This is one of the most complex areas within the domiciliary care sector. This organisation is aware of the need for clear and practical guidance for staff involved in this area of work.

Most service users who require domiciliary care are prescribed some form of medication at some time as part of their treatment by their doctor or nurse. Most service users can be responsible for their own medication, but some require help from the organisation’s staff. This organisation believes that any aid offered by our staff to assist a service user to take their medication or to administer medication must be agreed with the service user and care manager and recorded in the care plan according to the organisation’s medication policy.

This organisation understands that taking medication is essential for the health and well-being of the service user but the organisation also understands that there are circumstances wherein some service users may fail to comply with their prescribed treatments; wherein self-medicating service users may fail to take their medication as directed, or non-self-medicating service users may refuse prescribed medication, or fail to swallow it and then dispose of it. In such cases, the organisation is clear that its staff have no right to force non-compliant service users to take their medication but they do have a duty to report cases of non-compliance back to the manager who will inform the service user’s GP and/or other prescribers.

Access to Health Records 1990
Control of Substances Hazardous to Health (COSHH) Regulations 2002
Data Protection Act 2018
Hazardous Waste Regulations 2005
Health and Social Care Act 2008 (Regulation 2014)
Medicine Act 1968 (and Amendments)
Mental Capacity Act 2005
Misuse of Drugs Act 1971
Misuse of Drugs (Safe Custody) Regulations 1973 (amended 2007)
Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) (England, Wales and Scotland) Regulations 2014
Coronavirus Act 2020 and supporting guidance.

NICE Guideline (NG 67), published March 2017, Managing Medicines for Adults Receiving Social Care in the Community

NHS Digital. NHS Digital is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England, particularly those involved with the National Health Service of England

This list is not exhaustive but highlights the complexity of this area.
All medication training will be delivered by a qualified and trained member of staff or health professional. All staff will complete this course within 6 months of commencement of duties, or before if required.

This organisation intends to build up good community-based relationships with local pharmacies, whose advice and guidance is invaluable and appreciated.

Any reference to competence-assessed training for our staff by an appropriate person includes the following health professionals:

Prescribers are NHS professional who can write (prescribe) NHS prescriptions.

The process by which medicines are prescribed is determined by statute.

GP, prescribing nurses, optometrists, dentists, physiotherapists, chiropodists and radiographers are all prescribers in law and are recognised as an appropriate person. The following are excluded from the NHS list: any complimentary health practitioner, medical herbalist, chiropractor, osteopathic practitioner, and health shop assistant.

Due to the developing roles within the NHS and local clinical commissioning groups, there is an ever-widening range of prescribers.

This organisation will, during the care assessment stage, determine the level of support required and ensure that the appropriate staff training and record keeping needs are met. A separate medication care plan will be updated and reviewed as necessary for each service user.

Where multi-agency partners are involved in a package of care, the agreement needs to be reached about which provider takes the lead responsibility for support with medication. This must be recorded in the service user care plan.

This organisation believes that, as far as possible, all service users should be enabled to manage and self-administer medications wherever possible. At the assessment of needs stage, information must be sought and recorded so that the level of support required is properly indicated and that a risk assessment is completed.

When staff are responsible for the collection of prescriptions they follow the Collection of Prescriptions Policy.

Any member of staff who is unsure of what to do regarding medication in any given situation should contact their line supervisor or an organisation manager immediately

For most service user’s supplements are prescribed to be used in addition to their food intake. A record is kept on the MAR with a separate record sheet with other information on the service users progress such as daily weight checks or fluid intake according to the care plan.

An initial prescription is usually limited to one week and will be marked mixed flavours. After the weeks trial, the service user’s surgery or dietitian is contacted with details of the service users preferred flavour supplements.

Nutritional supplements should be stored separately from the service user’s medication, in an accessible place as agreed with the service user.
Supplements should be stored according to manufacturer’s instructions, generally required to be stored unopened in a cool dry place between 5°C and 25°C, when opened they should be dated and stored in the fridge between 2°C and 8°C.

The supplement packaging will show the shelf life after opening.

When using dry powder supplements the measure should be kept clean and dry.

Medicines with a limited life span once opened, must have the expiry date written on the container by the member of staff who opens it. The guidance information is found on the pharmacy label e.g. Do not use after 28 days from opening.

