Care Home Good Practice Guide 7: Self Medication, June 2019 Page 1 of 12 Review Date: June 2021

NWL CCG’s Medicines Optimisation Care Home Pharmacists Group

CARE HOME GOOD PRACTICE GUIDANCE 7: SUPPORTING SELF- ADMINISTRATION OF MEDICINES 1. NICE Guidance

1.1. It is important for people living in care homes to maintain their independence,

and that they can have as much involvement in taking their medicines as they want. They have a right to choose to manage their own medicines. It is important to take into account a person's choice and also to consider if this will be a risk to them or others.

1.2. When a person in a care home is able to look after and take their own

medicines, this is referred to as 'self-administration'. NICE Guidance states that care home staff should assume that a person can self-administer unless a

risk assessment has indicated otherwise.

1.3. People who live in care homes should be supported to self- administer their medicines if they wish to and it does not put them or others at risk. This is

particularly important for short term respite, or intermediate care, when people may need to be able to manage their own medicines when they return home.

1.4. Self-medication is not all or nothing, a care home service user may be able to

or want to look after some or all of their own medicines.

1.5. Care home providers should ensure they have a policy in place and that their process for self-administration of medicines including controlled drugs

includes;

Individual risk assessment

Obtaining or ordering medicines

Storing medicines

Recording administration

Reminding or prompting people to take their own medicines

Monitoring adherence

Disposal of unwanted medicines

2. Risk Assessments

2.1. Risk assessments are important to determine what support a person needs to help them to self-administer different medicines (for example, a service user may be able to manage oral tablets but not eye drops), allowing care homes to ensure that necessary support is provided.

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NWL CCG’s Medicines Optimisation Care Home Pharmacists Group

2.2. An individual risk assessment should be carried out for each service user to find out how much support the service user needs.

2.3. Other health and social care practitioners (such as the GP and pharmacist)

should be involved as appropriate to help identify whether the medicines regimen could be adjusted to enable the service user to self-administer.

2.4. Risk assessment should be reviewed periodically, and whenever

circumstances change, to address if any adjustment to the service user support is required.

2.5. Consideration should be given to a number of factors that can affect a service

user's ability to self-administer their own medicines, including their mental capacity, physical health, literacy, vision, hearing, language and culture.

2.6. Care Home staff need to ensure that these factors are considered for each

service user, and any barriers to self-administration of medicines are identified and taken into account.

2.7. Service users who retain responsibility for their own medicines should be asked to complete and sign a risk assessment form. The service user should be given a copy of the form and the original filed with the risk assessment in

the service user’s care plan.

2.8. In the event of a service user being away from home on planned social leave e.g. visiting family or attendance at a day support, and needs to continue taking prescribed medication that would otherwise be administered by care home staff, arrangements must be made for the administration of medications

due during the period of social leave.

2.9. Where service users are responsible for their own medication in the care home it can be expected that they will continue to be responsible for their

medication when away from the home, subject to an assessment of any risks to the safe taking of their medication while away from the care home.

2.10. Risk assessments should consider the following points;

Service user choice

If self-administration is a risk to the service user or other service users

If the service user can take the correct dose at the right time and in the

right way (e.g. does the service user have the mental capacity and/or manual dexterity to self-administer their own medicines)

How often will the assessment need to be repeated

How the medicines will be stored

Responsibilities of the care home staff

Sample risk assessments forms are included in Appendix 1 & 2.

2.11. Service users deemed to lack capacity are not suitable for self-administration

of medication. This is in the context of medicine administration, as defined by the Mental Capacity Act 2005 (MCA).

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NWL CCG’s Medicines Optimisation Care Home Pharmacists Group

2.12. Caution is also necessary for service users with;

A history of drug abuse or self-harm

Psychiatric illness, severe depression, suicidal tendencies

Physical disabilities where adaptations cannot be made to support medicines administration

2.13. Periodic assessments and compliance checks should be conducted to ensure

that the service user maintains their level of competence for self-administration. It is recommended that a compliance check should be

conducted daily for the first 3 days, and then weekly (sample form Appendix 4).

2.14. Service users should be withdrawn from the scheme for the following reasons

Poor Compliance

Unstable medical condition

Unstable mental condition

At the request of the service user

Any other untoward incident

3. Consent

3.1. It is recommended that written consent from the service users who self-administer their medication is obtained. As part of the consent process, service users should agree to store medicines safely and securely. Sample Self Administration Leaflet and consent form are included in Appendix 3 & 5.

3.2. Where appropriate the service user may be given a Medicine Reminder Chart (Appendix 5)

4. Ordering and Receipt of Medication

4.1. Agreement should be made with the service user regarding all tasks relating to

self-administration. A service user may wish the care home staff takes the responsibility to order/collect/accept delivery of their medication whilst another

may wish to order and collect themseves.

4.2. If the service user wishes to order and collect themselves, the community pharmacist and the General Practitioner need to be informed that the service

user is self-administering.

