In Association With Learning work book to contribute to ... · Version 1- 01/10/10 In Association...

Version 1- 01/10/10

In Association With

Learning work book to contribute to the

achievement of the underpinning

knowledge for unit: ASM 34

Administer Medication to

Individuals and Monitor the

Effects

Credit value 5

All rights reserved, no parts of this publication may be

reproduced, copied, stored or transmitted without the prior

permission of

The Learning Company Ltd

© The Learning Company Ltd

Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4

Learner’s Name:

Learner’s Signature:

(Please sign inside the box)

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Employer’s Address:

Start Date:

Anticipated End Date:

College Provider:

Learner’s Enrolment Number:

Mentor’s Name:

Assessor’s Name:

Internal Verifier’s Name:

I V’s Sampling Date:



INTRODUCTION

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THE STUDY PROGRAMME This unit is designed for individuals who are working in or wish to pursue a career in their chosen sector. It will provide a valuable,

detailed and informative insight into that sector and is an interesting and enjoyable way to learn. Your study programme will increase your knowledge, understanding and abilities in your industry and help you to become more

confident, by underpinning any practical experience you may have with sound theoretical knowledge.



WHERE TO STUDY The best way to complete this workbook is on your computer. That way you can

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can support you in your tutor/assessor’s absence; they will also confirm and sign off your evidence.



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Unit ASM 34: Administer medication to individuals, and

monitor the effects

About this unit

This unit is for those who prepare for, administer and monitor the effects of medication on individuals. The unit applies to all medication used for and by individuals, both prescribed and non-prescribed.

Learning outcomes

There are five learning outcomes to this unit. The learner will be

able to:

1. Understand legislation, policy and procedures relevant to administration of medication 2. Know about common types of medication and their use

3. Understand procedures and techniques for the administration of medication

4. Prepare for the administration of medication

5. Administer and monitor individuals’ medication

Legislation governing the administration of medication

All aspects of health and safety are covered by legislation. The administration of medication is no exception. The handling and use of medicines, drugs and poisons is governed by a series of Acts and Regulations of Parliament.

In Great Britain, two types of law apply to aspects

of health and safety in the workplace; these are Civil Law and Statute Law.

Civil Law - Claims can be made in civil courts for

damages (financial compensation) if harm, injury or damage has been caused due to the negligence of someone who owed a duty of care to the injured party.

Statute Law – health and safety at work legislation forms part of criminal law and therefore must be obeyed. Breaches of legislation can result in a criminal court imposing fines or imprisonment, on

companies, organisations or individuals.



The framework of this legislation is based on Acts of Parliament,

which usually impose broad general duties. Regulations are then made under the relevant Acts, to cover detailed health and safety

requirements that are to be observed. The majority of recent Regulations were made under

the Health & Safety At Work etc. Act 1974

Approved Codes of Practice - these are codes of practice approved by the Health and Safety

commission, and can supplement Acts and Regulations by giving guidance on the requirements

set out in the legislation

H & S Legislation The principal Act of Parliament regarding workplace Health and

Safety is the Health and Safety at Work, etc. Act 1974. It is important that the following main provisions of HASAWA are fully appreciated:

� The Act applies to all people “at work” (with a few minor

exceptions such as domestic servants) whether they are employees or self-employed. Trainees are regarded as

employees under the Act. � Employers have a duty, so far as is reasonably

practicable, to ensure the health, safety and welfare of their employees and any others who might be affected by

their activities, e.g. members of the public. � Self-employed persons have a duty to conduct their

business in such a way as to ensure their safety and the safety of others who may be affected by their activities.

� Employees have a duty to co-operate with their employer and to take reasonable care for the health and safety of

him or herself and of others who may be affected by his or her activities at work.

� and carried out in a safe manner

The Control of Substance Hazardous to Health (COSHH)

Regulations

COSHH Regulations of 1988 consolidated in 1994,

amended in 1996, 1997and 1998, 1999 and further consolidated in 2002 are the main piece of legislation

covering control of the risks to employees and other people arising from exposure to harmful substances generated out of or in connection with any work activity under the employer's control.



The main objective of the Regulations is to reduce occupational ill

health by setting out a simple framework for controlling hazardous substances in the workplace.

As with all other regulations building on the Health and Safety at Work etc. Act, legal duties under COSHH are laid primarily on

employers and it is their duty to see that proper systems of work and management are in place. In higher education, the "employer" is taken to be the governing body of the University e.g. the University

Council. Many of the duties that employers owe to their employees extend to non-employees, such as

students, who may be affected by the employer's activity.

Duties on employees include making proper use of any control measures, following safe systems of work, abiding by local rules

and reporting defects in safety equipment. Non-employees have no specific duties under COSHH but the requirements of the Health and Safety at Work etc. Act do apply, forbidding the misuse of anything provided in the interests of health, safety or welfare.

Complying with COSHH involves:

� Assessing the risks to health arising from hazardous substances at work and deciding what precautions are needed,

� Preventing or adequately controlling exposure, � Ensuring that control measures are used, maintained,

examined and tested,

� If necessary, monitoring exposure and carrying out health surveillance and

� Ensuring that employees are properly informed, trained and supervised.

The Misuse of Drugs Act 1971:

The Misuse of Drugs Act (MDA) is the major act controlling drugs. It places controlled drugs into one of three

classifications (A, B or C), depending on how dangerous the drug is thought to be at the time of inclusion - those drugs thought to be most

dangerous are Class A. There is no clear protocol that says what 'dangerous' effects warrant these

classifications, and it is therefore not possible to say that the toxicity, likelihood of dependence, or psychoactive effects of Class A drugs is vastly different to those drugs in Class C.