Expired medication should be returned to the pharmacywith consent.

We work closely with our GPs or other visiting medical professionals to ensure that all medication instructions are clear. This is particularly the case with variable dose or ‘when required’ medicines (when a clear indication of the circumstances to administer the medicine is needed).

This organisation understands ‘non-self-administering service users’ to refer to service users who require help from organisation staff in the collecting, storing and/or taking of their medication. Such help can range from helping a service user to take their medication out of a bottle, packet or monitored dosage system to administering the correct amounts and helping the service user to take it. All such help should be entered into the care plan and agreed upon with organisation managers before the help is given.

If the person is unable to take the medication because of difficulties with swallowing, the service users GP must be contacted to inform them of the problem and ask if there are suitable alternatives that can be prescribed or if the medication can be reviewed.

If no suitable alternative formulations are available and the medication is still required, it may be possible to crush the tablet or open a capsule. This MUST ONLY be done following the advice of a pharmacist to ensure that the pharmaceutical properties of the medication are not altered and that it is safe to administer the medication in this way. The advice of the pharmacist, including the name of the pharmacist contacted, must be recorded in the care notes. The method of administration must be agreed upon by the GP and recorded on the MAR.

Neither the medication(s) nor the MAR should be removed from the service user’s home unless asked to do so by the office.

If the MAR is not available, the medication must not be administered; the care worker should also contact the office or duty officer immediately and record the reason for not giving the medication in the attendance record in the service user’s home.

Staff should encourage and support service users and or their families to raise any concerns about their medication. This may include how to seek help or how to make a complaint and the role of advocacy services. This should be documented in the service users care plan

From time to time, errors can occur when prescribing, dispensing, or administering medicines. Whilst most of these errors do not harm the individual, on rare occasions there can be serious consequences. It is important that all errors and near misses are recorded and the cause investigated so that lessons can be learnt from the incident so that measures are put in place to prevent a similar error from happening again. In this organisation, we encourage an open transparent way of reporting any errors or near misses to ensure we constantly monitor and improve to prevent further errors.

Staff must immediately report any error or incident in the handling or administration of medicines. This report should be made to the manager or person in charge as appropriate, so that senior managers can take decisions regarding, Regulation 18 of the CQC (Registration) Regulations 2009 The error report form must also include near misses.

An error is a learning exercise and it is important that within a medication management system, errors are reported so that all can learn from the incident. It is imperative that when dealing with medicines you are focused and concentrating on the task at hand. Near misses are recorded so that they can be used as empirical evidence for medication training sessions.

Agencies should be aware that care workers are particularly vulnerable when being asked to manage or assist with the management of controlled drugs in a domiciliary care setting.

A controlled medication register is not required in domiciliary care. Staff are complete stock checks on all controlled medication, including liquids, prior to every administration. Details of administration should be recorded on the MAR chart following administration procedures. However, wherever two staff are present it is good practice that they should both witness the administration of a controlled drug and sign the MAR sheet.

Controlled drugs that are no longer required should be returned to the pharmacy for disposal. As good practice if staff have the responsibility of returning controlled medication two members of staff witness the removal and record accordingly but only if there are no family members who could assist.

Current guidance from NICE Clinical Knowledge Summaries Anticoagulation – Oral, last revised June 2019: https://cks.nice.org.uk/anticoagulation-oral

These procedures below set out the principles and values underpinning this organisations approach to the safe handling of medicines regarding warfarin (and other anticoagulants).

This organisation follows these good working practices

If the instruction on the MAR chart does not coincide with the label on the container (except where the medicine to be given is Warfarin, for which the instructions will be clearly written on the card or in the service user’s Warfarin record book) no dose should be given until written instructions have been received from the dispensing pharmacist, medical practitioner or the community nurse or prescriber.

For medicines used to manage a person’s behaviour staff should know how to support a person in a different way before using a medicine. For example, changes to the person’s environment. This information will be recorded in their care or support plan. This information should be accessible to staff at the time of medicines administration.

We work with prescribers to ensure that psychotropic medicines are regularly reviewed. They should only be prescribed where there is a clinical need. When required (PRN) medicines to manage a person’s behaviour, should be prescribed for as short a time as possible. The prescriber will be contacted if there is any concern about overuse. Overuse of medicines to control behaviour may need to be reported as a safeguarding incident.