4.3. The community pharmacist should be made aware that the service user is

self-administering to ensure the medication is dispensed in an appropriate container (including keeping the medicine in its original pack).

4.4. For service users who are visually impaired or have dexterity problems the

care home staff should check that any required adjustments have been made e.g. the labels have large print or the dispensing label is not covering the

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NWL CCG’s Medicines Optimisation Care Home Pharmacists Group

Braille on the original packs of medication, or correct bottle tops have been used.

5. Storage

5.1. Care homes should ensure that medicines for self-administration are stored as identified in the service users risk assessment (e.g. in a lockable cupboard or

drawer in a service users room).

5.2. Service users should be able to get any medicine that needs special storage (e.g. fridge item) at a time when they need to take or use them.

6. Documentation

6.1. Appropriate documentation must be kept when service users are supplied with medicines to self-administer or when service users are reminded to take their medicines. This should be clearly documented in the service user’s care plan

which should include how to monitor whether the person is self-administering.

6.2. Where a service user is taking the medicine themselves, clearly mark on the Medication Administration Record (MAR) against each relevant medication

that the service user is self-administering including for Controlled Drugs.

6.3. Where the medications include controlled drugs these must be signed out of the register by two members of staff.

6.4. If a service user only wishes to take partial responsibility to administer some

but not all medications (e.g. topical creams, inhalers but not tablets); this should be documented on the risk assessment. The service user’s MAR chart

should indicate which medicines are self-administered and which are administered by staff.

7. Controlled Drugs (CD’s)

7.1. Service users who can self-administer their own medicines can self-administer controlled drugs (CDs).

7.2. If the service user is wholly independent and is responsible for requesting a

prescription and collecting the controlled drugs personally from the community pharmacy, there is no requirement to keep a record in the controlled drug register.

7.3. Service users who self-administer controlled drugs do not need to use a controlled drugs cabinet to store them in, but should store them in their personal lockable non-portable cupboard or drawer.

7.4. Extra consideration should be applied during the risk assessment regarding the storage of the CD in the service user’s room to ensure it is not accessible to others.

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NWL CCG’s Medicines Optimisation Care Home Pharmacists Group

7.5. If the service user does not arrange the supply and collection of controlled drugs but relies on the care home staff to do so, there should be clear records

made in the controlled drugs register, including receipt from the supplying pharmacy, details of how much has been supplied to the service user and any subsequent disposal of unwanted controlled drugs.

8. Disposal

8.1. Care home staff must obtain the service user’s consent prior to disposing of their medication and follow the care home policy on disposing of medication.

9. References

9.1. NICE Guidance (SC1, 2014) Managing medications in care homes https://www.nice.org.uk/guidance/sc1

9.2. National Care Forum resources – Medication Safety Resources

http://www.nationalcareforum.org.uk/medsafetyresources.asp

9.3. Royal Pharmaceutical Society Great Britain (2007) The Handling of Medicines in Social Care

https://www.rpharms.com/.../handling-medicines-socialcare-guidance.pdf

10. Acknowledgements

North of England Commissioning Support Unit, Medicines Optimisation Care Home Good Practice Guidance PrescQIPP Bulletin B143: Supporting self-administration of medication in the

care home setting

Document History

Version V2

Approved By NWL Care Home Pharmacists Group

Brent, Ealing, Harrow, Hounslow and Hillingdon CCG’s

Ratified By Brent CCG Medicines Management Sub-Committee

Date Ratified June 2019

Name of Author Shamim Jivraj, Lead Pharmacist Adult Health Brent CCG

Date First Issued September 2019

Date of Next Formal Review June 2021 or sooner if amendments are made to national guidance

Target Audience NWL CCG’s GP’s, Care Homes and Local Authority

This document is no way intended to replace, supplement or augment the policies and procedures effective in each care home. Each Registered and non-registered practitioner remains accountable for their actions under the law and, where relevant, their Code of Conduct or Standards of Practice.

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Appendix 1: Mental Capacity Assessment (MCA) for Self-Administration Two Stage Test

Presume service users have capacity unless proved otherwise

Service users with reduced mental capacity should continue to have the opportunity to make informed decisions about those aspects of their care and personal lives for which they retain capacity.

A person is unable to make a decision at this time if the answer to any of the questions is NO.

Re-assess capacity if there are any changes in the service user’s medical condition.

Name of Service user: Date of Birth:

Date of Assessment: Review Date:

Name of individual undertaking assessment:

Designation of individual undertaking assessment:

STAGE 1 Yes/No Comments

Does the person have an impairment of, or a disturbance in the functioning of the mind or brain?

If the answer to the above question is yes, proceed to stage 2. If the answer is no then the person does not lack capacity.

STAGE 2 Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision? These questions should be answered in the context of self-administration of medicines.

STAGE 2 :The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:

Yes/No Comments

Can the service user understand the information given to them to make a decision on self-administration of medication at this time?

Can the service user retain the information long enough to be able to make the decision?

Can the service user weigh up or use the information available to make the decision?