Drugs are also placed within one of five schedules (1-5). The

Schedule that a drug is placed in relates to its perceived medical therapeutic use. Schedules determine whether a drug may be

prescribed or not, and impose duties relating to record keeping, manufacturing, storage and distribution. Schedule 1 drugs are thought to have no legitimate medical

therapeutic use, and possession is only legitimate with a home office licence; many schedule 5 drugs are sold without the need for a prescription.

Drug Offences: The drug offence that most people will be aware of is possession. If

you have controlled drugs in your physical possession or have control of them and are not entitled to do so then you could be

charged with this offence. Common types of possession are simple possession - you are knowingly in possession of a controlled drug,

joint possession - you own a pool of drugs jointly with other people, and past possession - you have previously been in possession of a controlled drug. Supply of a drug is a far more serious offence. If you pass drugs to another person you are supplying them with that

substance, whether or not money is involved. Sometimes a charge of possession with intent to supply is brought because of an admission by the person involved, or because the amount of the

drug involved is too large to be for personal use only. If you knowingly allow other people to use premises that you occupy in order to produce or supply drugs you are committing an offence. Restrictions about drug use on premises that you occupy relate only

to opium or cannabis; if you were aware that someone was injecting heroin you would be under no legal obligation to stop them, but you

are obliged to stop the consumption of cannabis. The Medicines Act 1968

The Medicines Act 1968 regulates drugs that are used for medicinal

purposes, and again there are three main categories. A pharmacist can only sell 'Prescription Only' drugs, but only if they have been prescribed by a doctor. The 'General' category allows the medicines to be sold without a prescription in any

shop, and a pharmacist can sell 'Pharmacy Medicines', without the need for a prescription. Possession of 'Prescription Only' medicines without a prescription is

a serious offence. Drugs such as amyl nitrite, GHB and ketamine are regulated under the Medicines Act.



Misuse of Drugs Regulations 1985

Defines who may produce, possess, supply, prescribe and

administer certain drugs. Schedule 1: Prohibited except with Home Office authority E.g. cannabis, LSD, raw opium, Ecstasy Schedule 2: Controlled drug Specific requirements for prescribing, safe custody, registering

e.g. diamorphine (heroin), pethidine, cocaine, amphetamine Schedule 3: Barbiturates, Pentazocine

Schedule 4: Benzodiazepines Schedule 5: Preparations containing small amounts of controlled

drugs e.g. Co-proxamol, Co-codamol

Infection control.

Hygiene is an important safety factor when working closely with individuals. Standards precautions and procedures for washing

hands and maintaining your own good standards of hygiene must be followed. This is vital when using the non-touch technique to administer medication.

Effective hand washing.

� Begin by removing your rings. Push your watch up on your

arm or remove it. This will allow for thorough cleaning and drying.

� Adjust the water to comfortably warm temperature and rinse your hands from the wrist downward.

� Apply soap either liquid or use a clean bar of soap (be sure it has a place to drain such as on a rack).

� Lather thoroughly. � Begin at your wrist and work downward. � Interlace your fingers and thumbs and

continue scrubbing by sliding your fingers

back and forth. Clean under your nails and around the nailbeads as well.

� 15-30 seconds of vigorous scrubbing will

eliminate most transient bacteria. ("Scrubbing" for surgery or other procedures requires at least 2 minutes)

� Then rinse your hands thoroughly from the wrist downward. � Dry your hands thoroughly. Paper towel is suggested.

Otherwise, fresh or disposable towels should be provided for personal use.



� Use the towel (preferably a dry section) to turn off the water

and protect your hands from recontamination.

Effective Hand Hygiene

Preparing and checking medication

Nurses and care staff are taught the five rights as a means of minimizing opportunities for errors. The five R's are: THE RIGHT

MEDICATION IN THE RIGHT DOSE, TO THE RIGHT PATIENT

BY THE RIGHT ROUTE AT THE RIGHT TIME. There are opportunities for errors even when complying with the five Rs.



Administration of the wrong drug is the most common error that

occurs. Factors that contribute to wrong drug error include similar labeling and packaging of products, medications with very similar

names and storage of these similar products together. In addition, poor communication is a common

cause of administering the wrong drug. When transcribing verbal orders or verifying transcription of orders, a few simple precautions can help avoid errors:

� Always repeat verbal orders

� Avoid using dosage and product abbreviations � Never assume ROUTE of administration

� Never use trailing zeros (write 25 not 25.0) � Never try to decipher illegible orders

� When in doubt, always check with the prescriber, pharmacist or literature

Always check the drug label and dose against the doctor's order

three times prior to administration

Do not administer any drug if you are unsure of its intended use

Many medications can be administered by a variety of routes, such as oral, rectal, intravenous, subcutaneous, intramuscular, or sublingual. The route selected by the prescriber depends on the

patient's condition and the speed with which the therapeutic effect will need to occur.

The prescribed dosage is based on the route by which the drug is given. In general, oral dosages are greater than injected dosages for the same drug. Errors can

occur when a dose intended for oral administration is given by injection. For example, 30 mg dose of Morphine Sulfate mistakenly given IV rather than orally could potentially result in respiratory arrest and

death. In today's hectic health care environment, it is

especially important to confirm an individual's identity prior to conducting any procedure. Many carers float between settings,

work part-time or work in ambulatory settings where large numbers of individuals are in and out during the day. These situations increase the probability of giving medication to the wrong person.