This follows the principles laid out in STOMP (stopping overmedication of people with a learning disability, autism or both).

This is a medicine that needs to be taken or given at a specific time where a delay in receiving the dose or omission of the dose may lead to serious harm, for example, insulin injections for diabetes or specific medicine for Parkinson’s.
When these medications are prescribed to our service users who require support in medication administration the medication will be given at the prescribed times.

Staff are aware of the importance of giving these medications at specific times and any errors relating to time will be documented on a medication error sheet and the office informed.

A homely or household remedy is another name for a non-prescription medicine available over the counter in community pharmacies and are used mainly for the short term management of minor, self-limiting conditions e.g. toothache, mild diarrhoea, cold symptoms, cough, headache, occasional pain, etc.

When a service begins a service user may be using some homely medicines and at the assessment have expressed their wish to continue.

When the administration of medication is part of the service delivered;

If attending a hospital or a day centre, staff who are responsible for the administration of medication should make sure that the service user has their regular prescribed medication for the day and any required documentation for recording.

If a service user is admitted to the hospital for longer, follow the instructions issued with the appointment from the hospital. It is usual to be asked for a list of current medication for the service user. A copy of the MAR sheet and their care passport should accompany the service user along with the hospital admission pack. Please be aware that changes may be made to service user’s medication following a stay in hospital

Before going on holiday, the relevant staff member must discuss medication needs, and where applicable, the administering process and recording method with the service user and the family/representative who is taking the service user on holiday.

A photocopy of the MAR chart (original to be retained in the home) and blister packs are to be given to the service user or family member/ representative for safe keeping for the duration of the holiday. Service user/families will be requested to sign for receipt of medication on the daily contact sheet.

The name and contact details of the service users GP and any other relevant information needed in an emergency must accompany the service user.

All blister packs, medication and signed MAR sheet to be returned to their home on arrival back from holiday.

The family/ representative must account for any medication that has not been taken or is missing etc.

Wherever possible, when a service user is admitted to the hospital a copy of the up to date MAR chart should accompany them, together with their care passport and any other document required. We do not send any medication with the service user unless it is a medication that may be needed in an emergency e.g. before the hospital pharmacy has had a chance to dispense the required medication for that service user i.e. inhalers/EpiPen etc.

Please be aware that changes may be made to the service user’s medication following a stay in the hospital, any changes should be recorded on our ‘Transfer between Services Passport’ including no changes. This document would have accompanied the Service User into hospital. If the form is incomplete or not returned this organsiation will confirm with the discharging organisation.

If the medication is time specific, then it may be necessary to interrupt the meal or sleeping time of the service user to administer the medication. Where the service user has the capacity, this should be explained when the medication is prescribed to enable them to understand why this disturbance is necessary and to give their consent.

The service user still maintains the right to refuse the medication. If the medication is not taken on time or refused this must be recorded using the correct code and reported to the office or manager.

When supporting or administering medication to the service user, they must be treated with dignity and respect and wherever possible their preferences are respected. However, we will explain to them that there will be times when medication must be given at these times and gain their consent to do so.

The MHRA’s Defective Medicines Report Centre (DMRC) issues alerts to healthcare professionals, hospitals, GPs, and wholesalers to tell them when a medicine is being recalled or when there are concerns about the quality that will affect its safety or effectiveness. These alerts are graded according to the seriousness of the threat to the public’s health. A recall may be issued if the medicine is:

A health hazard. Unfortunately, some health risks associated with certain medications are not realised until after they become widely used.
Mislabelled or packaged poorly. Sometimes medicine is recalled because of confusing dosing instructions or a problem with the dosing tool provided with the drug.

Potentially contaminated. During production or distribution, a medicine may become contaminated with a harmful or non-harmful substance.

Not what it says. E.g., a person may think they are taking a pain reliever based on the packaging material, when in fact what is inside the box is something else.

Poorly manufactured. Manufacturing defects related to a product’s quality, purity and potency may be to blame for a drug recall.

