ointment Ask service user to close eye and blink several times May cause blurred vision – falls risk Replace cap immediately after use Expiry of eye products

Ear Preparations Tilt head to one side Place prescribed number of drops/ applications in the ear Keep head tilted for several minutes Have cotton wool or tissue to absorb any run off

Nasal Drops Ask client to blow nose Tilt head back or ask client to lie down Ask service user to breath through mouth Place prescribed number of drops in nose Ask service user to keep head back or remain lying down for several minutes Tasting the drops is no cause for concern

Activity 4 Page 19, 23-25 of workbook

Mistake? What do you do? Anyone can make a mistake Reporting - no blame culture, near misses Documentation Learning from Audit Wrong drug Wrong dose Wrong strength Wrong time Remember, as we have just discussed, that any error with medication can have serious consequences and must be reported to line manager as soon as possible and if line manager is not available, or if the patient is suffering a reaction – contact the GP surgery. Before second half of slide ask what errors can occur. Write down what happened as soon after the event as possible

Activities 5,6 & 7 Page 19, 26-28 & 29-30 of workbook

Alcohol & medicine What do you do?

MCQ’s