It is imperative to check every individual's ID bracelet, if they have

one, prior to giving a medication. Always confirm their name, age and allergies, and ask them to state their name.

While it is important to utilize the five rights when administering medications, care responsibilities

related to drug therapy require an extensive knowledge of pharmacology and how the care process assists the practitioner in ensuring that each patient achieves the best possible outcome from his drug

regimen. You are often the first health care provider to identify signs and symptoms that may require drug therapy or may signal

an adverse outcome from ongoing therapy.

What can you do to minimise the opportunity for error?

� Ensure that information relating to individuals is current and available consistently to all health care providers.

� Include information such as age, weight, height (as needed to calculate body surface area), date of birth and known

allergies. � Know the treatment plan and the prognosis. � Ensure that the drug information is current and readily

available. � Know the indications and appropriate dosing for the

medication prescribed. If you are not sure, look it up or call the pharmacy.

� Know the precautions and contraindications. � Know the expected outcomes after the use of the medication.

� Know about potential adverse reactions. � Know the drug/drug and drug/food interactions. � Know how to minimize the effects of an adverse reaction. � Know how the drug should be administered and stored.

� Have pharmacy identify a patient's own medications and provide drug fact sheets prior to medication administration.

DID YOU KNOW?

The first video aired on MTV was “Video

Killed the Radio Star” by the Buggles in 1981.



ACTIVITY ONE

Circle the words or phrases you would associate with

reducing errors

Candy floss Current Information

Plan Hot dog Identify

Know Outcomes Toffee apple

Each medicine container should be labelled and show the:

� Date of supply � Name and form (tablet, capsule etc), quantity and strength of

medicine � Dosage and timings and how the medicine

should be administered � Name of the individual it is for

� Name and address of pharmacy and prescribing GP

Some of the most commonly used medications.

� Angiotensin converting enzyme (ACE) inhibitors are a group of drug originally developed to lower high blood pressure.

� Antacids and alginates Antacids are taken to treat dyspepsia - better known as

indigestion or heartburn. A number of antacids and related remedies are available without prescription from pharmacies and supermarkets, although these should still be considered to be medicines.

� Antibiotics Antibiotics, sometimes known as antibacterials,

are drugs used to treat infections caused by

bacteria (the plural of bacterium). � Antidepressants

As their name suggests, antidepressants are used to treat depression. There are many types of antidepressant. Here we will discuss the two most commonly used - tricyclic drugs such as amitriptiline (Lentizol) and imipramine (Tofranil) and

selective serotonin re-uptake inhibitors (SSRIs) such as fluoxetine (Prozac).



� Antihistamines

Antihistamines are most commonly found in medicines for allergic conditions like hay fever

and also in some cough and cold remedies, some preparations for sickness and some migraine treatments.

� Benzodiazepines This group of drugs are also known as minor tranquillisers and sedatives. The best known are probably diazepam (brand name Valium) and nitrazepam (Mogadon).

� Beta2 agonists � This article looks at the medicines used to relieve an asthma

attack - the blue-coloured inhalers containing medicines known as beta2 agonists.

� Beta-blockers Beta-adrenoreceptor blocking drugs, more commonly called

beta-blockers, work on the heart and circulatory system, reducing blood pressure and having other beneficial effects on the heart and circulation.

� Calcium-channel blockers

� These drugs are used to treat problems with the heart and circulatory system including high blood pressure and angina.

� Combined oral contraceptives (COCs)

Often just referred to as 'the pill', combined oral contraceptives (COCs) are one of many methods of preventing pregnancy. The COCs are so called because they combine two types of female hormone, oestrogen and

progestogen. � Eye preparations

There are several different groups of drugs that are included in eye preparations. Here we discuss the four main categories.

� Drugs for glaucoma Glaucoma is a condition in which the

pressure in the eye is too high. There are five main types of drug used in the treatment of glaucoma - miotics, sympathomimetics, beta-blockers, carbonic

anhydrase inhibitors, and latanoprost (Xalatan). � H2 antagonists

There are a number of medicines for treating stomach ulcers

and indigestion. One of the most important of these is a group of medicines known as H2-receptor antagonists or H2

antagonists. � Hormone replacement therapy

Hormone replacement therapy is usually just called HRT. It is recommended to women during and after the menopause, the

end of menstruation.



� Inhaled steroids Inhaled corticosteroid drugs, or inhaled steroids as they are usually known, are used

to prevent the symptoms of asthma. � Laxatives

There are several types of laxative that all

work in different ways to help relieve or prevent constipation. Here we discuss three of the main types.

� Loop diuretics (e.g. furosemide/frusemide) A diuretic is a type of drug that removes water from the body.

Loop diuretics are a particularly powerful type of diuretic used for treating heart failure.

� Nonsteroidal anti-inflammatory drugs Nonsteroidal anti-inflammatory drugs, more commonly called

NSAIDs (pronounced En-sayds), reduce inflammation and relieve pain. The most widely used NSAID is ibuprofen (e.g.

Brufen, Nurofen). � Paracetamol

Paracetamol is a painkiller, more technically described as a non-opioid analgesic. As a painkiller, it's similar in strength to

aspirin, but does not have the anti-inflammatory action of aspirin.

� Medicines for an enlarged prostate

Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland gradually enlarges. It occurs to some degree in most men from middle age onwards.