Before the service commences, a care needs assessment is carried out which includes a medication assessment. A record of all the medication is made and with the service, users consent checked with their local GP to ensure the list is current and complete. This medication record is reviewed and updated regularly at the care plan review or as required and by the GP. If the service user is lacking capacity the GP, involving the LPA or relevant person and following the Mental Capacity Act Code of Practice makes a best interest decision concerning medication.

All our service users have in their care plans a ‘My Medication Passport’. This contains all the information concerning the service user’s current medication, including inhalers, eye drops, patches injections and homely medicines. This accompanies the service user when they go into hospital, an outpatient appointment or other health or social care service. It also allows for any changes in the medication to be recorded and returned with the service user. This helps us to ensure continuity of medication administration and safety.

Staff will record any adjustments a person needs to communicate in the person’s medicines support care plan. This will be regularly reviewed and updated.

Keep medicines administration records for at least 8 years after the person’s care ended at the service. After 8 years, review the records. If they are no longer needed, destroy them in line with local policies.

If you scan your records, complete any quality checks and destroy the original paper copies following the standards of scanned records in the record management Code of Practice for Health and Social Care.

All confidential information about our service user’s medication is treated in confidence, respecting our service user’s rights and security. All MAR charts are stored as securely as possible in the service users’ home and a locked cupboard in the organisation’s office with access only by those who are involved in their care and medication administration and have the right to access the information. All emails, faxes, messages, reports, either written or electronic are kept in the service user’s care plans and stored securely. All records kept must be complete and accurate. Information is not safe if not accurate and each member of the team is responsible for recording and storing information in a way that makes it easy to share information as appropriate. The service users name and number should be seen on each document and signed and dated where required.

All medication is held electronically and only accessible by authorised staff.

As an organisation, we recognise the importance of members of a care team sharing information when it is needed for the safe and effective care of the service user. However, even where it is beneficial to share information concerning medication, rules about confidentiality and privacy still apply. This means that only those who have a clear need to know should have access to relevant confidential information.

Service users have the right to see their medication records and this is at the forefront of the minds of those recording notes and administering care. Service users should be informed about who will see this confidential information.

When considering whether to share information with a carer or family member relating to the service user’s medication, it is important that the wishes of the service user are followed and that the information shared is what the service user has consented to.

Where the service user does not have the capacity to give valid consent, information should only be shared when it is deemed in the service user’s best interest.

In safeguarding situations, it becomes an absolute imperative to share information in cases involving a threat to the safety of others.
Information regarding the sharing of information is in the Service Users’ guide and written consent is obtained from the Service User or family and a copy of this is in the service support plan.

Information that is shared for the benefit of the community should be anonymised. If this is ever required, then all confidential information will be anonymised in line with ICO Anonymisation Code of Practice: https://ico.org.uk/

Service users right to object to the sharing of confidential information about them should be respected. When the law says there is an obligation to share confidential information the service user should receive an explanation of why their objection must lawfully be overruled.

As an organisation, we have policies and procedures in place relating to confidentiality, record keeping and cyber security. These relate to both written and electronic information on the service user’s medication.

We have in place a lead medication member of staff who as part of her duties liaises with the appointed Confidentiality Officer to ensure the ongoing development of confidentiality in this area of care. The Registered Manager is responsible for this within this organisation.

The NICE guidance NG67, stated that there are seven rights of administration

Anticipatory prescribing means GPs issue a prescription before it is needed, in anticipation of managing symptoms, such as pain and nausea, that are common near the end of a service user’s life.

As an organisation, we work with the GP, district nurses, palliative care nurses and our pharmacist supporting the service user with any Advance Care Planning and following local processes to ensure our service users at end of life have access to anticipatory medicines.

Northumberland County Council. Completed Notification form emailed.

Accidents, Incidents and Emergencies Reporting (RIDDOR)
Advance Care Planning
Care and Support Planning
Confidentiality
Control of Substances Hazardous to Health (COSHH)
Co-operating with other providers
Collection of Prescriptions
Cyber Security
Data Protection Legislative Framework (GDPR)
Duty of Candour
Health and Safety
Infection Control
Notifications
Record Keeping
Service users Records (Home)

NICE Guidelines [NG67], Managing Medicines for Adults Receiving Social Care in the Community:
https://www.nice.org.uk/guidance/ng67

NICE Quality Standard [QS171] Medicine Management for People Receiving Social Care in the Community:
https://www.nice.org.uk/guidance/qs171

NICE Quality Standard [QS123] Quality Standard 2 Plan for Missed or Late Visits, June 2016
https://www.nice.org.uk/guidance/qs123

NICE Guidelines [NG5], March 2015, Medicines Optimisation: The Safe and Effective Use of Medicines to Enable The Best Possible Outcomes:
https://www.nice.org.uk/guidance/ng5.

