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

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

3. 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. 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

5. 5

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

7. 7 BNF  British National Formulary for all medicines (current / childrens)  http://bnf.org/bnf/bnf/current/  Contraindications  Cautions  Side Effects  Interactions

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

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

10. 10

11. 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. 12 Legal aspects  Medicines Act 1968 & Human Medicines Regs. 2012  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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 24 Medicines & Children  Oral Syringes  Out of reach?  Rare Conditions  Sugar Free?

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

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

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

28. 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. 29 Falls  What medicines could contribute to the risk of falls?

30. 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. 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. 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. 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. 34 Disposal of Medication  P.29 section 21.  In general return to pharmacist Not the domestic sewage system

35. 35 Administration  P22 section 11.2.1  Only Following training & Assessment- HCA working with an individualized planned package of care…naming both the patient & the HCA.  Routes of administration

36. 36 The Gut A&P

37. 37 Bristol Stool Chart

38. 38 Eye Drop administration

39. 39 Eye infections

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

41. 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