� Proton pump inhibitors

Proton pump inhibitors are a family of drugs used to treat stomach ulcers by completely blocking the production of

stomach acid. � Statins

Statins are a relatively new group of drugs used to lower blood cholesterol levels.

� Topical steroids Topical corticosteroids, more commonly called steroid creams, are applied to the skin to relieve eczema and some other skin

conditions. Routes of administration

When administering medicines via any route and in any form, it is

vital that you are fully aware of the needs and abilities of the individuals receiving the medicines. They may be totally independent and able to administer for themselves, or may need full support. Whatever their needs, it is vital that you select and

utilise the most appropriate equipment for their abilities.



It may be that liquid suspension is taken more easily than tablets,

see if you can request these if they are available. Or a dosset box may help with self administration. You may need to help measure

a liquid therefore a cup measure will be helpful. Oral medication

This is the most common form of medicine, and comes in tablet, capsule, syrup or suspension liquid. Often tablet have a special coating which reacts with the

digestive system to release the drug. If the instructions require medication to be taken with food or

with water, this is usually because it will help the drug work more effectively.

Inhaled medication

These are prescribed for respiratory disorders such as asthma and bronchitis. There are two types of inhaler, the aerosol puff inhaler and the spinhaler. For all inhaled medications the process is the

same. The user needs to breathe out, put the inhaler in their mouth, take a puff and breathe deeply. The dosage is measured in the number of puffs.

Some inhalers are used daily and others as required. In severe cases a nebuliser may be used which pumps air through a chamber containing the drug; this then passes into a face mask worn by the

user.

Eye preparations

Eye drops or ointments may be prescribed. When applying the lower eyelid should be gently pulled downwards and the correct

amount of the preparation inserted under the eyelid. It is important that hands are washed before and after this procedure and clients must be encouraged to do this as well if they are administering the medication.

Nasal preparations

Nasal medication can be drops or sprays. Sprays should be inserted into one nostril while the other

nostril is held closed. Ask the individual to breathe deeply through the nose whilst spraying and then repeat the process for the other nostril. Nasal drops should be administered with the head as far forward as

possible to give the drops the best chance of working.



This can be done by the person lying on a bed or across a chair with

their head hanging over the edge.

Ear drops

Ear drops are usually supplied in a bottle with

an applicator. The required number of drops should be dropped into the ear. The applicator must never be inserted into the ear as it could cause damage. Unless otherwise

advised, cotton wool should not be put into the ear following administration.

Vaginal and rectal preparations

These will generally always be administered by a care worker as

most clients will not have the mobility and suppleness to administer these themselves. For vaginal preparations, the individual should lie on the bed with

their knees bent and slightly apart. This will ease administration if the individual is able to relax. The best way to administer rectal preparations is for the individual

to lie on one side with their knees drawn up in front of them. Topical preparations

These are ointments and creams and are usually designed for a specific area of the body. Hands should be washed

before and after application. Ointments and creams should not be rubbed in unless this is specified in the instructions. Generally they are intended to be absorbed slowly into the affected areas.

Medication aids

Dosset boxes are simple boxes for pills, with compartments for

particular days of the week and times of day. They help people remember to take their medication at the right time. Simple versions are available from the local chemist. Automatic pill

dispensers are also available. When the medication needs to be taken, the dispenser beeps and a small opening allows access to the

particular pill at the right time. Drug wallets can also help people take the right doses at the right times. Drug wallets usually hold seven small containers to keep medication in (one for each day of the week).



Each container is divided into sections usually marked morning,

afternoon and evening. The containers can be removed if a person is going out and wants to take their medication with them.

Administering medication using a non-touch technique

Administration of intravenous drugs can often be defined as the introduction of a fixed volume of drug(s) into the cannula, generally already in situ (ready for the introduction of the drug). The aim of this procedure is to ensure that the prescribed drug will be given to the correct patient, at the correct time, in the

correct dose, without any contamination occurring. The principles of asepsis, including hand washing, minimal touch

technique and the cleansing of access points prior to use are essential.

This approach is also utilised for example during the administration and disposal of Cytotoxic medication in the community; enteral feeding, changing, removing or applying dressings, during

nasogastric feeding and for blood transfusions. The following recommendations apply;

� Hands that are visibly soiled or contaminated with dirt or

organic material must be washed with soap and water before using an alcohol hand rub

� Before accessing or dressing a wound or administering medication hands must be cleaned either by washing with

an anti microbial soap and water, or by using an alcohol (70%) hand rub

� An aseptic technique must always be used � Gloves should always be worn when accessing lines for the

prevention of blood borne pathogen exposure, or when administering Cytotoxic medication.

Administering injections

A subcutaneous injection is administered beneath the epidermis into the fat and connective tissue underlying

the dermis. For subcutaneous injections the skin should be gently pinched into a fold to elevate subcutaneous

tissue which lifts the adipose tissue away from the underlying muscle. An intramuscular injection is administered through the epidermis,

dermis, and subcutaneous tissue into the muscle.



Giving an injection (subcutaneous)-

� Wash your hands.

� Remove the cover, being careful to avoid touching or bending the needle.

� Do not attempt to replace the cover as you may

prick yourself or damage the needle. � There is a small air bubble in the syringe. This

should not be removed and helps to prevent pain and bruising.

� Pinch the skin gently to form a mound. � Push the needle in as far as it will go, with the syringe at a

right angle to the skin. � Inject slowly, holding the mound of skin.