This guideline offers best practice advice on the care of all people who are using medicines and those who are receiving suboptimal benefit from medicines. As an organisation, we work closely with our health partners concerning service user’s medication reviews and the monitoring of its effectiveness).

Health and Social Care Information Centre, NHS Digital, A Guide to Confidentiality In Health and Social Care:
https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-governance/codes-of-practice-for-handling-information-in-health-and-care/a-guide-to-confidentiality-in-health-and-social-care

CQC Medicines: information for all adult social care https://www.cqc.org.uk/guidance-providers/adult-social-care/medicines-information-all-adult-social-care-services

NHS England, Stopping Overmedication of People with a Learning Disability, Autism or Both (STOMP):
https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/

This organisation requires staff to have completed a Level 2 Safe Handling of Medicines Course, achieved the organisation’s agreed pass mark of 80%, and be observed and assessed as competent before being involved in the administration of medication.

Staff are monitored, their competencies assessed and attend medication updates annually or more frequent if required, this organisation monitors compliance via the training and competency matrices.

A training matrix is in place recording all training, updates, competency observations and evidence of any further training required by individual staff.

At supervisions and appraisal their knowledge, skills and competencies are reviewed and discussed

Staff involved in the monitoring of staff and auditing process are given the relevant support and training in this area at level 3.

Training is provided by Sphere Specialist Healthcare nursing staff.

Nursing staff will also receive training updates and observational assessments and be required to show continual professional development around medication as required for their revalidation process.

There is a lack of available evidence on expiry dates of creams and ointments once they are opened.

Follow any expiry date of creams and ointments once they are opened, that is written on the label. If it is not clear how long the cream should be used after opening please check with your pharmacist.

There is a lack of available evidence on expiry dates of creams and ointments once they are opened.

Follow any expiry date of creams and ointments once they are opened, that is written on the label. If it is not clear how long the cream should be used after opening please check with your pharmacist.

As a guide, the following table shows the difference in suitable quantities of topical creams/ointments compared to topical corticosteroids for an adult.

These should be applied no more frequently than twice daily and should be spread thinly.

The length of cream or ointment expelled from a tube can be measured in fingertip units (FTU) (the distance from the fingertip to the first crease of the finger in an adult index finger).

One FTU is approximately 500mg of cream or ointment which is enough to cover an area that is twice that of the flat adult handprint (palm and fingers).

Face and neck: 2.5.
One hand and arm: 4.
Trunk (front): 7.
Trunk (back) including buttocks: 7.
One leg and foot: 8.

Neither the product nor the MAR chart should be removed from the service user’s home unless instructed to do so by the office, on call duty officer or the community nurse.

If the medication records are unavailable, the prescribed product must not be administered; the care worker should also inform the office or on call duty officer immediately and record the reason for the product not being administered in the service user’s attendance record.

When two different preparations in the form of eye drops are required at the same time of day, dilution and overflow may occur when one immediately follows the other, e.g. pilocarpine and timolol in glaucoma. Therefore, an interval of 5 minutes should be left between the instillation of each preparation.

Immediately after completing the instillation of the eye drops, the care worker should:

Medication via inhalers are mainly used in the treatment of asthma and chronic obstructive pulmonary disease (COPD).

There are different types of inhalers, for different types of medicine. The member of staff supporting the service user to administer the medicine receives training on service user service users before supporting them in the administration of the medicine via this route. The care plan and medication plan clearly indicate the reason for using the inhaler or inhalers when multiple types are prescribed. We work closely with the service user and their family and GP or specialist nurse in this area.

Inhalers also come in various colours. Relievers are usually blue and preventers are usually brown (but some can be orange).