Can the service user communicate their decision (by talking, sign language, even simple muscle movements such as blinking an eye or squeezing a hand)?

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Appendix 2: Self Administration Risk Assessment

This assessment should be conducted by a member of care home staff who is competent to administer medication, the GP or a Pharmacist.

Name of Service user: Date of Birth:

Date of Assessment: Review Date:

Name & signature individual undertaking assessment:

Designation of individual undertaking assessment:

Question Yes/No Comments

1. Did the service user self-administer their medication prior to being admitted to the care home?

2. Does the service user wish to continue to self-administer?

3. Does the service user understand the following: a. What each of their medicines is for? b. How to take each medication? c. When to take each medication? d. What to do if a dose is missed? e. Any special instructions for taking the

medication e.g. ‘PRN’?

4. Is the service user experiencing any problems taking their medication or any side effects?

5. Does the service user have any particular beliefs or attitudes about their medication or condition?

6. Does the service user have a history of alcohol or drug abuse?

7. Does the service user have any dexterity problems and require additional support to take their medication safely?

a. Can the service user open bottles with child-resistant lids, remove tablets and capsules from blisters?

b. Can the service user measure out liquids? c. Can the service user administer their eye,

ear, or nasal drops, inhaler, emollients patches if required?

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8. Has the service user been observed administering any medicines which require special techniques, e.g. insulin or inhalers?

9. Does the service user have any visual impairment and require additional support?

a. Are they able to read the labels on the packaging? Ask them to demonstrate.

b. Are they colour blind or if they have problems differentiating colours?

10. Does the service user have access to, and is able to read a watch or clock?

11. Is the service user able to read and understand written words?

12. Does the service user understand the protocol for disposing of unwanted medication including sharps if appropriate?

13. Is there any other reason why the service user should not undertake self-administration of their medicine?

14. Did the assessment demonstrate that the service user is capable of administering any of their medication themselves?

Indicate which medicines the service user will be self-administering.

At 12 months a new assessment should be conducted and a consent form (where applicable) should be completed.

A service user’s ability to self-administer should be reviewed more often if their medical condition changes, a new medication is initiated or a current medication dose is changed.

Set review date

1 month 3 month 6 month

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Appendix 3: Service user Consent Form for Self-Administration

I……………………………………………………………… (Name of Service user), wish

to administer my own medication. I understand that I will be responsible for the taking and safe keeping of the following medication once it has been supplied to me by a member of staff.

My medication has been explained to me i.e. its therapeutic purpose, the dosage,

the time to be taken, any side-effects and who to ask if there are concerns.

I do not need supervision to take my medication and will take responsibility for its administration.

I will comply with the following:

I will keep all my medications and topical preparations in a locked drawer, cupboard or cabinet in my bedroom

I will ensure that the key is kept on me at all times I agree for staff to regularly check that my medicines are stored safely and

correctly, and agree to them carrying out a check of the stock balance I will ensure that I give any medicines that have been discontinued by my

doctor to a member of staff for safe disposal I understand that if there are any concerns expressed by staff that they will

talk to me about this and if necessary consult with the GP and/or pharmacist

Service users Name: …………………………… Service users Signature:

........................... Care Home Staff Name: …………………… Date: ……………………………………

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Appendix 4: Self-Administration Audit

Medication Date Tablet Count Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Expected Actual

Any Discrepancies?

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Appendix 5: Patient Information Leaflet and

Medication Reminder Chart

Self-administration

Self-administration means that you are able to look after and

take some or all of your own medicines whilst you are staying in

a care home.

Your medication will be stored in a lockable cupboard or drawer

in your room. Some medicines which require special storage

conditions, such as refrigeration, will be stored by the care home.

Your Responsibilities

To inform the care home staff if you are experiencing any

difficulties in taking your medication or have any queries.

To inform care home staff if you are running out of any

medication.

To inform the care home staff of any missed doses or

doses taken incorrectly, e.g. an extra tablet.

To report any side effects from taking your medicine.

Information about side effects can be found in the patient

information leaflet provided with each medicine. You

MUST inform the nurse/senior carer, or GP if you

experience any side effects.

To check that the medication you receive from the care

home staff is correct.

To keep your medicines stored securely in the cupboard

or drawer provided and ensure it is locked at all times.

To make sure you do not share your medicines with other

service users.

To make sure that you do not allow other service users or

visitors to have access to your medicines.

To inform care home staff if you wish to take or are taking

any herbal or complementary medicines, or medicines

bought over the counter in a pharmacy or shop.

Care home Staff Responsibilities

To provide support where necessary and practical advice

to enable you to continue to self-administer, if you wish to.

To provide you with sufficient medication to complete the

28 day medication cycle.

To provide you with adequate space to store your

medication securely.

To provide you with information about your medicines or

identify where you can access the information.

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Medication Reminder Chart for (Service users Name): ………………………………………………………………………………….

Date

Started

Medication Name and

Strength

What’s the

medication

for?

Morning

Midday Teatime Bedtime Additional advice/support

required

Date

Stopped