� Gently dab with a tissue or cotton wool if necessary. Do not press or rub as this may cause a painful bruise.

� Dispose of the syringe in the yellow 'sharps box' provided. Side effects

Medication may cause reactions that were not intended. These are known as side effects. Possible side effects are mentioned in the instructions that come with the medication, although the majority

do not last long and are not a serious risk to health. Nobody can predict whether a person will experience side effects, so it is vital for you to inform your Manager and the individual’s GP if

there are any unusual reactions. If this happens, it may be necessary for the individuals to stop taking the medication and try a

different form of treatment. Their GP will be able to advise whether the side effects outweigh the benefits of the medication. Many drugs have side effects, an adverse effect is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as a result of a therapy or other medical intervention, such as drug/chemotherapy, physical

therapy, surgery or medical procedure. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse

effects. Adverse effects may cause medical complications of a disease or procedure and negatively affect its prognosis.

The harmful outcome is usually indicated by some result such as blotchiness of the skin, reddening of the skin, sweating, clamminess, nausea, vomiting or any other change to condition.

The outcome can be fatal in some cases.



They may cause a reversible or irreversible change, including an

increase or decrease in the susceptibility of the individual to other chemicals, foods, or procedures (e.g. drug interaction).

The possibility of any adverse effects should be explained to the individual taking the medication.

Your role

Your support can be a key factor in ensuring that

individuals are able to manage their medical needs safely and effectively. Through discussion

with the individual you can ascertain the level of support and explanation required when taking

medication. Communication must be at the appropriate level for the individual concerned, and clear explanation around the need

and procedures for taking the medication must be given. Also offer reassurance that you are there to monitor and support them as necessary.

One of the factors you must consider when choosing the best method of communication is the person who is going to receive it. Make sure the method is appropriate for the person who will receive

it. Do not, for example, show the medication and details to a person who is visually impaired unless you know they have a method of having it read or Braille is provided. Do not attempt to pass on information to someone with hearing loss unless they have

a functioning hearing aid and you know it works and always use language which is at the right level for the person receiving the

information. Everything you say and do communicates a message so this must be carefully considered before delivery. Choose your words carefully and take care to manage information according to your setting’s policies and procedures.

Always keep a record of messages you have passed on. Include the date and time and who you passed the message on to. If there are any

disagreements later on, this can be useful in resolving them.

However it is also important not to act beyond your role and responsibilities. For example you must not take the responsibility of

giving alternative medications or doses to individuals. They need to be referred to their GP for this to happen. The results could be further illness or even fatality.



It is also vital to ensure that the medication has been taken, often it

can be stored in the individual’s mouth and they may spit it out later.

Discussions based around the administration of medicines, according to their route and the level of

privacy required, need to be held in private and not in the hearing of other residents or visitors. The level of privacy when discussing this with individuals may be determined by the setting you work in but you must do your best to

maintain dignity. For example the administration of suppositories or the application of creams may require absolute privacy.

If a person does require assistance, then this must be offered in a

quiet and unobtrusive manner. You must not discuss this loudly in front of others. Key to this is also establishing how an individual

will let you know they wish you to give assistance. They may feel perfectly able to administer their medication on day and not able to do this the next. Will they call or use a bell or buzzer, or simply wait for you to attend at an agreed time?

Privacy must be maintained although some situations may be far from ideal, for example curtains around a hospital bed.

Storage of medication

All medication should be examined for information about storage

conditions and these conditions must be adhered to. All medication, including Homely Remedies, for example Paracetamol, Simple

Linctus and Magnesium Tri-sil, must be stored in a lockable facility in a lockable room, with the key accessible to delegated staff only. The keys should be in the personal possession of identified staff. It is not

appropriate to keep the key in a known location such as a drawer, hook or unlocked key press. In addition there should be a secure area for medication storage and administration. If this is a room it should house a lockable

cabinet, ideally one that cannot be easily removed, a sink, if possible, and a lockable refrigerator. It is also necessary to provide separate storage for internal and external use only medicines. If

controlled drugs are kept on the premises then a Controlled Drugs cupboard must be provided. This cupboard must have a certificate

for its use from the provider, must be of a certain thickness and fixed to a permanent wall. A GP and/or prescribing pharmacist will be able to advise if a drug is a ‘controlled drug’.



If a drug is/or may be required urgently, e.g. steroid, then it can be

kept in a place for easy access but this must be based on risk and individual circumstances.

The current medication charts or Medication Administration Record sheets (MARS) must also be

kept in the same room for easy access and use. When complete they should be transferred to the case file. If individuals self medicate they must be able to lock their medication away in a drawer or cupboard.

Cupboards must be sited away from sources of heat, moisture or

direct sunlight as any of these elements can cause medicines to deteriorate.

� When not in use, trolleys must be secured to a wall or kept in

a lockable cupboard. � Medicines which are to be swallowed should be kept apart

from external items. � Medication requiring refrigeration should be stored in a

lockable drug fridge. If such a fridge is not available medicines may be stored in a domestic fridge in a locked container labelled "medicines - authorised access only".

� Stock should be rotated as it is received. NEVER mix the remains of an old prescription with a freshly supplied prescription.

� Some medications, e.g. antibiotic suspensions, require

storage in a refrigerator, which should be for medication only and locked – this applies particularly to registered homes and

where possible in other settings.

DID YOU KNOW?

The creator of the NIKE Swoosh symbol was paid only $35 for the design.