Press-and-breathe metered dose inhalers (MDIs) are often called ‘puffers’. MDIs work better with a spacer. Spacers collect the medicine inside them, so that the person does not have to worry about pressing the inhaler and breathing in at exactly the same time. This makes these inhalers easier to use and more effective. An MDI uses a small canister with a mixture of the medicine and a gas or liquid that turns the medicine into a very fine spray as the canister is pressed. Most people call this a ‘puff’ of medicine. To get the best result shake the inhaler before each puff so that the medicine mixes well before use.

Breathe in normally breath-actuated MDIs are usually given to people who have difficulty using a standard ‘puffer’. These inhalers are activated by your breath so that when you breathe in normally through the mouthpiece, it releases medicine in a fine spray form. With this inhaler you don’t have to push the canister to release a dose. Autohaler and Easi-breathe are examples of breath actuated MDIs. These inhalers need to be shaken before each puff so that the medicine mixes well before use.

Breathe-in-hard dry powder inhaler (DPIs) release medicine in very fine powder form instead of a spray when breathing in through the mouthpiece. The person needs to breathe in fairly hard to get the powder into the lungs. Examples of DPIs include Accuhalers, Clickhalers, Easyhalers, Novolizers, Turbohalers, Diskhalers and Twisthalers.

If using a spacer remove the cap from the canister and shake, place the canister in the back of the spacer. Breathe out, place the mouthpiece of the spacer in the mouth and take a deep breath and hold for 10 seconds. Gently breathe out through the nose. Repeat as above as required.

When the inhaler is for administering steroids encourage the person to brush their teeth, gargle and spit out after using this preventer inhaler and always use a spacer.

If the person is having problems using their inhalers staff must report this to their manager who will ensure that the GP or specialist nurse is informed quickly.

There are other types of inhalers that may be prescribed and it is important to get instruction on use from the GP or specialist nurse and read patient information leaflets (PILs).

BAI – breath-actuated metered dose inhaler.
DPI – dry powder inhaler.
pMDI – pressurised metered dose inhaler.

It is important to monitor and record the effectiveness of the inhaler and report any changes in its effectiveness.

The patient information leaflet (PIL) included with the medicine explains the best way to use, clean, store and look after the inhaler.It is important that these instructions are followed.

Before removal or application of the hosiery the care worker should explain the procedure.

The care worker should check the medication plan of care for specific instructions about the times of removal/application and any special instruction related to the type of hosiery used.

When the hosiery has been removed, the care worker should gently wash and dry the service user’s skin using warm water and soap. Skin covered by hosiery can become very dry; if a cream has been prescribed then this should be applied; if no cream has been prescribed then the service user’s surgery should be contacted to seek advice.

If the hosiery is to be reapplied immediately following skin cleansing it is advisable to apply a light dusting of powder to the skin to aid application. If an application aid has been provided this should be used according to the manufacturer’s instruction.

If the service user experiences pain at any time then the care worker should cease the application and check if any skin damage has occurred. If this is the case contact the service user’s surgery for further advice and remove the hosiery.

Hosiery should be washed at 40 degrees and hung to dry (UNDER NO CIRCUMSTANCES SHOULD THEY BE IRONED)

Service users should always wear hosiery on both legs.

Hosiery should be replaced every three months or earlier if they become damaged or worn.

Before any staff member can administer medication via an enteral feeding tube, they will receive Level 3 training from a health professional. This will be recorded, dated and signed off by the health professional only when the staff member is deemed competent to administer medication to the service user service user. The training will also include the recognition of adverse or side effects and actions to take in the event of an emergency.

Enteral feeding tubes are designed to provide access to the lumen of the stomach or jejunum. They are designed to bypass dysfunction and obstruction, reduce discomfort or remove the need for service users to actively eat. The lumen of a narrow enteral tube has the potential to occlude and once occluded can be difficult to unblock It is therefore important when caring for a service user with an enteral feeding tube to know the type of material the tube is made of, the type of tube and the abbreviation used should be standardised for example ‘nasogastric tube’ (NG). It is important to know where the tip of the enteral feeding tube lies and therefore the site for medication administration. The position of the tip may affect the type of feed that can be used and the absorption of some medications.