ACTIVITY TWO

Circle the words or phrases you would associate with storing

medication

Dodgems Fridge Locked

Container Helter skelter Trolley

Cupboard Access Wurlitzer Records for administration.

Receipt of Medicines

All medicines brought into the home from whatever source,

including discharge medicines from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular on

going basis or those brought from another home should be recorded. Care should be taken to include medicines brought from the individual’s own home or those brought in by friends/relatives.

The record should show:

� Date of receipt. � Name, strength and dosage of medicine. � Quantity received. � The individual for whom medication is prescribed or

purchased. � Signature of the member of staff receiving the

medicines. At any given time the home should be able to identify the medicines prescribed for each individual. On admission, written confirmation of

the medicine an individual is taking should be obtained from an authoritative source. The home may find it useful to record requests for prescriptions on behalf of a service user. This will allow the

home to ensure that all items ordered have been received and that no inadvertent changes to the medication have been made.



Monitored Dosage Systems (MDS)

There is an increasing use of monitored dosage systems (MDS) within care homes. The community pharmacist, in conjunction with

the care home manager, should assess the overall needs of the care home and its service users when deciding how the medicines should be dispensed.

This would include the possible waste of drugs and the implications associated with altering drug prescriptions and dosages (such as updating computer treatment records), before deciding

whether or not to use a monitored dosage system. It should be explained to home managers that these systems are only suitable

for some medicines. The expiry date of medicines repacked by the pharmacist into an MDS will be affected, therefore they

should not be used for ‘as required’ medication as this could lead to increased wastage. The pharmacist should seek guidance from the

medicine manufacturer about the suitability of including the medicine in an MDS. For medicines that are suitable for inclusion in an MDS, the pharmacist seals each dose of tablet(s) or capsule(s) into a separate compartment in the dosage system depending on

the dosage regimen required for the individual service user. There are several types of these systems available and the pharmacist should assess the needs of the service user and the staff in the

home before supplying medicines in such systems. Tablets or capsules, which cannot be identified and readily distinguished from each other, should not be placed together in a monitored dosage system. Labelling should enable identification of individual

medicines to be made.

Disposal of Medicines

From 01 April 2005 a new NHS contract for community pharmacists was introduced. This highlighted that community pharmacists cannot accept medication waste from care homes (nursing) unless

their pharmacy holds a Waste Management Licence. This change does not apply to care homes offering personal care only. Disposal of waste is subject to legislation and regulated by the Environment

Agency. Implications for the Care Home (Nursing)

National Minimum Standards require registered providers to have a suitable and safe system to dispose of

unwanted medication within a reasonable time, including:

� Medication remaining after a service user has died; � Medication that has been stopped by the prescriber;



� Refused doses of medication; and

� Medication that has gone beyond the 'use by' date.

A care home (nursing) is required to safely dispose of clinical waste from the premises. It will now be necessary for the care home to make arrangements for the collection

of waste medication as well as other clinical waste products with a licensed waste disposal company. This will incur a direct cost to the care home (nursing). Disposal of medicines on site through the

sewage system is not appropriate.

Care homes (nursing) may be faced with problems as a result of the new contractual framework for community pharmacy having

highlighted the prohibition in the waste legislation of pharmacists accepting waste, and particularly if they are faced with financing a

process that was previously provided free through the local PCT For those care homes that use MDS, any tablets/capsules that have not been administered to service users should not be returned to the pharmacy with the equipment. The care home procedures must

ensure that the remaining doses are removed to a CinBin or similar. The waste disposal company will advise accordingly.

Safely administering medication

There is a requirement for care homes to provide written policies and procedures for staff administering medication.

Medicines must never be used for social control or punishment. The care home owner or manager might appoint another member of

staff to be the designated person' to look after the medicines when individuals are unable to manage their own medicines. Designated persons and members of staff involved with medicines should be appropriately trained and

assessed as competent to undertake this role. The supplying pharmacist or dispensing doctor should know, and be known by, the manager or the appointed 'designated person' in a care home

The times of administering medication are essential and there are often set times. It would be desirable if the individual were brought

to the medical/designated room rather than medication taken to them. However, it must be recognised that this is not always

acceptable and appropriate and can be classed as institutionalisation. Notable exceptions include:

� If administered in a homely setting (i.e. in a private

dwelling in the community) this will not be appropriate.



� Where service users require their medication with food.

� Other situations e.g. service users in wheelchairs or ill in bed.

� Occasions when flexibility is required to suit local and individual needs e.g. if on an outing.

There is a need for managers and all staff to recognise the pressure on staff and this can affect the administration of medication. There is a need to be clear about the names of medication as the

brand name and the generic name can be different. If there is any confusion staff must check before administering. If in doubt do not

administer but take advice immediately.

Medicines must be prepared from the original labelled container at the point of administration and not pre-prepared except in special

circumstances. Tablets and medications must not be handled, although it is recognised that often service users will handle tablets. You must check that medication has been taken and swallowed. If

not taken, a record must be made on an individual’s file. If an individual refuses their medication then there may well be circumstances that require immediate confirmation (e.g. GP advice)

but this is by no means the accepted normality. You must identify those service users where this will apply and provide specific guidance about reasonable actions in these cases. Individuals may elect to refuse medication and this will not normally be referred to

the GP at every refusal.

Staff to sign or initial to say the correct person had the correct medication and amount at the correct time. Taking physiological measurements prior to administering

medication.

There are occasions when, prior to administering medication, you may need to take physiological measurements, for example blood pressure or to check blood glucose levels. Someone who has diabetes might need monitoring

by urine tests or blood glucose monitoring and their medication might be changed according to

the results, however this may not be the case for all diabetics. The same applies with digoxin a tablet for irregular heart beat - in some cases the individual’s pulse might be taken prior to them taking the tablet.



With regard to blood pressure if someone’s blood pressure is

unstable then it might be necessary to monitor this if their medication is being changed.

Refusal to Take Medication

If an individual refuses their medication, verbal encouragement should be used, offer the

medication again to the person as soon as possible. If they still refuse then record listed code on the MARS sheet and record the incident in the service user’s case file. If necessary inform carers/relatives

as soon as possible. No double doses should ever be given e.g. if an individual refuses

one dose do not give two doses the next time round. The MARS sheet can be used to include PRN medications using appropriate code if it is offered and refused and record comments.

If medication is dropped on the floor or wasted this must be recorded and advice taken e.g. from GP or pharmacist on the affect

of not taking If mistakes are made then advice must be sought immediately from GP or pharmacist, particularly if

medication is missed or a double dose is accidentally given.

All staff involved in the medication error should submit a written statement immediately as to their understanding of the incident.

These statements must be from: -

� The person making the error. � The person reporting the error. � The unit manager on duty. � The report of the incident must immediately be

presented to the appropriate line manager for action.



Checklist For An Error or Incident in the Administration of Medicines

Organisation

Name of Service User………………………………………………………………….. Name of Staff Member……………………………………………………………

Names of any Witnesses……………………………………………………………….

……………………………………………………………………………………………. Date of error/incident………………………. Date reported …………………………

Briefly describe what happened………………………………………………………. …………………………………………………………………………………………….

Date & time emergency advice sought/from who?………………………………….. What action was taken?………………………………………………………………….

……………………………………………………………………………………………… Have the details been entered into: - The organisation report/ incident book? Yes/No Date………………………. The service user’s case notes? Yes/No Date……………………….

Has the Medication Administration Record been amended? Yes/No Has the service user’s next of kin been informed? Yes/No Date……………..

Have you informed your Resource Manager? Yes/No Date…………………….. Have you completed CSCI Incident Form? Yes/No Date………………………..

What action has been agreed?………………………………………………………… Signature ………………………………………………………Date……………………

Recording and passing on information

It is recommended that one person take responsibility for writing

the medication charts as appropriate. Ideally this should be a senior member of staff.

The areas that need to be covered in the written policies are all aspects of how medicines are managed in the care home. In addition to covering procedures such as obtaining, storing and recording medicines, the policy should incorporate any specialist

procedures involving medicines relevant to that home, e.g. administration of PEG feeds/nutritional supplements.



The home must have a policy in place so that they can identify

which members of staff have signed the MAR (Medication Administration Record) Chart following the

administration of a medicine. The home must also have a written policy for the action

to be taken if a medicine administration error is identified. The registered person must be responsible for ensuring the

appropriate maintenance of records and the manner in which records will be kept. The standard of record keeping should ensure

that records are properly completed, legible and current, providing a complete audit trail of medication. The style or manner of record

is for the home to determine, although the supplying pharmacist or dispensing doctor may be able to advise. All charts should be

referenced back to the original prescription and not the previous chart. The care home must retain an up to date reference of current medication prescribed for each person.

The care home owner and / or care home manager will have the overall responsibility for the home.

The medicine administration record chart (MAR chart) is the working document, which is signed to record administration of medicines. The MAR chart should include all prescribed medicines. This may also be used to record other medicines administered e.g. non-

prescription medicines. The chart must be dated when the medicines are administered.

The signature of the person administering the medicine must be linked to a specific medicine. This is to facilitate audits at a later date and to ensure that the records are clear. It is essential that the

person who administers the medicine refers to the record chart at the time of administration. Although it is not part of a GP contract to sign the

MAR chart, it would be considered an element of good practice, particularly for changes to doses or discontinuation of medicines. In the case of hand-

written charts not checked by the GP, it is strongly recommended that these be checked by a second person and referenced back to

the original prescription. There is no legal impediment to a care home constructing a hand-written MAR chart but there is the potential for error when charts are regularly re-written by care staff.



The GP should ideally have the medical notes (hand-written or

electronic) accessible at the time of a visit, to enable changes to be made directly, to ease communication

links and smooth the processes of generating the future prescription. The record of medicines taken, including common or homely remedies, should be made available to the general medical practitioner whenever s/he sees the service user. The GP should also be informed when the individual does not take the medicines that are prescribed.

It is a legal requirement for care home records to be retained within

the home even when an individual has left the home. It is recommended that these records be retained for a minimum of

three years from the date of last entry, and should be retrievable if needed. In the case of children’s homes, medicine records must

normally be kept for at least fifteen years from the date of the last entry.

Administration by Self-Administration

Some individuals wish to, and are able to, administer their own medication and keep it themselves. They may choose to do this. In

all cases of self medication, it is essential that a risk assessment is carried out, at point of referral, to ascertain the ability of the individual to self medicate and to identify and eliminate any risk to themselves or to others. The record of the risk assessment is to be

kept on the individual’s file.

Also, when medication is self administered, agreement needs to be made with the individual that they will take responsibility over the administration and storage of their own medication. This should be in writing.

Ideally, the individual must be supervised, but in all circumstances managers must monitor to ensure individuals are self-medicating correctly.

A record should be maintained of the risk assessment, outcomes and of medicines given to a self-administering individual, including the date and signature of the responsible care worker. This

information will assist staff to monitor compliance with therapy. A self-administering person does not need to complete a medicine

administration record chart (MAR chart).



Printed Medicine Administration Record (MAR) Charts

The community pharmacist may supply printed MAR charts. This is

an additional service, which is not remunerated by the NHS. The chart will usually be constructed from the same software as the product label; but is subject to the

limitations of communication and can only be accurate when there is adequate communication between the prescriber, care home and pharmacist. Pharmacists have a duty to ensure that the information printed on the MAR that they

produce is correct.

If a community pharmacist agrees to produce printed MAR charts via their computer system, the charts may only be able to include

the items that the pharmacy has dispensed for that individual in the home. The choice of whether the home wishes to use these MAR

charts or whether they wish to produce their own should be decided by the care home manager after the consideration of all the relevant issues. Residential special schools and large children’s homes where the service users are prescribed medicines on a

regular basis may find printed MAR charts beneficial. However, in the majority of children’s homes, prescribed medicines will be obtained an irregular basis when the child is ill. In these

circumstances, printed MAR charts may not be the most suitable form of record keeping. Care staff must not tamper with prescribed packs of medicines for

example by mixing batches of medicines, as this may lead to potential for claims under product liability law. Pharmaceutical

preparations should not be decanted from one container to another for the purposes of storage. This applies to medications that remain from the current supply when the new supply is received; the original supply should be finished first. The care home must take

precautions that the stock levels of medication for each service user are kept at an appropriate level dependent upon need. The Royal Pharmaceutical Society of Great Britain (RPSGB)

recognises that service users in homes may have to accept a certain restriction of freedom of choice as to where their prescriptions are dispensed. The Society

recommends that the person in charge of the care home should select one pharmacy where the home

obtains medicines on behalf of its service users in order to ensure continuity of care. The supplier of medicines, which may be a registered pharmacy or dispensing doctor, should be able to provide a timely and responsive service.



The care home owner or manager must make a decision as to which

supplier is best able to meet the needs of the home and service users.

Consideration of the services and accessibility should be made before using that pharmacy for the supply of medication and advice to the home. Some pharmacies may undertake services that are not

included in the NHS contract such as delivery, supply of a Monitored Dosage System (MDS) device and staff training.

DID YOU KNOW?

The name for Oz in “The Wizard of Oz” was thought up when the creator, Frank

Baum, looked at his filing cabinet and saw A-N, and O-Z, hence “Oz”.

ACTIVITY THREE

Circle the words or phrases you would associate with recording information

USA MAR Medicines

Printed Africa Records

Maintained Administration Europe

UNIT ASM 34: SIGN-OFF

Assessor’s Name: _________________________________

Assessor’s Signature:_________________________Date:___________

Learner’s Name: __________________________________

Learner’s Signature:_________________Date:___________

Mentor’s Name: ________________________________

Mentor’s Signature: _________________Date:___________



UNIT ASM 34: ASSESSMENT

ASSESSMENT ONE

Identify current legislation, guidelines policies and protocols

relevant to the administration of medication

ASSESSMENT TWO

Describe common types of medication including their effects and potential side effects



ASSESSMENT THREE

Identify medication which demands the measurement of

specific physiological measurements

ASSESSMENT FOUR

Describe the common adverse reactions to medication, how

each can be recognised and the appropriate action(s)

required



ASSESSMENT FIVE

Explain the different routes of medicine administration

ASSESSMENT SIX

Explain the types, purpose and function of materials and

equipment needed for the administration of medication via

the different routes



ASSESSMENT SEVEN

Identify the required information from prescriptions /

medication administration charts

ASSESSMENT EIGHT

Explain how to apply standard precautions for infection

control



ASSESSMENT NINE

Explain the appropriate timing of medication e.g. check that

the individual has not taken any medication recently

ASSESSMENT TEN

Explain how to obtain the individuals consent and offer

information, support and reassurance throughout, in a

manner which encourages their co-operation and which is

appropriate to their needs and concerns



ASSESSMENT ELEVEN

Explain how to select, check and prepare correctly the

medication according to the medication administration

record or medication information leaflet

ASSESSMENT TWELVE

Explain how to select the route for the administration of

medication, according to the patient’s plan of care and the

drug to be administered, and prepare the site if necessary



ASSESSMENT THIRTEEN

Explain how to safely administer the medication

(a) in line with legislation and local policies

(b) in a way which minimises pain, discomfort and trauma

to the individual



ASSESSMENT FOURTEEN

Describe how to report any immediate problems with the

administration

ASSESSMENT FIFTEEN

Explain how to monitor the individual’s condition

throughout, recognise any adverse effects and take the

appropriate action without delay



ASSESSMENT SIXTEEN

Explain why it may be necessary to confirm that the

individual actually takes the medication and does not pass

the medication to others

ASSESSMENT SEVENTEEN

Explain how to maintain the security of medication and

related records throughout the process and return them to

the correct place for storage



ASSESSMENT EIGHTEEN

Describe how to dispose of out of date and part-used

medications in accordance with legal and organisational

requirements

UNIT ASM 34 : ASSESSMENT SIGN-OFF

Assessor’s Name: _________________________________

Assessor’s Signature:________________Date:___________

Learner’s Name: __________________________________

Learner’s

Signature:_________________________Date:___________

Mentor’s Name: ___________________________________

Mentor’s Signature:_________________Date:___________

In Association With Learning work book to contribute to ... · Version 1- 01/10/10 In Association...

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