Further Information Leaflets published by the British Association for Parenteral and Enteral Nutrition are available to staff. www.bapen.org.uk http://www.evidence.nhs.uk/search?q=medication+via+peg+tubes

In exceptional circumstances Sphere Specialist Healthcare (SSH) support staff may be asked to administer medication rectally this can be in the form of a suppository or enema. Service users may require this for pain relief when it is deemed impractical to administer orally, as emergency management plan for seizures or for service users with a spinal cord injury who are unable to open their bowels by other means. This must be on the CSP 1 and in the SSH Support plan. It must be clearly documented on the MAR chart to be given by this route and signed for appropriately by staff once administered. There must be a detailed clinical care plan in place before we commence this procedure.

This is a delegated nursing task and staff must be specially trained and deemed competent by a registered nurse before administering medication via this route. The training will be recorded, dated and signed off by the health professional only when the staff member is deemed competent to administer medication to the service user. The training will also include the recognition of adverse or side effects and actions to take in the event of an emergency.

General support needs should be identified at the care assessment stage and recorded in the service user’s plan. Ongoing records will also be required in the continuation notes when care needs are reviewed.

Adults can retain independence by using compliance aids. These should be considered if packs and bottles are difficult to open, or if the person has difficulty remembering whether they taken medicines.

The compliance aid will be filled and labelled by the community pharmacist or dispensing GP. The person may qualify for a free service from a community pharmacist if they meet criteria under the Disability Discrimination Act.

This organisation will not take responsibility for the filling of the compliance aid unless trained and competence-assessed to do so by an appropriate person e.g. district nurse, pharmacist. The Level 3 criteria applies in these circumstances.

The need for assistance with medication should be identified at the care assessment stage and recorded in the care plan, with ongoing records in the notes updated when care needs are reviewed. This organisation will have in place training to ensure that only competent and confident staff are assigned to service users who require assistance. Care workers have the right to refuse to administer medication where they themselves feel they have not received adequate training and do not feel competent to do so.

Care workers should only administer medication from the original container dispensed and labelled by a pharmacist or dispensing GP, including monitored dosage systems and compliance aids.

Service users discharged from hospital may have medication that differs from those in the home prior to admission. Care must be taken to ensure checks are in place to provide clear instructions as to which medicines are to be administered. Additional support should be in place for care workers when this occurs.

In the above circumstances this company will strive to maintain the service user with true regard to their wishes, whilst seeking to ensure that the service user will be cared for in an appropriate manner by staff that are fully trained and competent to do so.

If the decision is taken that the task to be delegated to the care worker the HEALTHCARE PROFESSIONAL must train the worker(s) and be satisfied they are competent to carry out the task, this must be recorded on the Level 3 Training Record and signed off by the HEALTHCARE PROFESSIONAL involved in the training. Any additional support appropriate to the circumstances must be available by the health services involved.

Care workers who feel that they are not competent to assist with the administration of medication by specialised techniques can refuse to assist.

This area of activity must be clearly assessed and recorded during the care assessment. Specialist training must be undertaken and staff must be competent and confident in their own abilities to undertake the tasks required. The appropriate healthcare professional must sign off the training, and the competency of the care worker and the information should be recorded on the Level 3 staff training record.

Health-related activities will be undertaken only with the express agreement of the manager, and when the appropriate care assessment has been completed and recorded in the care plan. Reviews should take place and care plans updated as required.

All staff should be able to refuse to undertake tasks which they themselves feel they are not competent to do

The function of monitoring and auditing needs to be a planned and systematic process that is embedded throughout this organisation.

Monitor means to check, observe, identify task or system performance.

Audit means to evaluate, examine, critically analyse conformance to set standards by reviewing the objective evidence from statements, records, files and any formal monitoring systems which are in place.

Medication monitoring is part of the observed practice of staff which is recorded, dated and signed off and is usually delivered via a spot check. The spot check findings are then followed through using the error sheets, and advice and guidance to staff. This includes any training and further monitoring as required.

Auditing of medication is a part of this organisation’s quality audit process. Auditing of all medication documentation including MAR charts is done monthly or as necessary, and solutions implemented with immediate effect where any shortfalls are identified.

Peer auditing forms the core of the audit regime and staff are constantly reminded of the importance of signatures, dates and appropriate record keeping.

Health and social care practitioners should share relevant information about the person and their medicines when that person transfers from one care or health provider to another. This should include, but is not limited to, all the following: