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<<Insert Company Name>>Medicines Policy

Written by Approved by Reason for update: of 68

Date written Date approved Version1

Reference Medication Policy for Care Homes using the Proactive Care System (PCS)

Date approved July 2015 Approving Body

Guidance policy only – all care homes must adapt this guidance to meet the care needs of their residents. This document does not in itself comprise a fully functional policy and should only be used for guidance purposes only. Invatech Health accepts no responsibility for any legal or regulatory challenge of this document in connection with its content or references.

Implementation date From July 2015Version BD.INV.04 (Updated November 2017)

Includes changes to:1. Updated guidance on CQC ratings for KLOE – page 72. Covert medication guidance – page 28

Supersedes BD.INV.03 (October 2016)Consultation undertaken None

Target audience Invatech Care Homes using PCSKey Supporting Procedures

and Reference documents

Medicines Act 1968 Misuse of Drugs Act 1972 Health and Social Care Act 2008 – (Regulation

12 – 1+2) Care Standard Act 2000 – NMS (Wales) –

Standard 17 NICE Developing Care Homes Medicines Policy

May 2014 NICE Quality Standard 85 – March 2015 Royal Pharmaceutical Society – The Handling of

Medicines in Social Care 2007 CQC Key Lines of Enquiry Changes October

2017Review Date January 2018

Author/Lead Manager Invatech Health Ltd

Further Guidance/Information Invatech Health Ltd

Equality Impact Assessment All staff, contractors and third party partners are required when following this guidance to ensure that they do not disadvantage any person or group on the grounds of race, faith, age, gender, disability and sexual orientation. If you or any other group believe you may be disadvantaged by this procedure, please contact your Lead Officer




Contents1. Introduction....................................................................................................................5

1.1. Purpose.....................................................................................................................51.2. Scope.........................................................................................................................51.3. Elements of the care home medicines policy............................................................51.4. Medicines Management Systems within <<Insert Company Name>> Care Homes.71.5. Responsibilities of the Care Home Manager.............................................................8

2. The Pro-active Care System and arrangements for pharmaceutical services........92.1. The Pro-active Care System......................................................................................9

2.1.1. Fundamental requirements for using the PCS device........................................92.2. Support for the PCS device.....................................................................................102.3. Arrangements for the pharmaceutical service.........................................................10

2.3.1. Dispensing of medicines...................................................................................112.4. Service Level Agreement (SLA)..............................................................................112.5. Customer support and escalation procedures for resolving issues.........................11

2.6 Important Contact details 123. Supply and Storage of Medicines...............................................................................13

3.1. Introduction..............................................................................................................133.2. Supply of medicines.................................................................................................13

3.2.1. Dispensing of medicines and label requirements.............................................133.2.2. Prescribed medicines - the property of the resident ........................................14

3.3. Records of medicines, dressings and appliances received.....................................143.3.1. Booking out medicines in periods of absence from the care home..................15

3.4. Records of disposal of medicines............................................................................153.4.1. Storage and collection of medicines for disposal.............................................163.4.2. Disposal of controlled drugs.............................................................................16

3.5. Storage of medicines...............................................................................................163.5.1. Expiry dates......................................................................................................173.5.2. Expiry dates for “in use” medicines..................................................................173.5.3. Items requiring refrigeration..............................................................................18

3.6. Controlled Drugs (CDs)...........................................................................................193.6.1. Storage of Controlled Drugs.............................................................................193.6.2. Controlled Drugs Register................................................................................193.6.3. Controlled Drug Register entries......................................................................203.6.4. Dealing with discrepancies...............................................................................20

3.7. Use of oxygen in care homes..................................................................................213.7.1. Storage of oxygen............................................................................................22

4. Medicines Administration............................................................................................234.1. Introduction..............................................................................................................234.2. General requirements relating to administration of medicines................................244.3. Medicines administration procedure........................................................................25

4.3.1. Resident refusal and covert medication requirements ..................................284.3.2. Administration of controlled drugs....................................................................30

4.3.3 Injections 30 4.3.4 Dressings 31 4.3.5 Enemas 31

4.3.6 Suppositories, Pessaries, Vaginal/Rectal creams and Ointments 31 4.3.7 Eye drops, ear drops, Nasal Sprays and Inhalers 32




4.3.8 Creams, Ointments and Gels 32 4.3.9 Percuataneous Endoscopic Gastrostomy (PEG) 33

4.3.10 External Diagnostic Procedures 36 4.3.11 Subcutaneous Infusion 36 4.3.12 Syringe Drivers 36 4.3.13 Nutritional Supplements 37 4.3.14 Use of Thick and Easy / Fluid thickeners 37 4.3.15 Oral anticoagulants 37 4.4 When Required Medication (PRN) 39 4.4.1 Structured PRNs 40 4.4.2 Non- structured PRNs 41

4.5. Regular prescribed medicines.................................................................................424.5.1. Specific times for administration.......................................................................42

4.5.2 Hand written MAR sheets 42 4.5.3 Discontinued Treatment 42 4.5.4 Change of dosage 43 4.5.5 Telephone/verbal instruction 43 4.5.6 Prescriptions obtained out of hours 43

4.6. Records of medicines administered using PCS.......................................................43 4.6.1 Audit of medication administration records 45 4.6.2 Clinical readings and monitoring 46 4.6.3 Access to medicines information 46

4.7. Self-administration of medicines..............................................................................474.8. Homely Remedies...................................................................................................48

5. Ordering and receiving medicines in to the care home...........................................515.1. Introduction..............................................................................................................515.2. Determining which medicines are needed...............................................................515.3. The prescription ordering process...........................................................................525.4. The prescription collection, dispensing and delivery process..................................535.5. Interim prescriptions................................................................................................53

5.5.1. Urgent supplies.................................................................................................545.5.2. Receiving an interim supply of medicines........................................................55

5.6. Monthly medication cycle.........................................................................................555.6.1. General Requirements.....................................................................................555.6.2. Monthly process using the PCS device............................................................55Step 1 Placing orders on PCS........................................................................................56Step 2 Ordering the monthly prescriptions.....................................................................56Step 3 Collecting your monthly prescriptions and reconciliation against PCS order......56Step 4 Checking of missing prescriptions and discrepancies........................................57Step 5 Dispensing, packaging and delivery...................................................................57Step 6 Booking in your monthly medication supply with the PCS device......................57Step 7 New medication cycle.........................................................................................58

5.7. Checking of authorized prescriptions on the Invalife web portal.............................585.7.1. The Invalife web portal.....................................................................................59

5.8. Communicating with the Pharmacy.........................................................................595.8.1. New Resident Registration ..............................................................................59




6. Special considerations................................................................................................606.1. Introduction..............................................................................................................606.2. Promoting Independence.........................................................................................606.3. Informed consent and freedom of choice................................................................606.4. Confidentiality and data protection..........................................................................606.5. Care home inspections and medicines....................................................................616.6. Residents Medication Reviews................................................................................61

7. Procedure for dealing with medication errors .........................................................62 7.1. Medication errors.........................................................................................................628. Staff Training for medicines administration and assessment of competence................639. Damaged medicines 6310. Responding to adverse drug reactions and medicine alerts 6411. Day care and respite service users 6512. Unplanned outings for residents 6513. Holidays and planned outings for residents 6514 Residents leaving the care home 6615. Repeat Prescriptions and Specials Medication 67 16. Emergency evacuation of the care home 6717 Archived paper MARR charts and PCS electronic records 67 18. Failure to comply with xxxx Medication Policy 68




1. IntroductionIt is <<Insert Company Name>> policy to ensure that medication management promotes residents’ safety and wellbeing and provides a framework of safe practices by all Care Staff and Nurses. Compliance with this medicines policy and procedures within will promote safe administration of medication to residents, efficient medicines management and compliance with legal and regulatory requirements.

In writing this policy the following regulations and guidance have been taken in to account: The Medicines Act 1968 The Misuse of Drugs Act 1971 Mental Capacity Act 2005 and CPPE Covert Medicines Guidance January 2016 In England: Health and Social Care Act 2008 – Regulation 12 In Wales: CSSIW: National Minimum Standards for care homes for older people:

Standard 17- Medication NICE – Developing and updating a Care Home Medication Policy – May 2014 NICE Quality Standard 85 – Medicines Management CQC – ‘How we inspect and regulate’ – KLOE Update October2017 Royal Pharmaceutical Society – The Handling Medicines in Social Care - 2007

1.1.PurposeThis policy ensures a safe framework for the correct and timely ordering of prescriptions, receipt, storage, administration and disposal of medicines in all xxxxxxx care homes.The promotion of safety and the enhancement of the wellbeing of residents must be considered and upheld at all times.

1.2.ScopeAll registered managers and all qualified nursing staff involved in medication management in care homes with residents with nursing needs and all senior carers in residential settings who deal with medication including all agency staff.

1.3.Elements of the care home medicines policy

It is recommended that all care homes should possess a Medication Policy document which will assist care home owners, care home managers and care home staff to:

inform the development of care home/organisational structures, systems and processes

clarify existing lines of accountability between the care home and wider members of the care team to include for example GPs, Pharmacists and community nurses

identify training and competency needs of care home staff improve the transfer of care between service providers to include hospitals and other

care homes

The National Institute for Health and Care Excellence (NICE) has produced a Guideline for care homes to support them in developing and updating a care home medicines policy and this Guideline (dated March 2014) can be accessed in full via the NICE website at:http://www.nice.org.uk/guidance/SC1

http://www.nice.org.uk/guidance/SC1




The NICE Guideline can be fully viewed and printed by clicking on the Download tab at the top right hand corner of the page.NICE has also published a Quality Standard 85 issued in March 2015 relating to medicines management in care homes and reference should also be made to this document when developing a care home policy. The document can be located at the NICE website (www.NICE.org.uk ) and use the search facility for NICE QS 85 Medicines Management.

Areas that should be covered by a Care Home Medicines PolicyThe NICE Guideline has recommended that the following areas should be covered within a care home medicines policy:

Sharing information about a resident’s medicines, including when they transfer between different care settings to include discharge summaries and availability of medicines on the day that they transfer to a new setting

Ensuring that records relating to residents’ medicines are accurate and up to date Identifying, reporting and reviewing medicines–related problems Keeping residents safe (Safeguarding) Accurately listing a resident’s medicines and reconciling them with the prescriber’s

current intentions Reviewing residents’ medicines with multidisciplinary teams Ordering medicines Receiving, storing and disposing of medicines Helping residents to look after and take their medicines themselves if appropriate

(self-administration) Care home staff administering medicines to residents, including staff training and

competency requirements Care home staff giving medicines to residents without their knowledge (covert

administration) Care home staff giving non-prescription and over the counter products (homely

remedies) to residents if appropriate

The Medicines Policy Checklist (dated May 2014) provides more information about these areas and processes that should be covered within a care home medicines policy. The checklist can be located from the same page that the NICE Guideline is accessed at:http://www.nice.org.uk/guidance/SC1 Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print the Checklist for Care Homes Medicines Policy.

Using the Medication Policy ChecklistCare Home providers may wish to consider:

how they can use the checklist as a tool for the development and improvement of practices and processes within the care home

how each section and topic area applies to the scope of practice within the care setting

how care home providers will ensure that the care home staff are aware of the content of the care home medicines policy and understand how to put it into practice

whether any changes to their care home medicines policy are needed to reflect the care setting in which it is being used

how often they will review and update the care homes medicines policy, taking into accounts new evidence on best practice


http://www.NICE.org.uk/




Baseline Assessment ToolNICE have also produced a baseline assessment tool which can be used by care homes to evaluate their current practices against the recommendations in the NICE Guideline on Managing Medicines in Care homes. This tool can also be used to help care homes plan any activity to meet these recommendations.The baseline assessment tool (dated March 2014) can be located from the same page that the NICE Guideline is accessed at:http://www.nice.org.uk/guidance/SC1 Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print the baseline assessment tool.In England - A care home policy should also contain reference to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 and to the new CQC inspection guidance (revised in May 2015 and updated in October 2017) to include the standard set of key lines of enquiry (KLOE) that relate to the five key measures of service provision – are services safe, effective, caring, responsive and well led – with a key focus for medicines management being included in the ‘safe’ category and the recognition of using technology included in the ‘well led category. Further guidance on updated KLOE, prompts and ratings characteristics can be accessed at:http://www.cqc.org.uk/sites/default/files/20171020-adult-social-care-kloes-prompts-and-characteristics-final.pdf This guidance now replaces the previous reference to Outcome 9 – ‘Management of medicines’In Wales – There have been no recent changes and CSSIW will continue to make reference in their inspection visits and reporting to the National Minimum Standards – Standard 17 (Medication). CSSIW are currently reviewing the Medicines Policy guidance which has been issued by NICE (March 2014)For InformationInvatech Health takes no responsibility for the medication policies of individual care homes and it is recommended that a reference to the use of the Proactive Care System (PCS) is included within the care home medicines policy with cross referencing to PCS processes and procedures available via Invatech e-learning and on line help guides. Care homes are responsible for ensuring that any NICE or other guidance used in the development of medicines policy is obtained from the latest available versions.Invatech Health are able to offer limited assistance in signposting care homes to the appropriate documentation referenced in the NICE guidance.All organisational performance targets should be agreed with the Care Home manager.

1.4.Medicines Management Systems within <<Insert Company Name>> Care Homes

It is a key aim of <<Insert Company Name>> care homes to provide safe, efficient and accountable systems of medicines management. <<Insert Company Name>>. XXXX has entered into an agreement with Beacon Digital or Invatech (delete as appropriate) and XXXXXX Pharmacy and introduced an electronic medication management system called the Proactive Care System (PCS). This consists of a hand held device that is used by nurses and carers to support the administration and documentation of medicines and a range of supporting services that ensure the company’s aims under section 1.3 are met.All medicines related activities within the care home will therefore be processed using the PCS system and the adoption of the use of original pack dispensing in place of previous Monitored Dosage Systems.





1.5.Responsibilities of the Care Home ManagerThis medicines policy requires the Care Home manager to be responsible for the delivery of the organisations aims under section 1.3 and for the following tasks which protect residents from harm due to medicines administration:

To ensure that a safe environment exists at all times in the home in relation to the ordering, storage, administration and the disposal of medicines

In discharging this responsibility, the manager must promote a safety conscious approach in which all members of staff involved understand what is expected of them and the procedures that need to be followed and complied with.

To ensure members of staff are adequately trained and competent in the use of the PCS device for the administration of medicines to residents and in the associated systems and processes in the care home for medicines management

Assessing at induction and the subsequent monitoring of the competency of all appropriate staff to administer medicines safely

Checking of on-line medication administration records every week and assessment of performance of staff in relation to medicines management as well acting on the various management information reports available.

Arrangements for the preparation of timely orders for medication from the surgery and forwarding of the requests to the GP surgery in line with the Service Level Agreement (SLA) which is in place between the pharmacy provider and care home.

Arrangements for the collection of the prescriptions, dispensing and delivery as agreed within the SLA provided by the pharmacy provider. This will include out of hours and weekend arrangements

Arrangements for the accurate and timely booking in of the medicines to the care home Safe Storage and security of Medicines, including Controlled Drugs Liaising with GPs and other allied healthcare clinicians and staff and communicating

changes to residents’ medication to the pharmacy provider as appropriate and via the PCS handset as per agreed processes and protocols

Recording and accounting for the medicines administered to residents Ensuring appropriate access and review of all records relating to medicines management Maintaining a list of all homely remedies used in the home and clearly indicating and

recording the administration to each appropriate resident




2. The Pro-active Care System and arrangements for pharmaceutical servicesThis section outlines the procedure for using the electronic medication system called the Pro-active Care System (PCS) and the agreement in place with xxxxxxxxxx as the provider of pharmaceutical services and a partner in the management of medicines at the care home.The Care Home Manager must ensure that the agreed Service Level Agreement with the Pharmacy Provider is upheld at all times to support the integrity of the Pharmacy service and to ensure residents receive their medication when they require it.

2.1.The Pro-active Care SystemAll <<Insert Company Name>> care homes will employ the PCS system to manage medicines related activities. This will ensure the safe, efficient, consistent and accountable management of residents’ medicines at all times. The medicines related activities to be carried out using the PCS system includes:

Administration of medicines Communication of changes to medicines or therapy Ordering of prescriptions Receipt of medicines Disposal and return of medicines Viewing prescriptions (via Invalife) Accessing medicines or clinical information (in development) Stock management and control

2.1.1. Fundamental requirements for using the PCS deviceThere are a number of fundamental requirements for the use and application of the PCS system which will ensure high standards of medicines management in the care home. All members of staff are required to meet these fundamental requirements at all times:1. Scan the barcodes on the medication labels of the medicines selected prior to

administration.This policy requires that 100% of medicines which have barcodes on their instruction labels are scanned prior to administration.

2. “Dock” or “Synchronise” the PCS device before and after every medication round and when prompted.This policy requires that the PCS device is “docked” before and after each medicines round.

3. Book in all supplies of medicines received on the PCS device.This policy requires that 100% of all medicines received in to the care home are booked in promptly using the PCS device.

4. Carry out a stock take for the prompted medicines.This policy requires that 100% of all required stock takes are carried out when requested

5. Take action on the “low stock” medicines prompted.This policy requires that 100% of “low stock” items are acted up on promptly.

6. Order the Monthly medicines on time. This policy requires that the Monthly Medicines are ordered on the day that they are prompted and this is typically day 8 of the monthly cycle and where possible to use the PCS summary order reports in agreement with your local GP surgeries to ensure accuracy and efficiency of ordering




7. Account for all “Missing Entries”.This policy requires that all 100% of “missing entries” are accounted for at every hand over or by using the Invalife web portal.

8. Complete the administration plans for “PRNs”, “Emollients”, and “Dressings”.This policy requires that 100% of administration plans are completed.

9. Ensure the PCS device is charged.This policy requires that the PCS device is charged 100% of time when not in use and that its battery charge does not drop below 40%. All members of staff are required to be vigilant and never allow the PCS device to run out of charge.

10. Ensure that paper MAR charts are only used in exceptional circumstances once all options to address issues and problems have been explored.This policy requires that the use of paper MAR charts in the care home is only initiated in conjunction with your pharmacy provider once Invatech customer services department has been consulted and all attempts to resolve the situation have been fully explored.

2.2.Support for the PCS deviceEach care home will have available as a minimum one member of staff trained on the PCS device 24 hours a day. This will ensure capability of each care home to train agency staff or newly inducted staff in the use of the PCS device to administer medicines. The names of members of staff trained and competent in the use of PCS should be recorded by the care home manager and included as an appendix in the care home medication policy folder.It is a requirement that all staff involved in the administration of medication to residents must have successfully completed the appropriate e-learning modules and deemed competent by the Home Manager as proven by the successful completion of a competency assessment.

All staff involved in the administration of medication will be required to register on www.Invalife.com to receive a unique Personal Identification Number (PIN) for use with the PCS device at the care home. Ongoing access to the device will only be authorised by the care home manager for staff who have completed or refreshed their training according to xxxxxxx care home / Group policy requirements.

Please also note that there will be rare occasions where the PCS device is temporarily rendered inactive. In this situation, and after contacting your providing Pharmacy for advice, care homes may record administrations temporarily on paper MAR using the MAR sheets which are either printed from Invalife or provided to the home via e-mail from Invatech on a weekly or monthly basis according to the care home preference.

2.3.Arrangements for the pharmaceutical serviceThe care home will use xxxxxxxx Pharmacy as far as is practically possible to supply all prescriptions for its residents. This will ensure that all medication details are automatically updated to the PCS device and that there is the added safety net of barcode validation at the point of administering medicines to the resident. Any medicines which are obtained from a pharmacy which is not your main medicines provider must be entered into the PCS device as soon as possible to ensure that the integrity and accuracy of residents’ medicines information is up to date at all times.

http://www.Invalife.com/




2.3.1. Dispensing of medicinesAll medicines will be dispensed in manufacturer’s original packages or traditional dispensing boxes and bottles. There will be no routine dispensing of medicines in monitored dosage systems, and halving of tablets will only be carried out by xxxxxxxxx Pharmacy with the pharmacist’s approval.

All medicines will be dispensed against valid legal prescriptions and will be provided with legally compliant instruction labels.

All medicines dispensed in manufacturer’s original packages will be provided with patient information leaflets.

2.4 Service Level Agreement

All care homes should have a Service Level Agreement in place with their main pharmacy provider to include details for:

Arrangements of the ordering and provision of monthly, interim and same day medication

Daily delivery and cut off times for emergency and interim medication Details of key contact names at the Pharmacy Provision for out of hours or weekend and Bank holiday pharmaceutical services or

advice Pharmacist advice / resident medication review visits to the care home Learning and support resources Waste management services Arrangements for controlled drugs delivery and recording Provision of equipment and consumables for the purposes of medicines

management Escalation and complaints procedures

2.5 Customer support and escalation procedures for resolving issues

All enquiries or complaints relating to the provision of pharmaceutical services should be escalated to your main pharmacy provider in order to resolve any immediate concerns or queries.The care home will be provided with access to self-help on line files to support the early resolution of the most common queries and access to a library of resources via Invalife.

Should there be an unresolved technical or medication supply issue, then the care home will raise this matter directly with your main pharmacy provider in the first instance. If the matter cannot be resolved by the pharmacy provider, then the pharmacy supplier will escalate the issue directly to the Invatech support desk.




2.6 Contact Details

The name and contact details for the following persons should be clearly visible in all care home medication rooms:

The key contact / Medication PCS lead for the care home and their deputy The key contact at the main pharmacy provider / help desk location to include

telephone and fax details The name, address and number of the nearest out of hours pharmacy to include

telephone and fax number The names and contact details for all GP practices in the locality who provide a

service to the care home Contact details for Invatech Health support desk and ‘out of hours’ procedures




3 Supply and Storage of Medicines

3.1 Introduction The over-riding principle is to ensure that the supply and storage of medicines are compliant with all relevant regulations and that the risk of harm to residents and staff is minimised.

This section of the policy outlines the following: Legal classification of medicines Requirements for prescriptions and associated instructions Requirements for dispensing labels Storage requirements for medicines Records for the receipt and disposal of medicines in the care home Requirements for controlled drugs Storage of Oxygen

3.2 Supply of medicinesThe supply of medicines to all care homes in the UK is governed by the Medicines Act 1968 which defines three legal categories of medicines:

Prescription Only Medicines (POM): May only be obtained upon presentation of a written prescription, signed by an authorised prescriber. Most medicines in the care home are POMs.

Pharmacy Only (P): May be purchased within a community pharmacy when a pharmacist supervises the sale.

General Sales List (GSL): May be purchased from any retail outlet.o e.g. Homely remedies that are bought without a prescription and used as

stock medication in the care home and given to residents when needed.

In addition the Misuse of Drugs Act defines some medicines that are subject to additional controls because they are liable to abuse – these are “controlled drugs”. In the care home many of the medicines given to control pain at end of life are classes as controlled drugs. Please note that it is illegal for a pharmacy to supply a POM without a prescription and it is illegal for someone to administer such medicines to a resident without a valid prescription.

This policy provides details of the arrangements for the supply of monthly and interim prescriptions.

3.2.1 Dispensing of medicines and label requirements

All medicines will be dispensed in manufacturer’s original packages or traditional dispensing boxes and bottles. There will be no routine dispensing of medicines into monitored dosage systems or halving of solid dose forms (tablets) unless agreed with the main pharmacy provider.




All medicines in the care home must have a pharmacy label so that carers know who to administer the medicines to and how many and how frequently to administer the medicines.

The pharmacy label should have the following information:

1. Quantity of the medicine dispensed. 2. The name of the medicine, the formulation, and the strength.3. Directions for use: dosage and frequency. It must be noted that directions such as

“use as directed” are not acceptable. In these situations the instruction for administration must be clarified with the prescribing doctor and documented in the care plan.

4. Warning labels: e.g. avoid Alcoholic drink, Take with or after food, Take regularly and complete the course.

5. The resident’s name.6. The date the medicine was dispensed.7. The name of the pharmacy and “keep out of the sight and reach of children”.

3.2.2 Prescribed medicines are the property of the resident for whom they are supplied

Medicines prescribed, labelled and supplied for an individual resident are the property of the named resident and they may not at any time be used for other residents as though they were “stock” held by the care home. This principle applies to medicines, dressings, appliances and nutritional supplements or any other prescribed item.

3.3 Records of medicines, dressings and appliances receivedAll medicines, dressings and appliances brought into the home from whatever source must be booked in using the PCS device. This includes all prescribed items, hospital discharge medicines, medicines brought from another home and medicines brought in by residents’ friends or relatives (including supplements, homely remedies and herbal medicines, etc.).The GP and Pharmacist should be consulted prior to any non-prescribed medicine being administered to ensure there is no incompatibility or risk to current medication or health conditions.

The booking in process with the PCS device simply involves scanning the barcode on the medicine labels. This will record the receipt of medicines and their quantities (see Section xxx).

On admission of a new resident, written confirmation of the current medicines they are on must be obtained from an authoritative source and this should be either a hospital discharge letter/summary or a copy of their current repeat medicines list obtained from their surgery. It is not acceptable to obtain this information from the labels of the medicines brought in by the resident or family to the care home.

Records of medicines booked in to the care home for each resident is available on the resident’s record on Invalife and which is reproduced on the resident’s PCS MAR chart. In addition Invalife produces a STOCK MOVEMENT report of all stock related activities for the care home as a whole.




3.3.1 Booking out medicines in periods of resident absence from the care homeAll medicines taken out of the care home for whatever reason must also be logged out / recorded using the PCS device. This includes all prescribed items that residents may take with them to hospital, or for short periods of absence from the home e.g. day visits or weekend stays with relatives. In such scenarios it is recommended that the entire supply of medicines required for the duration is taken with the resident and an up to date and valid paper MAR provided for the purposes and ease of recording administration. This will ensure that the medicines are supplied complete in original packs with labels and the instructions for administration. The Home Manager should be satisfied that the person taking responsibility for the resident whilst away from the home is fully aware of the administration requirements and safe keeping of the medication.If a resident is absent from the care home or in hospital, their status on the PCS device should be changed accordingly. This will avoid the creation of “missing entries”. On returning to the care home, the resident’s status must be amended on the PCS and their medicines and quantities booked in following the processes outlined in the PCS user manual.

3.4 Records of disposal of medicinesA record is required to identify the removal from the home of a resident’s medicines. Only those medicines appropriate to current therapy should be stored within the care home. All items prescribed for an individual resident remain their property. Thus if a resident leaves the home then their medicines should be given to them or a suitable representative unless consent is given for their safe disposal. The following are scenarios where medicines may need to be disposed of: Medication remaining after a resident has died. These medicines must be kept

separately from all other medication in the home and disposed after a period of 7 days unless otherwise directed by an enforcement officer.

Medication that has been stopped by the prescriber must be removed from the resident’s current medicines immediately and stored separately. These medicines may be disposed of or returned immediately.

Refused doses of medication that have been removed from the manufacturer’s original container, must be placed into a pot or waste bag or pouch labelled “refused medicines” and recorded appropriately on the PCS device.

The “refused medicines” containers are available from your main pharmacy provider Expired medication identified as part of the checking process that are required prior to

administration of medicines

The PCS device must be used to record the return and disposal of medicines. The device has a “Returns” functionality which is used to record the items being returned. The record of returns made using the PCS device is then “faxed back” to the care home (copies can also be printed off using the Invalife web portal).

The record of disposal must show: The date of return The name, strength and quantity of the medicine The resident for whom medication was prescribed or purchased The signature of the member of staff who checked all the items out




3.4.1 Storage and collection of medicines for disposalAll medicines to be disposed must be stored separately to the current residents’ medicines in the home and a regular routine and frequency for the return of medication should be defined by the home manager to prevent the accumulation of unwanted medication in the care home.

The medicines to be disposed must be labelled for “disposal or return”.

The home manager must ensure that waste collection arrangements are in place with the current main pharmacy provider according to the Service Level Agreement.

The regulatory requirements for collection of waste medication from nursing homes will differ to collection requirements and arrangements from residential homes. The care home manager must be satisfied that the correct arrangements are in place for the care home.

On collection of the medicines to be disposed: the nurse / carer in charge both need to sign the “faxed back” returns log. Additional copies of the returns list are available on Invalife; refer to the PCS user guide for further details. The local pharmacy provider may wish to make additional or separate arrangements for the recording of returns medicines and the care home manager must ensure that these arrangements comply with regulatory guidelines.

3.4.2 Disposal of controlled drugs

Controlled drugs are denatured using “denaturing kits” available from your main Pharmacy provider. Arrangements for CD destruction and return should be agreed within the Service Level Agreement between the care home and the pharmacy.

Nursing homes must denature any unused or out of date controlled drugs prior to promptly returning the medication to the pharmacy provider /waste carrier.

Residential homes must make prompt collection arrangements with the pharmacy provider to return controlled drugs in their original packs or bottles.

When returning controlled drugs an entry is required in the controlled drugs register along with a second authorised signatory. All items for disposal should be locked in the CD cupboard including the active denaturing kit until immediately before collection.

3.5 Storage of medicinesIt is the responsibility of the care home manager to ensure that there are appropriate facilities to ensure the safe, secure and appropriate storage of medicines.

There must be a designated medicines room (s) for storing medicines that is secure. Consideration must be given to the size of the home and the nature of the medicines to be supplied. The room must be maintained at an appropriate temperature for medicines storage; for most products this is 25°C or below, some products require refrigeration (2 – 8 C).

The required conditions for storage will always be stated on the packaging of the medicines and this must always be followed. There must be sufficient room to store nutritional supplements, dressings and appliances (such as incontinence and ostomy products); no




medical items should ever be stored on the floor. All medicines must be stored away from direct sunlight.

For all but very small homes the usual arrangement is to have a designated medication room containing medicines cupboards. Cupboards for storing medication not contained in the medication trolleys should be of a suitable size and construction with a robust lock. The security of medicines should not be compromised by using the lockable cupboard for storage of non-clinical items. There should be no access to the medicines room via an external door and there should preferably be no external windows. Where windows are included then arrangements should be considered to fix metal bars over the windows and any direct vision into the room should be prevented.

The medicines trolley must have sufficient capacity for all residents medicines to be locked away during a medicines round whilst a nurse or carer is away from the trolley administering medication to residents. The trolley must be locked and secured to a fixed wall in a secure area or room when not in use and preferably in the designated medication room where space permits.

The keys to the medicines storage cupboards, trolleys and controlled drug cabinets must be kept with an authorised member of staff at all times. The safe custody of spare keys to all medicines storage areas is the responsibility of the care home manager.A key control log should be in place at all times for all keys and entries made and updated at each shift change or appropriate handover. The home manager should check control log compliance on a regular basis.

3.5.1 Expiry datesAll medicines stored in the care home must have their expiry date checked on a regular basis according to ……… policy. This date is usually printed on the packaging. Medicines storage areas should be regularly checked for expired medicines. Some products have a limited life once opened. In these cases the manufacturer’s expiry dated printed on the packaging only applies if the product is left unopened and sealed and stored according to manufacturer’s instructions.

Medicines must never be used beyond their expiry date under any circumstances.

Staff must rotate the stock stored in the cupboards, placing the products with the longest expiry at the back and using the most recent expiry first.

Staff must always check the expiry dates of medicines prior to administration to the resident and advice should be sought from the supplying pharmacy should any concerns or queries arise as to the integrity of any medication.

3.5.2 Expiry dates for “in use” medicinesThese refer to the length of time from the date of first opening, that these preparations remain usable before they should be disposed of. The date of opening should be marked on the container so that these expiry dates can be applied. Always refer to the manufacturer’s labelling or your main pharmacy provider for advice if in any doubt.




“In use” expiry of certain medicinesProduct Type Expiry

Eye drops or eye ointment 28 days (in most cases. Always check label or Patient Inf.Leaflet)

Oral liquid preparations 6 months or less*

External liquids, lotions, etc. and creams and ointments packed in tubes

6 months

Topical preparations in pump packs 6 months or lessTopical preparations in tubs (eg aqueous cream) 4 weeksInsulin 4-6 weeks (dependent upon

specific brand – check PIL)Tablets or capsules dispensed into amber tablet bottles

6 months from date of dispensing (Unless pharmacy labelling states otherwise)

* Some liquid preparations have a shorter usable life once opened. Always refer to the manufacturer’s labelling or the pharmacy labelling. Reconstituted antibiotics will usually have a 7 day shelf life from the date of supply.

3.5.3 Items requiring refrigerationA separate, secure and dedicated fridge should be available in the home to be used exclusively for the storage of medicines requiring cold storage.

The temperature of the medicines fridge should be monitored and recorded daily when in use, using a maximum/minimum thermometer or built in facility, ensuring that both the maximum and minimum temperatures are recorded, and that the thermometer/built in facility is reset after the readings have been taken.

The normal range for medication fridge items is 2–8°C but it is important to check the product literature or ask the pharmacist if in any doubt.

If the temperature falls outside this range, the care home manager MUST be informed. The care home manager should contact the pharmacist to check the integrity of the medicines and to seek advice on the repair or replacement of the refrigerator. In the meantime, action should be taken to store fridge items appropriately whilst the medicines fridge is repaired or replaced. This must not be in a fridge which is used for the purpose of food storage.

Please note that whilst some medicines need to be kept in the fridge whilst they are being stored, they do not necessarily need to be in the fridge whilst they are being used. For example some Insulin types and eye drops, once opened do not need to be kept in the fridge. They will last around 28 days outside the fridge. In addition because the medicines are not cold when injected or inserted then they do not cause irritation or pain on administration.Advice should always be sought from the supplying Pharmacy to confirm storage requirements if this is not made clear on the packaging or pharmacy label.




3.6 Controlled Drugs (CDs)Controlled drugs are medicines that require additional legal control on their supply, storage and administration because they are liable to abuse. These are defined by the Misuse of Drugs Act.

3.6.1 Storage of Controlled DrugsControlled drugs for residents who are not self-medicating must be stored in cupboards meeting the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973.

Only members of staff who are authorised to access the CD cupboard are permitted to hold the keys. The keys should never be passed to a member of staff who is not authorised to access it. The controlled drugs cupboard must be used for the storage of controlled drugs only, not jewellery or money or any other personal belongings.

All CD transactions to include the issue, administration, receipt and destruction should be carried out by two staff, one of whom is authorised to administer medication, the other as a trained witness to the transaction. Both members of staff must ensure that their PINs are recorded at each stage on the PCS device. Please note that on rare occasions there may not be two members of staff present to witness the administration of controlled drugs. The PCS device accommodates these rare occasions by allowing the self-witness of administrations. These events are also highlighted to the care home manager on the daily reports received.

Controlled drugs should only be taken out of the controlled drugs cupboard whilst they are being dispensed or counted for stock purposes.

If a care home wishes to set up a palliative care service in their care home then they should seek the advice and guidance of their pharmacy provider, clinical commissioning group / health board and local NHS pharmaceutical adviser.

The use and application of CD patches e.g. Fentanyl, BuTrans require additional precautions and procedures (e.g. body maps) to ensure correct and safe administration. Nurses and senior carers should refer to the pharmacist for advice as appropriate and should refer to the patient information leaflet for further guidance as required.

3.6.2 Controlled Drugs RegisterStrict recording of CDs must be kept in the CD register. It must be a bound book with numbered pages and the following details must be recorded:

- The date the drug was received- The signature of the person who received the drug and a witness- The amount received and where from- The form of the drug e.g. Tablet, liquid, ampoule- The name of the resident who the drug is administered to- The date, time and amount to be administered- The signature of the person who administered the drug and a witness- The date and amount returned/transferred and where to- The signature of the person returning/transferring and a witness- The balance remaining for each item must be recorded and regular balance checks by

line management should be conducted according to care home policy e.g. weekly.




3.6.3 Controlled Drug Register entriesThe entries in the controlled drug register:

Must be clear, neat and legible Must be in chronological order Must have a separate page for each drug for each resident Must be recorded as soon as the drug is administered, received or returned

The register should not be used for other purposes and must never be altered by changing entries or crossing out entries; a footnote to correct the entry should always be used. Correction fluid should never be used.

The register must be kept available for three years after last entry and should never be removed from the home.

3.6.4 Dealing with CD discrepanciesThere must be a weekly check as a minimum of all stock balances of controlled drugs. These should be carried out by two members of staff.Discrepancies should be notified and investigated by the care home manager. If the discrepancy is resolved, then an appropriate record should be made, see the examples below.If the discrepancy is not resolved, then the care home manager needs to take advice from their line manager in the first instance and then from the pharmacy provider or the central CQC / CSSIW telephone line and the police as appropriate.

The following actions must be taken in the event of a discrepancy or incorrect entry with Controlled Drugs

1. Where a discrepancy is found, it should be reported immediately to the care home manager who should investigate promptly and escalate to their line manager for advice.

2. If the discrepancy cannot be resolved, the advice of the pharmacist should be sought and the care home manager should contact the central CQC telephone line 03000 616161 or CSSIW on 03007900126. If the reason for the discrepancy cannot be determined, and the CDs appear to have gone missing, then all relevant people mentioned above, including the police, should be notified.

3. If the discrepancy is found to be an error of calculation of stock balance or other entry reason, do not change the balance column or use correction fluid. Under the last entry, write the following:

• The date • The error in subtraction/addition (indicated with an asterisk) • The correct balance • The signature of the nurse/member of staff and the witnessing nurse/member of staff

4. In care homes providing nursing or residential care where a dose is given, but the administering nurse or carer fails to complete the CD register at the time of administration under the last entry, write the following:

• The current day’s date




• “DOSE ADMINISTERED, BUT NOT RECORDED AT THE TIME” followed by the resident’s details

• The signature of the administering nurse/carer and that of a witness • The correct balance

Such incidents MUST be reported to the care home manager at all times.

Loss of Medicine Keys

The loss of medication room/cupboard/trolley keys must be reported to the Home Manager without delay by the Nurse/ Senior Carer. The Home Manager is to decide on appropriate action to ensure public safety. If following an initial investigation, keys are still not found, this must be reported to the Line Manager or the Emergency on-call Manager. The Home Manager (or person in charge of the home in his/her absence) must report the loss and subsequent action to the local relevant regulator at CQC (England), CSSIW (Wales) or SCSWIS (Scotland).Arrangements for the safe holding of spare keys must be in line with company policy.

Theft of Medication

In the event of obvious theft of medication the following action needs to be carried out by the most senior person in the home:

a) Do not touch anythingb) Inform organisational Line Manager or on-call Managerc) Inform the local Policed) Document events clearlye) Inform regulatory body verbally and through completion of appropriate

documentation as requestedf) Inform local contracting officer if contractually required

3.7 Use of oxygen in care homesOxygen cylinders and concentrators must be prescribed by a medical practitioner for a named resident only and obtained from an authorised supplier. The GP surgery can advise on local supply arrangements. Prophylactic oxygen (for use for non-named residents on an emergency basis) should not be kept in the care home.

Oxygen should never be given to a resident for whom it has not been prescribed. A prescription for oxygen should specify the dosage of oxygen to be given and the amount in litres per minute.

Oxygen must be administered via a mask which fits over the resident’s mouth and nose or via a nasal cannula which fits into the nostrils.

Some residents may be prescribed oxygen concentrators which acquire oxygen from the air.

A risk assessment must be conducted for both oxygen cylinder and concentrators.




3.7.1 Storage of oxygen Cylinders being stored should be under cover, upright, secured to a wall or within a

special secured lockable room or container, and not subject to extreme temperatures They should be stored in dry, clean, well-ventilated areas so that they do not become

dirty or rusty Cylinders should be away from highly flammable liquids and other combustible

materials and from sources of heat and ignition They should be separate from other gases They should be preferably be stored on a cylinder stand or chained to the wall, but in

any case in a position where they are unlikely to fall over The storage area should allow for segregation of full and empty cylinders All rooms where oxygen is in use or stored should display the statutory warning

notices: Compressed Gas. Oxygen: No Smoking, No Naked Lights




4 Medicines Administration

4.1 IntroductionThe over-riding principle is to ensure there are procedures in place that ensure adherence to the seven rights of medicines administration and to optimise the benefit from medicines for residents.

The Seven Rights are:1. Right resident. Medicines must be administered to the right resident. 2. The right medicine. The right medicines must be given to the resident. 3. The right dose. The exact amount of the required medicine must be administered.4. The right time. The medicines must be administered at the right time.5. Right route. The medicines must be administered via the right route. 6. Right Documents and entries into the PCS device7. Right of the resident to refuse their medication

In this section the following procedures are described:• Safe practices and procedures in medicines administration• The requirements for record keeping and accounting for medicines administrations• Monitoring the effects of medicines• Supporting residents in self-administration of their medicines• Administering Homely Remedies

Who Can Administer Medicines?

In a Care Home with Nursing, medicines may only be administered by a first-level nurse or a second-level nurse who has undergone appropriate training and assessment of competence in medicines administration, known as a Registered Nurse (or RN). The RN may occasionally delegate to a suitably qualified person the administration of oral and topical medicines, but will at all times be responsible. This RN needs to hold a valid current registration and PIN check; and may be either an employee or an employee of an approved agency

or

In residential Care Homes, medicines may only be administered by an Authorised Person who is generally a senior carer or carer, or once medicines are prepared and ready for administration may delegate to a suitably qualified person the administration of oral and topical medicines, but will at all times be responsible. The Authorised Person will never give medication to care staff to administer unless that person has been formally trained and deemed competent in the administration of medication

or

a) The Resident (only if self-medication has been agreed and risk -assessed or




b) Relatives (where agreed and recorded) and other appropriate Healthcare professionals (where agreed and recorded) e.g. community nurses, GPs

4.2 General requirements relating to administration of medicinesThe following are general requirements of this policy which relate to the administration of medicines.

Medicines should be administered to residents only against a written prescription which has been signed by an appropriate practitioner. If there is no prescription then the supply and administration is being carried out illegally. The only exception would be homely remedies administered in accordance with the section on homely remedies or where a GP authorises an emergency supply request directly to the pharmacy.

Medicines that have been prescribed and dispensed for one resident should not, under any circumstances be given to another resident or used for a purpose which is different to that for which they were prescribed.

Medication which has been prescribed for use by members of staff by their own GP must be kept separate to residents medication and should be stored in a lockable personal receptacle or locker or by prior arrangements with the care home manager to be kept safe elsewhere e.g. the use of inhalers for asthma. Staff must not at any time use medication which has been prescribed for a resident.

Medicines should only be administered when there is a proper dosage instruction. The dosage instruction “use as directed” should not be accepted and a clear and specific instruction should be agreed with the prescriber by the pharmacist.

The medicines must have a pharmacy label with the directions for administration as written on the prescription. The exception to this principle is when there is documented evidence to show that a GP has authorised a change to the dosage of a medication which has already been prescribed and this has been recorded and witnessed if the GP is present in the home or recorded and witnessed by two people if new instruction is issued via a phone conversation. An entry should be made in the residents notes and the change processed and witnessed on the PCS device.

Medicines administration must only be undertaken by nursing and care staff that are trained and deemed competent to do so.

Medication should never be removed from the original container in which it was supplied until the time of administration.

Administration of medicines may take place in the dining room, the lounge, or the resident’s bedroom. At all times it is important to respect the dignity, preferences and wishes of the resident when administering medicines.

When medicines are transported around the home, transportation must be done in a secure manner such that they can be quickly and securely locked away in the event of an emergency.




The Home Manager must retain an up to date list of staff authorised and competent to administer medicines. This list can be viewed on the front screen of the PCS device and Home Managers can also access and amend this list via Invalife.

Each member of staff must log on to the PCS device using their own details and Personal Identification Number (PIN). This PIN must be kept confidential. The use of another members details to log on to the device will result in disciplinary action. Agency staff are required to use their own allocated PIN which can be accessed by request through Invalife to the PCS administrator, or temporary 48-hour access can be granted through the PCS itself with a witness to verify. The Home Manager is responsible for ensuring that all agency staff are allocated their personal PCS PIN. Managers can also determine the duration/expiry of the PIN for each member of staff depending on the timescales working at the home, this includes agency staff.

4.3 Medicines administration procedureAll staff must comply with the following procedure for the administration of medicines.

1. Before you begin you must wash your hands thoroughly. Then assemble all the equipment required: medicines trolley (if used), the PCS device or medicine record, a sufficient supply of medicines pots, medicines spoons, oral syringes (if required), tablet cutters, gloves, water, glasses, paper towels and container for collection of waste materials. Medicines should be administered to each resident in turn according to the clinical needs / preferences of residents e.g. residents requiring medication for pain relief should have their medication administered as a priority.

2. Identify the first resident by asking their name and date of birth and using the PCS device scan the barcode on the plastic container which is used to store the medicine for that resident. This will present a photograph of the resident which you are required to confirm is correct. If this is not practical or possible due to the resident’s lack of capacity or physical state, then their identity must be verified by another member of staff who is familiar with them.

3. Obtain the resident’s consent to administer their medication. This may be implied consent through the resident cooperating with your request to administer. All residents have the right to refuse their medicines and medicines should not be given without consent unless this is specifically documented in the care plan and agreed by a multidisciplinary team (see section for ‘covert medication’)

4. Using the PCS device read the list of medicines presented, and note which medicines have a red background which indicates that they are due to be given at this time.

5. Select the first medicine due to be given and using the PCS device scan the barcode on the medicine label. This will confirm the correct medicine by presenting the number of tablets / capsules to be placed in the pot for administration to the resident.

6. Check this prompted number against the label on the medicine package/container; if there is a discrepancy a check should be made with the supplying pharmacy or person-in-charge before giving the medicine to the resident. Having checked that the




medicine is correct and checked its expiry date, remove it from its pack directly and place into a medicines pot (tablets and capsules). If the tablet or capsule is in a bottle then it can be gently tipped into the lid before transferring to the medicines pot. Tablets and capsules should never be dispensed into your hand and protective gloves should be used for this purpose.Bottles of liquid preparations should always be shaken well before measuring a dose. Oral liquid medicines should be measured using a medicines measure for doses of 5ml or more. For smaller doses, an oral syringe (obtained from your Pharmacy Provider) should be used because the medicines measure is not accurate enough.If the medicine dose requires the tablet to be cut in half, guidance and support should always be sought from your pharmacy provider as they should provide pre-cut tablets on request and ensure that the container is labelled with the correct dose.All medicines, nutritional supplements, patches, medicated dressings and topical medicines must be administered and recorded using the PCS device. In some situations it is acceptable to record topical preparations, dressings and nutritional supplements via individual paper MAR records which must be kept securely in the resident’s room with their permission. These items and the use of paper MAR records should only be administered by trained and competent staff. The use of paper MAR records for these items must be recorded/referenced on the PCS device. Stock records must be kept up to date routinely on the PCS device.

7. On the PCS device select “add to pot”.

8. Select the next medicine that is due for administration and repeat step 5.

9. Find any other items to be administered such as creams or eye drops. Offer any “when required” or “prn” medicines that the resident has been prescribed according to their care plan.

10. Once all items for the first resident have been potted, they should be taken directly to the resident and administered via the prescribed route immediately. Medicines should not be left with the resident to “take later”.

11. Account for all of the medicines immediately after administration by confirming the administration on the PCS device.Please note that medicines refused/spat out or not taken should be accounted for by selecting the appropriate code. Medicines that have been “spat out” or “spilled” can be placed in the “refused medicines” receptacles/pouches supplied by your supplying pharmacy. When returning medication, the actual refused medication items should be reconciled with the returns report to ensure that all refused meds can be accounted for.After administration, place the pot(s) and measure (if used) in a container for washing up and cleansing for future use as appropriate; pots and measures should not be re-used for another resident without washing. Your pharmacy provider can advise if pots can be washed and re-used.

12. Repeat procedure from step 2 with all other residents.




13. Ensure that the resident has their choice of drink/food (if applicable to the administration of that medicine) at the time. Oral medication should be taken with sufficient water if the resident chooses water. If a resident does not wish to take his/her medication at the time of offering, the Authorised Person must explain that (s)he will return later with it at a time suitable to the resident and in line with prescribed times, allowing for time specific medications e.g. Medicines to treat Parkinson’s Disease. Medication must be given at the exact time as stated by the prescriber.

NB Oral medication should not be administered when the resident is lying down. The resident should be sitting upright or standing.

14. Medication should be directly administered to the resident and not left where another resident may pick it up

15. Administration should be only from the container labelled with the resident’s name and for topical medicines the date of opening should be recorded on the tube or container.

16. Medication must never be administered from an unmarked bottle and only medication for a single resident should be prepared for administration at any one time.

17. At no time must the drugs trolley be left unattended unless it is locked and all medication is inside and the keys removed. Once the medication round is completed the trolley must be returned to its place of storage and secured to the wall.

18. Administration of medicines should be avoided (where possible) during residents’ mealtimes unless that particular medication is required to be taken with food or the resident requests this. The medication trolley should always be stored in a safe and discrete area when in use.

19. Following the administration of medication all pots and utensils used during the process must be thoroughly washed, rinsed and dried according to company infection control procedures prior to re-use. All plastic medication measures containing a figure 2 on the base are intended for single use only and should not be re-used. If in doubt consult with your Pharmacy provider.

20. The nurse or carer should ensure that all full and appropriate entries are recorded on the PCS for each resident with a final check made at the end of each medication round to ensure that there are no missing entries. Any missing entries from previous administration rounds must be reported by the authorised nurse or senior carer identifying the missing entry to the Home Manager for investigation without delay and actions recorded to include entry into the residents care plan as appropriate. It is good practice to ensure that the PCS device is taken to shift handover meetings so that any outstanding actions can be discussed and followed up.

21. All calendar packed medicines and blister packs should be used to follow and match the day of the week correctly where it is printed on the tablet blister and where more than one pack is provided e.g. 2 x 28 packs of the same medication and strength,




then one pack should be started, marked with a pen on the box (not on the label) and finished before opening up the second box. The same applies to liquid medicines e.g Gaviscon Liquid and boxes containing sachets e.g. Laxido. It is also good practice to write the date of first use/opening on the pack.

22. Disposable vinyl unpowered gloves should be used to administer creams, ointments and other topical medication and should also be used when handling any cytotoxic medications (Advice on the safe handling of cytotoxic medication should be obtained from the Pharmacist). Disposable vinyl gloves must also be worn if there is a requirement to handle solid dose medication e.g. tablets or capsules which are provided loose in brown labelled bottles or for the purpose of stock counting.

23. If a resident is prescribed a dose of medication to be administered via

the halving of a tablet then appropriate tablet cutters should be used to ensure that an accurate dose of medication is administered. Care homes should in the first instance contact their pharmacy provider should they need advice or support and in most situations the pharmacy provider will undertake the halving of the tables prior to receipt at the care home. It is important that the prescriber instructions are well understood and that the pharmacy label reflects clear instructions with no ambiguity.

4.3.1 Resident Refusal and Covert Administration of Medication

Resident refusal:

i) Refusal to take medicines, or omissions, should be recorded on the PCS device, clearly indicating correct code with reason, and this also recorded within the resident’s Care Documentation. The PCS device also allows notes to be written regarding the administration if this is required to provide more detail. Residents have the right to challenge and refuse medication that is prescribed for them and should this occur the consequences should be explained to the resident where it is appropriate to do so. Consistent or persistent refusals must be recorded in the Care Documentation and through a risk assessment process with all involved parties including the GP and other healthcare professionals as soon as possible and within 48 hours in order to support the wellbeing of the resident.

ii) There should be no blank space or entries on the PCS.

Covert medication:

It is xxxxxxx stated position that covert medication should only be administered in exceptional circumstances and only after following the correct xxxxx policy and procedures.




‘Covert’ is the term used when medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example, contained in food or in a drink.

Giving medication by deception is potentially an assault. The covert administration of medicines should only take place within the context of existing legal and best practice frameworks to protect the person receiving the medicines and the authorised persons involved in administering the medicines. This decision should involve a multi-disciplinary team assessment, including resident/relative/advocate/attorney (where appropriate), the GP, pharmacist and care home staff. The decision, action taken, names of the parties concerned should be documented within a risk assessment and all relevant sections of the care documentation. The Line Manager of the care home manager is to be consulted of any such decision.

A Mental Capacity Assessment (Mental Capacity Act 2005) and a Best Interests Decision Plan must also be considered and undertaken and further advice can be obtained from your regulator or local compliance team and via NICE Quality Standard 85 and Guideline SC1.Advice should be sought from the pharmacist or GP when administering medicines to residents (including dysphagia) who are unable to take or swallow solid oral forms. Most tablets and capsules are also available as liquids and the doctor or pharmacist will be able to advise if liquid medication might be more suitable and is available as an alternative. If this is not possible the decision needs to be made with the pharmacist and the residents GP for the most suitable form of administering and this must be confirmed in writing by the GP. If a resident suffers any harm as a direct result of a resident’s medication being crushed or a capsule opened to make it easier to swallow then the authorised nurse or senior carer could be held legally liable. Each drug has a product licence which covers its use and places liability with the manufacturer. By crushing a tablet which is not designed or licensed to be crushed, the drug is being altered and the manufacturer is no longer responsible.

Whilst xxxx do not condone the process of administering medicines in an unlicensed manner, the organisation has a duty of care to follow the instruction of the prescriber. The nurse or senior carer may be requested to crush or disperse tablets or open capsules by the prescriber. Initially this request should be challenged and the option of other suitable medicines explored, however if no other suitable medicines are available the decision to administer medicines in an unlicensed manner must be made with the pharmacy provider (Pharmacist) and a written instruction must be made by and received from the GP. A care plan must then be formulated on the basis of the instruction, detailing the medicine prescribed, the reason for the administration in an unlicensed manner, how the medicine will be administered, the strength and dosage of the medicine, the frequency of administration, this support plan must be evaluated on a monthly basis within the home and discussed monthly with the GP to continue in an attempt to find an alternative medicine which can be used in its licensed form.Regular attempts should continue to be made to encourage the resident to take their medication conventionally, and ongoing review must be documented in the care plan.

In summary, Care Home Managers should ensure that the following guidance about administering medication covertly is complied with: Establish that the resident does not have capacity to make a decision or consent to treatment in line with the MCA 2005 The treatment provided should be deemed necessary and be the least restrictive option for the resident




A ‘best interests’ meeting and MCA assessment should take place where the best course of action for the resident is decided

A multi-disciplinary team assessment should be held to determine the suitability and detail of any covert medicines plan The decision is conducted with proper involvement of family or named representative person Any decision notified to the appropriate supervisory body including when there is any change to the medication regime Kept regularly under review with reference and possible enforcement by conditions attached to any DoLS authorisation

Ensure that antibiotics are given at the prescribed intervals and the full course completed as per GP instructions.

Any problems encountered, e.g. difficulty in swallowing, side effects, whether observed or mentioned by the resident, should be recorded and brought to the immediate attention of the GP.

4.3.2 Administration of controlled drugsAdministrations of controlled drugs must follow the same procedure as above using the PCS device. However the following additional procedure must be complied with:

The person administering the medicines must take the CD from the CD cupboard and check against the medicine’s record on the PCS device. This must be witnessed by a second authorised person.

Return remaining stock to CD cupboard and lock it Administer the medicine according to procedures above. A witness will be required to

confirm the administration on the PCS device by entering their PIN. Please note that this second person does not need to be accredited for administering medicines, but must be trained and approved for witnessing medicines administration.

Complete CD register in full ensuring the stock balance is correct. A witness will be required to check and sign the CD register.

Patches that are used for analgesic purposes e.g. Fentanyl, BuTrans should be administered as per the Patient Information Leaflet Instructions and patches should be checked on a daily basis ( this can be done and recorded by care staff when conducting personal care to residents) to observe that it is secure and confirmation recorded and checked periodically by qualified staff i.e. nurse or senior carer.

Fentanyl Patches may cause serious or life threatening breathing problems, especially during the first 72 hours of treatment. The use of this particular patch must be treated with caution and additional procedures put in place to ensure safe practice of administration and management as well as recording.

If a controlled drug is wasted or partly used this must be recorded and witnessed and appropriate entries made on the PCS device and in the CD register.

4.3.3 Injections

a) Injections must be administered to residents only by the Authorised




Person (Registered Nurses only within the scope of this section of the policy), acting in accordance with the prescription written and signed by a medical practitioner, unless the resident is self-medicating.

b) RNs, GPs/Community Nurses administering injections in the home must be asked to sign the Record of Administration (MAR sheet if this is appropriate) or suitable alternative documentation which is kept in the home. Refusal of this request should be documented in the resident support plan. Regular care home staff are responsible for ensuring that the PCS administration entries are accurate and up to date. Records of administration held by the visiting healthcare professional must also be held at the home and accessible by authorised staff for the purposes of monitoring and review. This process may vary from home to home according to the co-operation of visiting clinicians/professionals.

c) Injections should never be prepared in advance of their immediate use.

d) Insulin may be administered only by a RN, the resident him/herself or by a community/district nurse. In exceptional circumstances this may also be by a relative where this has been mutually agreed by all concerned and clearly documented and signed on the Care Documentation. Care staff are not permitted to administer insulin unless this is an agreed policy within the home. Insulin to be checked and administered by a Registered Nurse with a 2nd Nominated Person to witness the procedure. Both persons should then record and confirm administration using appropriate company documentation and a single confirmation of administration entered on the PCS device.Community nurses should be requested to complete organisational documentation as well as their own CCG/HB/NHS documents.

4.3.4 Dressings

a) Care Staff may apply first aid dressings to minor injuries.

b) Socialised dressings, e.g. for leg ulcers or pressure sores, are the responsibility of the Authorised Person (RNs only within the scope of this section of the policy)/Tissue Viability Nurse/Community Nurse (Residential Care Home). Under the direction and regular assessment by a RN/TV Nurse or Community Nurse (Residential Care Home) this treatment may be continued by an Authorised Person trained and deemed competent to do so.

4.3.5 Enemas

Enemas must be prescribed by a doctor and administered by a RN/ Community Nurse or an Authorised Person trained and deemed competent by a recognised authority. A record of administration must be completed.

4.3.6 Suppositories, Pessaries, Vaginal/Rectal Creams and Ointments

a) These must be administered by a RN (Care Home with




Nursing) or a Community Nurse (care home), or self-administered by a resident deemed competent to do so.

b) A RN may administer these preparations with the resident’s consent as long as he/she has received the appropriate training and is deemed competent. The written consent is to be recorded and maintained with the care records

c) The RN within a Care Home, administering these preparations must have received suitable training from Community Nurses, Doctors or appropriate health professionals authorised to administer such training. Evidence of the training must be held in the training file and in the individual Authorised Person’s personnel file.

d) Disposable vinyl unpowdered gloves must be worn.

e) In all circumstances a record of administration must be maintainedon the PCS device.

4.3.7 Eye drops, ear drops, nasal sprays, inhalers

For administration of eye drops the lower eyelid should be gently pulled downwards and the drops administered into the pocket between the lower lid and eye ball. One drop is usually sufficient unless otherwise directed; most individual’s eye cannot hold more than two drops – any excess runs out of the eye and is wasted.

Ear drops should be administered with the resident’s head tipped to one side; the head should remain tipped for a minute or two to ensure the drops run thoroughly inside the ear before drops are placed in the other ear (if appropriate). The ear may hold at least 3-4 drops, more may be appropriate in some cases, always follow the prescriber’s instructions

Nasal sprays should be administered by placing the nozzle into one nostril whilst holding the other one closed, the resident should then be asked to breathe in gently through their nose whilst the spray is activated.

For standard aerosol inhalers, the resident should exhale deeply; insert the inhaler between their lips ensuring a good seal then they should inhale deeply and steadily whilst activating the inhaler. There are a few types of dry power inhalers; these are usually breath activated and then the contents of the activated dose inhaled.

These preparations may be administered by the resident him/herself or by an Authorised Person and be recorded on the PCS device.

NB. Eye drops may in general only be used for only four weeks after opening with date of opening to be recorded on the label to ensure audit trail. They must be dated when first opened using the ‘date opened’ labels provided by some pharmacy providers.. Separate bottles, clearly labelled, must be used for each eye (when prescribed separately).

4.3.8 Creams, Ointments, Gels (Including Medicated Shampoos, Bath Oils)




a) These may be applied by care staff where appropriate training hasbeen given and the person has been assessed as competent. It is the responsibility of the authorised nurse or carer even if applied by a care staff member to ensure that administration is being conducted correctly and recorded correctly by the carer on PCS device or e.g. T- MAR Administration Plan for Topical Applications

The Authorised person must visually check skin condition at regular intervals as agreed and recorded in the care documentation. The T-MAR Administration Plan should remain in the resident’s room for ease of access by authorised staff and the topical preparation must be marked on the PCS that it is being managed on paper to confirm that a T-MAR is being used and is located in the resident’s room.

It is xxxxxx policy to use T-MARs for the application of topical medications and the T-MARS should be kept in the resident’s room with the care plan documentation unless by exception there are individual residents for whom this approach is not desirable and this is agreed by the Home Manager. At the end of the 28 day cycle, the completed and printed T-MAR should be securely attached to the corresponding paper MAR for that resident for the same month.

For some topical applications, e.g. prescribed for infections or severe bed sores, then it is likely that the nurse or senior carer will be responsible for administering this medication and this should be recorded directly on the PCS device or on the T-MAR as appropriate and care staff should be informed of the agreed method of administration and recording in these situations to avoid any doubt or confusion.

b) All staff must be aware that some topical preparations contain potent medication and they must be applied in accordance with the instructions. Disposable vinyl unperfumed gloves should be worn by staff for their own protection.

c) Creams, ointments and gels may be stored in the resident’s bedroom at the discretion of the Authorised Person in agreement with the Home Manager or an appropriately qualified Nominated Person provided that they can be locked away. These should be risk-assessed as there is a need to consider the individual and other residents. Some preparations require storage in the medication fridge and arrangements must be made at local level to ensure these arrangements are in place.

d) Prescribed creams, ointments and gels (e.g. E45 cream) must only be used for named residents only and not applied to any other residents.

4.3.9 Percutaneous Endoscopic Gastrostomy (PEG)

A PEG is a feeding tube which passes through the abdominal wall directly into the stomach, so that nutrition can be provided without swallowing, or in some cases to supplement ordinary food. The PEG tube can be connected to a ‘giving set’ to provide feeds continuously or a syringe can be used to receive feeds at intervals.




PEGs are used in people of all ages, who are unable to swallow or unable to eat enough and need long term artificial feeding. Common causes include stroke (CVA), head injuries, neurological diseases such as multiple sclerosis or motor neurone disease, or surgery to the head or neck. In some cases PEGs are used to give extra nutrition (or supplements) to people who can still eat, such as patients with cystic fibrosis.

Nutrition given via PEG must be prescribed by an appropriately qualified and authorised practitioner for a named individual. The nutritional supplements may be delivered by your pharmacy or another supplier. These nutritional supplements must be treated in the same way as other medicines and only administered by a trained and competent individual. Therefore they need to be appropriately booked in, securely stored, their administration and management accounted for on the PCS device.

Infection controlMinimal handling and an aseptic non-touch technique should be used when administering water/medication/feed via a PEG tube.

Effective hand hygiene must be carried out prior to handling the tube and/or administration of feed/medication/water. Hands should be washed thoroughly with liquid soap and water, using a technique, which will cover all surfaces of the hands. They should be rinsed under running water and dried well with a disposable paper towel. A detergent skin cleansing wipe can be used. Alternatively alcohol gel can be used on visibly clean hands i.e. free from dirt and organic material, using the same technique. Carers who carry out these tasks should be made aware of the importance of hand hygiene.

Hand hygiene must be maintained throughout the procedure and carried out prior to a clean procedure and after any activity or contact that could potentially result in hands becoming contaminated.

Potential infection control risks should be integral to the education of staff at the care home.

Administration of medicines via PEGThe over-riding principle is to ensure residents receive medicines in a form that benefits them without causing problems. To comply with this principle pharmacists and GPs must be consulted on the suitability of the form of the medicine to be administered via the PEG. Liquid formulations are preferable and at all times the PEG tube must be flushed with water before and after administrations. The following procedure must be followed when administering medicines via a PEG:

Stop the infusion of feed if need arises. (With some drugs, the feed must be stopped in advance.)

To prevent blockage, the enteral feeding tube should be flushed before and after feeding or administrating medicines. Flush the feeding tube with at least 30mls of water. Use freshly boiled and cooled water.

Enteral feeding tubes for patients who are immunosuppressed should be flushed with either cooled boiled water or sterile water from a freshly opened container.

Administer the dose in an appropriate syringe via the feeding tube. Draw up 10mls of water in the same syringe and administer via the tube to flush. If more than one medication, flush between each drug with a least 10ml of water

then repeat steps 2-4 (Each medication requires a separate syringe)




Flush the tube with at least 30ml water following administration of the last drugPEG administration must only be conducted by suitably qualified, trained and competent staff.

Care of PEG

Ensure the tube is firmly clamped or the end of the tube fully closed. The PEG tube should not interfere with normal activities and when clamped and not in use it can be hidden discreetly beneath the residents normal clothes.

Mouth care

It is important to look after the teeth and mouth of individuals with PEGs. This may be helped by using a mouth wash or swabs moistened with water. The doctor or nurse will advise on whether the individual can suck ice cubes or on other ways to keep the mouth moist.

Replacement of PEG tubes

Several PEG tubes are available and the doctor will decide on the best type and size. Some are designed to last for a few months, while others may function for one or two years or even longer. If the tube wears out and PEG feeding needs to be continued the tube can be easily replaced. If however, swallowing condition improves and PEG feeding is no longer required the PEG tube can be removed by the hospital. The doctor should always be consulted before this is done.

Below is a list of some possible problems and how to prevent or overcome them.

Diarrhoea, bloating, constipation, reflux

The dietician will advise on the correct type of feed and rate of feeding. If constipation is experienced it may be advised to have a high fibre feed. If reflux or vomiting occurs after feeds it may help to change position during feeding. The doctor must be informed in abdominal symptoms occur at any time.

Skin infection

It is important that the skin around the PEG is cared for well. It should be kept clean and, after washing, bathing etc., should be dried carefully. Ensure that the area under the disc is also carefully dried. If the skin becomes red, swollen or sore you should contact your doctor or nurse.

Feeding tube problems

The prescriber must give clear instructions on the feeds and medicines that can be given through the PEG tube. Only specially prepared feeds should be used and medicines should be given in the form of liquids where ever possible. There are also other issues which must be considered such as crushing of tablets and covert administration. The tube should be flushed with 30-50ml of cooled, boiled water before and after each feed or medication. If this is not done, feed or medicines can solidify in the tube and cause blockages. The care home




manager must ensure that staff have training on what to do if the tube blocks. If the measures fail the doctor or nurse must be contacted as soon as possible.

If the tube splits or the hub breaks

The tube must be clamped shut close to the retention disc to prevent leakage. Contact the nurse or doctor as soon as possible. It may be possible to repair the tube otherwise they will arrange for a replacement to be inserted.

If the tube falls out

The exit hole will not close immediately. If trained appropriately to insert another tube do so as soon as possible. If not, cover with a dressing to absorb any leakage and get in touch with the nurse or doctor who will arrange for a replacement to be inserted. If there is any delay the dressing may need to be replaced so that the skin remains dry.

4.3.10 External Diagnostic Procedures

a. Urine testing may be performed by a competent resident or a trained person using prescribed diagnostic sticks e.g. Clinstix. following appropriate training. Results must be monitored by a Registered Nurse within a care home for Nursing or by the GP or Community Nurse in residential homes.

b. The taking and checking of blood in any form must be done by a Registered Nurse within a Care Home for Nursing, competent in venepuncture, or the GP or Community Nurse in residential homes. Results must continue to be monitored by the Nurse, GP or Community Nurse.

c. The use of a glucometer (by an authorised person or a competent resident) prior to the taking of insulin including the frequency must be indicated in the residents care plan documentation. This must also include indications of other times when the use of the glucometer is advisable e.g. indications of low blood sugar.

4.3.11 Sub Cutaneous Infusion – For use in nursing homes only

Sub Cutaneous fluids are prescribed and used to support residents who have compromised hydration. Staff should refer to xxxxx nursing / care policy for full information and procedures on subcutaneous infusion.

Details of the fluids infusion time and other relevant information should be recorded on a sub-cutaneous Infusion Record.

Fluids must be obtained through procedures set out and agreed by the GP practice.




The agreed process for administering subcutaneous fluids should be well understood by nurses and staff must ensure that a local policy is followed in relation to obtaining supplies ( including giving sets and butterfly needles)checking of batch numbers, setting up and recording. It is important that there is continuity of medication for the resident according to GP instruction and prescribing requirements.

4.3.12 Syringe Drivers – For use in nursing homes only

Staff should refer to xxxx Nursing Policies for full information and procedures on the administration of drugs via a syringe driver. Staff should undergo a competency assessment and received appropriate training before being assessed as competetent by an approved assessor.

The driver of choice in xxxx care homes is xxxxxxx

Additional details on the administration of syringe drivers must be recorded on a Syringe Driver Monitoring Record .This record must be signed by the RN and witnessed by a competent person who has been assessed by the home manager in order to witness the setting up of the syringe driver.

All syringe drivers must be serviced on an annual basis and records of servicing maintained along with PAT service records

4.3.13 Nutritional Supplements

All nutritional supplements must be prescribed for individual named residents and are not transferable for use with other residents. An administration plan and record of nutritional supplements form should be completed for all residents who are prescribed nutritional supplements and these records should be filed in a separate folder and kept on the medication trolley for completion by care staff. Nurses and senior carers who are conducting the medication round should ensure that the records are fully completed to ensure that all appropriate residents have received their supplements in accordance with GP/Dietician instructions.The use of nutritional supplements should be reviewed regularly for each resident to ascertain ongoing requirements or cessation in order to best meet the needs of the resident.

4.3.14 The use of Thick and Easy or other fluid thickeners

The use of thickeners as for all prescribed medication must be for named residents only and not used for other residents who have not been prescribed this by their GP. Details of usage must be documented in the Nutrition Care or Support Plan (or equivalent) and stock levels checked on a regular weekly basis or sooner if necessary. Nurses and senior carers authorised to administer medication should ensure that all care staff involved in the usage of fluid thickeners are aware of the




quantity to be used (usually expressed as the number of scoops) for individual residents as per the instructions entered in the Nutrition Care or Support Plan.

4.3.15 Oral Anticoagulant medication

An Anticoagulant medicine is used to prevent or treat the formation of harmful blood clots within the body by making the blood take longer to clot. Warfarin is the most commonly used oral anticoagulant which must be monitored regularly, other anticoagulant medicines may be used and do not require regular INR monitoring e.g. Dabigatran. Each individual resident must have a risk assessment in place when prescribed anticoagulant medication.

Monitoring Anticoagulant Treatment

Whilst the resident is on Warfarin they must have a regular blood test called an INR test (International Normalised Ratio), these are very important. The results of the blood test will determine if the dose of the anticoagulant needs to be increased, decreased or stay the same. The anticoagulant clinic or GP surgery should give the resident an information booklet and an anticoagulant alert card. The residents will need to attend the anticoagulant clinic, and it is important to contact the GP/Clinic immediately if an appointment is missed. Alternative arrangements will need to be made for residents who are unable or incapable of attending the clinics.

The clinic or GP surgery will also issue treatment records (this may be a separate typewritten form which is sent after each blood test or in a yellow record book which summarises the recent and current anticoagulant therapy and regime.) that will indicate the latest blood test result, the dosage of anticoagulant and the date of the next blood test.

The procedure for regular blood testing and the use of the treatment card will need to be agreed with the resident’s GP and should be included in the residents care plan and also within the home’s medication policy.

Pharmacists are contractually required to request and review all INR record cards on each occasion that a prescription for an anticoagulant is received. The care home should fax a copy of the latest INR card entry to the pharmacy provider or attach a copy of the INR card to the prescription prior to collection / receipt of the prescriptions by the supplying pharmacy. Prior to the prescription being sent to xxxx Pharmacy the authorized person to check the prescription against the treatment card to ensure they correspond. Any discrepancies should be passed onto the GP and or Pharmacist immediately.

Pharmacists will dispense anticoagulant medicines in their original containers or white dispensing boxes usually with the instructions “Take Daily according to INR”. It is recommended that the care home adds a “note” for each Warfarin therapy with the words “Please refer to the separate INR communication for the latest dose of




Warfarin to administer”. This “note” will then appear each time an administration of Warfarin is required. All Warfarin medication must be administered in accordance with the INR yellow booklet or equivalent documentation provided by the anticoagulant team. The PCS device will not prompt with a dose for Warfarin and will refer staff to the INR documentation as the dosage can be variable from day to day according to the needs of the resident.

Warfarin is available in various strengths – 500 micrograms, 1mg, 3mg, 5mg - and great care should be taken to select the correct strength.

Upon receipt of the prescribed medicines the authorised Person must check the medicine, yellow treatment card and prescription correspond.

All changes to the strength of warfarin must be confirmed in writing by the GP or by a new prescription. Dosage changes often result as a review visit to the anticoagulant clinic who may directly inform the care home of any changes to medication strength via fax or letter. Dose changes should not be made unless authorised or confirmed in writing by the GP or the clinic.

1. Medicines Administration Records:a. The dose of Warfarin intended for the resident must be clearly stated on the

residents individual record received from the clinic/GP surgery. b. The words “as before” must never be used. c. Warfarin must never be administered before the fax, yellow book and

medicines administration records are cross-referenced for dose clarity or discrepancies.

d. If a hand written MAR sheet is required it is good practice to have the sheet checked and signed by a second member of staff for accuracy. The PCS device is not set up for a second witnessing signature and care homes should use their own documentation for these purposes if this is an agreed policy.

2. Administration:a. The least number of tablets required to provide the specific dose of Warfarin

should be administered to the resident. b. Avoiding breaking tablets in half. There are 500 microgram tablets available. c. Ensure that all administrations of Warfarin are carried out by using the PCS

device to scan the barcode on the medicines label.d. Ensure all members of staff are aware of the potential for error surrounding

500 microgram and 5mg tablets.

Pharmacists undertaking ‘Pharmacy Advice Visits’ to the homes will incorporate a check to ensure the home has written safe procedures for the administration of oral anticoagulants.

Home Managers should be satisfied that arrangements for the safe administration of Warfarin are in place and in accordance with the local arrangements as defined by their local anticoagulant clinic.




4.4 ‘When required’ PRN Medicines and variable dosage instructions on regular medication

When medicines are intended for use ‘when required’ (PRN), the label should state the minimum interval between doses and indicate reasons for use, e.g. for pain, for nausea. It should also include the maximum dosage which could be given within a twenty-four-hour period. This also applies to the PCS instructions. There should not be ambiguity in the dosage; e.g. ‘1 or 2 tabs to be taken three or four times a day when required’ and every effort should be made to contact the Pharmacist or GP to avoid the usage of these variable doses and a specific administration instruction obtained. The avoidance of variable administration instructions for regular medication as well as PRN medication must also be avoided and clarity sought from the GP or Pharmacist.

When PRN medicines are prescribed it is recommended that a clinical note is added against the medicines on the PCS. The note should state:

a) The maximum frequencyb) The maximum number of doses in 24 hoursc) The reason for treatment (e.g. for nausea)

If PRN medicine is not administered, the MAR record should not be left blank for that medication and should be identified as not required. This will prevent any blank entries on the MAR record .PRN medicine should not normally be administered as routine. All residents who are prescribed PRN medication must undergo an administration assessment plan for PRN medicines before administration. If a PRN medicine is being given on a regular basis, a discussion with the prescribing GP should take place with a view to it becoming a regular medication. A copy of the PRN administration plan should be kept available at all times for purposes of cross reference with the PCS record and the plan should be reviewed with the GP on a regular basis.

If PRNs are not being administered routinely then the dose reminder should be switched off. A summary of the key notes on the PRN assessment plan should also be entered into the appropriate notes section of the PCS.

PRN medication for sedative and tranquillising medication is not considered good practice and should be avoided or discouraged wherever possible. Where it is prescribed there must be a clear record of reasons and it must be reviewed on a monthly basis with the GP.

The administration plan should also include confirmation of structured or unstructured administration:

4.4.1 “Structured PRNs”

Medicines classed as “Structured PRN” are those with a “when required” dosage that must be offered at every medicines administration time. These would typically be medicines prescribed for pain relief or a condition that the resident is likely to experience on a regular basis. See below for an example PRN care plan:




Resident Name Mr A. N. OtherName, Strength and Form of medicine

Paracetamol 500mg Tablets

Prescribed Dosage Take ONE to Two four times a day When Required

What is the medicine prescribed for?

For general pain and osteoarthritis

When to give the medicine?

Offer the medicine to the resident up to four times a day and record if the resident refuses or does not require the medicine.

Assessment Criteria and signs to look for

If resident is rubbing knee joints or grimacing on getting up or complaining of pain

How many to give? Offer two tablets for maximum relief, remember to record the number of tablets administered and the time of administration

Maximum quantity and dosage interval

Maximum of Two tablets at any one time, at least four hours interval between dosages. Maximum of eight tablets per 24 hours

Extra Notes and instructions

Contact GP if pain relief is not achieved, or if the medicine is requested regularly as this will indicate the need for a review

Signature of author of the plan

A senior nurseDate: 01.01.2016

Date for Review Date: 01.06.20164.4.2 “Non-Structured PRNs”

Medicines classed as “Non-Structured PRN” are those with a “when required” dosage that must be used / offered on the rare occasion that a resident experiences a condition. These would typically be medicines prescribed for specific conditions for example to control behaviour or for relief of diarrhoea, constipation and dry skin. See below for an example PRN care plan.

Resident Name Mr A. N. OtherName, Strength and Form of medicine

Haloperidol 500mcg

Prescribed Dosage

Give 1-2 capsules when required for agitation

What is the medicine prescribed for?

To reduce agitation and restlessness

When to give the When the resident is in an extremely agitated state




medicine? that is likely to result in harm to the resident or others and when the methods below have been tried without any success:

Re-directing their attention to something interesting

Providing intensive one-to-one direct care Letting the resident have time alone Talking to the resident about what is

bothering them Removing the resident to a different area in

the nursing home Leaving the resident and returning at a later

timeAssessment Criteria and signs to look for

If the resident attempts to strike out at another resident or staff member. If the resident attempts to harm themselves for example throwing themselves out of bed.

How many to give?

Offer one capsule to start and then an additional capsule 6-8 hours later if still needed. Remember to record the number of capsules administered and the time of administration

Maximum quantity and dosage interval

Maximum of one capsule at any one time, and no more than 2 capsules in 24 hours. Call the GP if there is a need to give the medicine for more than 48 hours.

Extra Notes and instructions

Make sure that you have explored what the underlying cause of the agitation and restlessness is and try and resolve this if you can. Try all other methods of calming the resident before giving the medicine. Document all the signs and symptoms in the care plan.

Signature of author of the plan

A senior nurseDate: 01.01.2016

Date for Review Date: 01.06.2016

Any PRN medications which are being administered on a regular every day basis should be referred for review by the GP as should any PRN medications where there has not been an ongoing requirement for administration to the resident.

4.5 Prescribed Regular Medicines

4.5.1 Specific Times for Administration




Medicines intended to be given regularly shall be given every day at the times specified by the prescriber or pharmacist until the prescription is cancelled or instructions are given to the contrary. Careful consideration should be given to ensuring the resident receives their medication at appropriate intervals so as to ensure a safe therapeutic level is achieved especially when considering the resident’s routine. Medicines which are deemed to be time critical e.g. for Parkinsons disease, must be given at the time stated on the prescription/PCS and staff should ensure that any prescribed analgesic medication is administered at the right times to meet the needs of the resident e.g. early and near to rising if a resident suffers with joint pain when getting up or dressed and to allow a sufficient period of time between doses e.g. a minimum of four hours is required between doses of Paracetamol up to a maximum dose per day.Managers should ensure that every effort is made to complete medication rounds within a reasonable time period each day with particular emphasis on the main morning round wherever possible being completed each day by xxxxxxx e.g. 10.15am.

4.5.2 Hand written MAR records

A hand-written MAR sheet should only be completed in an emergency situation and where the PCS device is unusable. A printed MAR sheet can be requested directly from the PCS device for an individual or, for the whole home, the Invalife web portal allows paper MAR charts to be generated and printed.

4.5.3 Discontinued TreatmentWhen the treatment is to be discontinued, the PCS system should be used to discontinue the drug.

4.5.4 Change of Dosage – If a GP authorises a change of dosage to an existing medicine then this must be witnessed on the PCS device by a second authorised person and a note/reason of the changes also made in the notes section on the PCS device and care documentation.

4.5.5 Telephone/Verbal Instructions from GPs

GPs retain the right not to attend a patient. On occasions where a GP refuses to attend a resident, this must be fully recorded within the resident’s Care Documentation.

In an emergency a Nominated/Authorised Person may accept a verbal instruction from a GP for a change to instructions for existing medication as long as the GP then reiterates the instructions to a second Authorised Person or nominated person who fully understands the process. Each then writes down the instructions, compares, and confirms, dates and signs records in the care plan sheet. This should be followed up as appropriate with the GP if practical and a signature obtained from the GP and the pharmacist informed of any changes for future medication supply e.g. via a pharmacy servicer user update form (copies available from your local supplying pharmacy) or directly via the PCS device.

4.5.6 Urgent prescriptions obtained out of hours from late night Pharmacies




Urgent prescriptions can be obtained from local late night or out of town Pharmacies. Arrangements should be made to contact the Pharmacist in the first instance to establish that the medication is available and the prescription should be taken or faxed to the Pharmacy and arrangements for delivery or collection agreed. The nurse or senior carer on duty is responsible for ensuring that a photocopy of the prescription is taken and kept at the home and on delivery / receipt of the medication, an entry for the medications is made onto the PCS device and a check made to ensure that the correct medication for the resident with correct dosage has been supplied and recorded and a second signatory obtained for the PCS entry.

4.6 Records of medicines administered using PCSIt is a requirement to keep records of all medicines administered to a resident including prescribed and non - prescribed medicines. The care home records of medicines administered will be kept on the PCS device and downloaded on to a central database. The historical records of medicines administered over the previous three years will be made available to the care home on request to the Invalife support desk. These MAR records must be printed by the care home at the end of each complete cycle or PDF versions downloaded from Invalife and stored securely. These records should be available to show CQC/HB / Local Authority inspectors or compliance teams on request.

The records will contain the following information: Name and date of birth of the resident, and their room number if appropriate. Details of any allergies that the resident may have. Name, strength and route of all medicines. Frequency and times of administration. Any special instructions such as “before food” Codes to explain reasons for omission. As required medication should have information on maximum dosage and

frequency – PCS does not capture this detail for all PRN medication and where this information is absent, the care home must ensure that details are correct and assistance sought from the pharmacy provider if required.

Please note that in addition to the medicines administration records described above, care homes can access a detailed record for every transaction via Invalife relating to a resident’s specific medicine. This detailed record must be accessed/requested in scenarios where inspectors or others wish to carry out a detailed investigation or for the purposes of audit or clinical reviews with GPs or pharmacists.

To ensure accurate records are maintained on the PCS device the following requirements must be observed by all staff:

Always ensure that the most up to date information is on the device by “docking” the device before and after each medication round.

Always scan the barcode on the medicine label prior to administering the medicines. This gives you an extra level of safety.

Use the device to account for the administrations. Complete one resident’s transaction and then move on to another resident. .




Account for all medicines which are due for administration. These are indicated by being displayed against a red background. There should be no “red” unaccounted medicines at the end of each residents medication episode or the completed medication round even if a medicine has been potted / not potted and not administered

The administration of topical preparations and nutritional supplements must always be accounted for on the PCS device. The administration of emollients and/or barrier creams which are applied by carers who do not have access to the PCS device, need not be recorded on the PCS device. For these preparations a suitable paper topical MAR record Emollients” can be used. Dressings should be accounted for on the resident’s care plan.If paper MAR records are used in place of direct PCS entry then it is imperative that this is coded and referenced on the PCS device. Nurses and senior carers must conduct random checks to ensure that paper MAR entries completed by trained carers are correct and complete.

If a medicine is not given then the reason must always be clearly stated. The PCS device provides a list of reasons for why medicines are not administered.

The administration of homely remedies must always be recorded on the PCS device in addition to the use of a stock administration / management record

Ensure there are PRN assessment plans completed for all individual “when required” medicines. This ensures a consistent approach to offering to administer medicines which may be needed regularly and those medicines which may only be needed when the resident experiences a specific condition. Please note that PRN plans should also be recorded in the resident’s care documentation.

The actual quantity of medicines given must always be recorded for variable doses e.g. 1 or 2 tablets three to four times a day

If a dose is changed following advice from the resident’s GP, then update this information via the PCS system with a second signatory. Then “dock” the device to ensure the new information is updated on the device and to the central database. A note should also be made in the care plan.

Controlled drugs administrations are recorded on the device as well as the CD register. To ensure there is full adherence to CD requirements, the PCS device will require a second member of staff to witness administration of controlled drugs.

Account for all “missing entries” at the end of each medication round. At hand over meetings the PCS device should not be accepted unless all “missing entries” have been accounted for.

4.6.1 Audit of Medication Administration Records and medicines related activities through the Invalife Web portal

All records of administration, medicines received, copies of original prescriptions, and medicines orders are available via the online system.

It is a requirement that all care home managers access the Invalife web portal reports to audit and monitor administration records as well as all other medicines related activities. The information on Invalife web portal can be used for the following purposes:

To investigate interim orders placed To review copies of original prescriptions for residents To investigate medicines received




To review recent dosage changes To print drug information (being developed) To review administration times for each resident To print paper MAR charts

Managers should ensure that Invalife Web portal is accessed at least on a monthly basis to review the following:

Number of missed doses for residents. The reasons for missed doses Percentage of medicines administered using barcode validation. Performance of individual staff in terms of medicines administrations Progress of the care home in terms of the medicines management cycle.

Managers should review the management information reports available on the Invalife Web portal to ensure that the fundamental requirements for the use of PCS are being maintained.

The fundamental requirements are captured on the daily reports which managers and deputies receive as an email.

Care home managers may be required to report the actions following their internal medication/PCS audits to their allocated Quality Assurance Manager (or equivalent).

The Quality Assurance Managers (or equivalent), if in place, are also required to monitor the performance of each home and take appropriate action.Care home organisations should consider the use of their own internal medication audits to assess performance and compliance in addition to the medication audits provided by local compliance teams and the regular pharmacy provider.

Monitoring the use of medicinesStaff members who administer medicines are required to monitor and report on the wellness of residents after taking medicines. These observations of residents are essential and can be recorded as PCS notes as well as entered into the relevant section of the residents care documentation.

The observations will help the resident’s GP to decide if side effects are being experienced as a result of the new medicines or if the resident is allergic or intolerant to that particular medicine. These observations may also help the GP in considering alternative treatments or medicines.

Nurses and senior carers are able to report all incidents where residents have experienced side effects or intolerance to medication to the GP immediately and via the yellow card reporting procedure at yellowcard.mhra.gov.uk

4.6.2 Clinical readings and monitoring testsRequirements for clinical readings e.g. pulse, and monitoring tests e.g. INR result must be observed by all members of staff who administer medicines. The recording and taking of pulses or other readings should only be conducted by nursing staff. In residential homes this should be conducted by visiting community nurses.




The PCS device will prompt to record the pulse readings associated with the administration of Digoxin only. Care homes must add in prompts for other medicines via the PCS notes facility according to the care home medication policy.

Members of staff must be vigilant and ensure that residents attend any appointments for monitoring tests requested by GPs or clinics to include anticoagulants, dentist, chiropodists opticians and any other appropriate healthcare professionals or clinicians.

4.6.3 Access to Medicines InformationStaff members must have access to medicines information to help monitor the use of medicines and report on potential side effects.

Patient information leaflets are available in the packaging of the medicines supplied..

The following resources are recommended as a source of medicine information: The British National Formulary (BNF) which provides detailed information about

prescription only medicines (www.bnf.org ) Patient information leaflets (PILs) available in the medicines original packs or from

the pharmacy. These usually list what the medicine is for, common side effects and how the medicines should be stored (www.emc.medicines.org).

You may also contact your supplying pharmacy and speak to one of the pharmacists

It is the responsibility of the care home manger to ensure that staff members know how to access this information.

4.7 Self-administration of medicinesSelf-administration of medicines by residents is good practice and should be the route of choice in order to promote independence, offer dignity and respect and encourage residents to have greater control of their own care. The right of a resident to take responsibility for his or her own medication must be observed at all times. New residents to the care home must always be offered the choice of self-administration of some or all of their medicines.

Self-administration or self-medication is not an “all or nothing” scenario. Some residents may wish to self-medicate eye drops, inhalers or creams but allow the home to take care of their tablets. There may be situations where a resident wishes to retain custody of all their medicines but needs some help at the time of administration. Safely enabling any degree of self-medication is always considered good practice and residents who wish to self-medicate should be encouraged to do so.

In general, the care home takes full responsibility for the re-ordering of medication and making sure that a resident has full access to all of their medication at all times.

Should a resident wish to self-administer any medication then an individual assessment must be made to confirm that self- medication is suitable and safe for the resident.

This assessment should be reviewed after an appropriate period of time.

A record must be kept of the medicines given to residents for the purposes of self-medication.

http://www.bnf.org/




Effort should be made to monitor compliance by the resident and issues should be reported and acted on and a new assessment conducted as appropriate.Residents who self-medicate must be provided with a lockable drawer or cupboard for the storage of all of their medicines. There must be adequate procedures in place to ensure residents understand that medicines must be locked away and the care home must ensure that this happens.

The PCS device allows for self-administration of medicines and the care homes are required to change the medicines “management” settings to “Self-Medicating”. This allows for PCS to be used for the re-ordering of medication along with all other medication orders for the care home.

4.8 Homely RemediesA homely remedy is a medicine that can be obtained without a prescription that is used for treating minor self-limiting ailments e.g. diarrhoea, headaches, cough and dry skin.

Homely Remedies are usually purchased from a pharmacy and held by the care home as stock; they should be stored in a lockable medicine cupboard and separate from all prescribed medicines and clearly marked as “Homely Remedies”.

The person-in-charge, the pharmacist and the GPs should approve a list of medicines that are to be made available as Homely Remedies, and a letter should be sent to GPs for approval of homely remedies for all individual residents. Only those medicines on the approved list may be used for that resident. The situations under which staff can administer Homely Remedies are detailed below.

The directions on the box or bottle should be followed carefully and generally they should only be administered for a maximum of two days without the pharmacist or GP being consulted. This will be dependent upon your care home’s policy and the wishes of the individual GPs.

The administration of all Homely Remedies must always be recorded on the PCS device. This will involve adding the Homely Remedy to the resident’s record and ensuring that the settings for the medicine is set to Homely Remedy.




If there is any doubt as to whether a Homely Remedy is suitable for a particular resident, for example interaction with current regular medication, then the pharmacist or GP should be consulted.

Expiry dates of Homely Remedies should be checked regularly by the care home and a record kept of these checks.

Medicines brought in by a resident or friend or relative must be reviewed against the list of approved homely remedies to be used for that resident. If they are not on the approved list, they should be removed and not administered to the resident. If the medicines are on the approved homely remedy list then they should only be used for that resident. The care home manager and GP should be consulted where a resident or relative is insistent on providing non-prescribed medication for a resident.

Dressings and items for first-aid, etc. are NOT classed as homely remedies.

All homely remedies must be purchased by the home and clearly labelled ‘Homely remedies’. They are to be stored in a safe and secure area in the medication room

This policy sets out a range of conditions or symptoms considered appropriate for this type of medication:

Indigestion Mild Pain Coughs Constipation Mild diarrhoea Mild skin conditions

Remedies should only be administered to residents at the discretion of the senior person on duty. They should be administered to the resident according to the criteria and instructions given.

Homely remedies should only be administered to a resident for a maximum of two days. If it is considered that there is a need for continued treatment, the doctor should be contacted and the appropriate medicine prescribed.

Recommended conditions and Homely Remedies to be used

Constipation and Recommended Laxatives: Senna Tablets: 1 – 3 Tablets at bedtime. Start with a low dose on the first day,

increasing very gradually (if necessary, only half a tablet) at the same time on the following day or

Senokot Syrup: 2 – 4 x 5ml spoonfuls at bedtime. Note: Syrups are unsuitable for Diabetics

Most people do not need regular doses of any laxative. Constipation may be corrected by increasing the amount of fibre and possibly fluids, in the diet.

Side effects: If the dosage adjustments are too large, tummy griping and diahorrea

may result. Small dosage adjustments avoid this problem.




The correct dose is reached when a soft, well-formed bowel motion is produced.

Senna may colour the urine yellow/ red – this is a normal and harmless effect.

IF CONSTIPATION PERSISTS, CONSULT A MEDICAL PRACTITIONER

Cough: Simple Linctus ( Unsuitable for diabetics): Dose 2 x 5ml spoonfuls up to

three times daily and at night Cough mixtures may be used occasionally when the cough is troublesome.

They are rarely effective but people have come to believe in them. CAUTION: BE AWARE OF THE EFFECT OF SYRUPS TAKEN BY

DIABETICS AS NOT ALL SYRUPS ARE SUITABLE.

Indigestion Magnesium Trisilicate mixture: Dose 10 – 20 mls up to 4 times daily, in

between meals and at bedtime if required Side effects: Too much can cause loose motions/ diarrhoea Precautions: Indigestion is likely to be brought on by heavy and/ or fatty

meals, eating too quickly, smoking, and drinking alcohol. Do not give indigestion remedies to residents who are prescribed drugs for acid conditions of the stomach such as H2 inhibitors (Zantac) and PPI’s (Omeprazole/ Losec). Discard after 4 weeks of opening.

Mild Diarrhoea Dioralyte sachets: Dose: the contents of one sachet to be mixed with

200ml of water and taken slowly. Up to 4 sachets may be used a day. Precautions: If diarrhoea persists for more than 48 hours contact the

doctor.Pain (Mild, e.g. Headache, toothache) Paracetamol Tablets 500mg, Soluble Paracetamol Tablets: Dose Adults – 2

tablets (1 gram) up to 4 times daily. No more than 8 tablets in 24 hours) for occasional pain.

Precautions: For any persistent pain, painful movement or pain which is not controlled by paracetamol, consult a doctor. Records need to be kept with regard to dose, frequency, maximum daily dose, indications for the drugs use, and the time of day administered. Ensure that the maximum dose is not exceeded by other drugs already prescribed which contain hidden paracetamol, e.g. Co- proxamol, Co-dydramol.




5 Ordering and receiving medicines in to the care home

5.1 IntroductionThe over-riding principles of this section of the policy are to ensure that the ordering and receipt of medicines is carried out in a timely manner so that residents do not run out of medicines and hence go without taking important medicines. Equally important is to ensure that there is not an excessive amount of stock of medicines which could expire and become a high wastage cost to the NHS.

This section describes the processes that must be followed in the ordering of prescriptions, their collection, delivery, booking in to the care home and checking the details of prescriptions.

5.2 Determining which medicines are neededStaff members must be specific about which medicines are necessary to be re-ordered. Below is a list of specific requirements that must be complied with:

Ordering medicines that are taken regularly by residents and ordered via repeat prescriptions. These medicines are usually ordered on a monthly basis. These are referred to as “Monthly medicines”.

Order those medicines which have a supply of less than 9 days remaining and which are likely to run out before the next delivery is made. These are referred to as “Interim medicines”.

Orders for prescriptions must be made in good time. It is recommended that medicines are ordered at least 9 days before they are due to run out.

Do not order medicines which are used infrequently and whose stock are going to last for a number of weeks e.g. PRN medication

Take care to consider carefully the quantities needed for medicines whose quantities are difficult to predict to last four weeks e.g. Creams and ointment. It is important not to over order or stockpile. Equally, it is essential that you do not run out of stock and are able to maintain ongoing administration of all medicines

Please note the PCS device has a facility that keeps a running total of stocks of medicines and prompts you to order medicines that are running low. In addition the PCS device will prompt items that need to have a stock take. It is a requirement of this policy that these stock take prompts are acted on immediately. Failure to comply with this guidance can result in residents not being given their appropriate medication and this may lead to disciplinary action if staff have not been compliant with the above processes.

Accounting for dressings and appliancesThe PCS device will not prompt the application of dressings or the use of appliances. This is because the uses of these items are not predictable and they are often applied by other personnel (e.g. district nurses) outside the normal medicines administration rounds. The PCS device, however, must be used to place orders for these items if required.

Dressings and appliances must be accounted for on paper Administration Plans




The Dressing and Appliance administration plans are to be kept securely in the resident’s room, or the treatment room, together with the dressings and appliances to comply with security and confidentiality requirements. Dressings which are used regularly may be kept in the residents room and stored in a secure place to ensure dignity for the resident at all times.

5.3 The prescription ordering processThe ordering of all prescriptions must be processed using the PCS device. This will ensure that the supplying pharmacy know when to collect the authorised prescriptions and that there is information on the status of the order. There will be variations in the prescription ordering process which is dependent on the preference of the GP surgery. The process involves the following:

1. Sending a written /printed request to the resident’s GP for the required medicines with the appropriate details including resident’s name and date of birth, medicine name strength and form, dosage instruction and quantity needed.

As a preference, care homes should print off the monthly / interim medicines order summary report and seek the permission of all supplying surgeries to accept this mode of re-ordering which will save valuable nurse and carer time.

* Note some surgeries insist on the use of the right hand side copy of prescriptions (or a paper copy of the most recent PCS records) which have a list of resident’s active medicines as the written request. These are known as “repeat slips”.

It is imperative that the correct agreed method of sending requests for prescriptions to GPs is used.

2. The prescription clerk / receptionist at the medical surgery will print off a prescription for the items, if appropriate.

Note some medicines may not be able to be issued by the prescription clerk as these may need to be reviewed by the GP. This can cause a delay in issuing of the prescription and the receipt of the supply of the medicines.

3. The GP then signs the printed prescriptions and thus authorises the supply.

4. The prescriptions are now ready to be collected from the surgery for dispensing and supply. Your SLA with your Pharmacy should confirm collection arrangements.

5. The status of the prescription orders placed can be checked on the PCS device. This is categorised by “Monthly” and “Interim” prescription orders. The pharmacy will also send a Monthly Outstanding Report to the care home, indicating items that have been ordered by the care home but where a prescription has not been received.

6. The images of all prescriptions received at the pharmacy, will be available to be reviewed on the Invalife Website.

7. Appropriate members of care home staff are required to review both the status of the orders and to actively resolve any discrepancies with the surgery. In this way the risk




of non-availability of medicines for monthly and interim medicines is reduced and requirements for checking of prescriptions is adhered to (See section 5.7). Your pharmacy provider must be updated with the details of the issues resolved.

Please note that most practices state that requests for prescriptions take at least 48 hours to process providing that there are no further problems or clarifications required. In practice 48 hours is too short a time and this is the reason why this policy states that medicines are ordered at least 9 days before they are due to run out.

5.4 The prescription collection, dispensing and delivery processOnce the prescriptions have been authorised by the GP, they are ready for collection and dispensing.

Your supplying pharmacy will collect the vast majority of authorised prescriptions. This process involves the following:

1. Pharmacy collects authorised prescriptions from surgeries in the mornings Please note: sometimes the authorised prescriptions are not ready at the time

that the Pharmacy visits the surgery. This can further delay the supply to the care home.

Please note: sometimes not all of the requested medicines are issued at the same time, especially in the case of monthly medicines and the pharmacy may need to make more than one visit to the surgery. This can further delay the supply to the care home.

2. Prescriptions are taken back to the Pharmacy for dispensing Medicines sometimes need to be ordered. This can further delay the supply to

the care home.

3. Medicines are dispensed

4. Deliveries of the dispensed medicines are made to the care home at an agreed time e.g. a.m. or p.m. and on an agreed day (unless there are urgent items) as confirmed in the Service Level Agreement (SLA).

Each of the processes above can potentially delay the medicine reaching the care home. This is why it is important to order medicines in plenty of time.

For Interim medicines, this policy states that medicines are ordered at least 9 days before they are due to run out. Monthly medicines are ordered on or before day 8 of the current medicine cycle.

5.5. Interim prescriptionsInterim medicines are defined as those medicines that are outside of the monthly medicines supply process. For example there may be times when a resident may be running low on their “PRN” medication due to more regular usage or stock is in short supply due to a resident regularly refusing their medication which has already been potted.




When making requests for these medicines from the surgeries it is a requirement that all relevant information be provided to the surgery so that there is an understanding as to why the extra request is being made and how quickly it is needed.The order for the interim items must be placed on the PCS device. This involves selecting the specific medicine that is required from the resident’s record and then selecting the “Order Interim” option. Any other local arrangements must be communicated to and understood by relevant pharmacy and care home staff.

The status of the interim order can also be viewed on the device so that its progress can be determined.

5.5.1 Urgent prescription left at the care home

In the scenario where a GP visits the resident and leaves a prescription at the home which needs to be administered the same day the following actions must be taken:

Fax the prescription immediately to your Pharmacy. If the faxed prescription is received by the pharmacy before the agreed cut off

time, the supply will be delivered the same day, subject to the item being in stock. If the prescription is issued after your agreed cut off time, please ring your

Pharmacy after faxing the prescription to see if the supply can be made on the same day.

o If this is not possible for delivery the same day, ask when the delivery will be made the following day.

If it is important that the resident has the medicine on the same day and if the Pharmacy cannot deliver, then you will have to arrange to have the medicine dispensed at another pharmacy.

o If new medicines are obtained from another pharmacy, please ensure that you update the resident’s records via the PCS device.

oUrgent prescription left at the GP surgery.

In the scenario where a GP visits the resident and informs you that he/she will write an urgent prescription when they get back to the surgery.

You MUST as a matter of urgency inform your Pharmacy via the phone that there is an urgent prescription at the surgery for the resident.

The Pharmacy will then contact the surgery, explain that the prescription is urgent and ask the surgery to fax the prescription to the Pharmacy for same day delivery.

Please note that the surgery may refuse to fax prescriptions, in which case you will have to arrange for the prescription to be collected and brought to the home for faxing to the Pharmacy or delivered directly to the Pharmacy

Also note that there will be occasions when the prescription is issued after the locally agreed cut off time which means that you may have to take the prescription to another pharmacy for dispensing.

o If new medicines are obtained from another pharmacy, please ensure that you update the resident’s records using the PCS device.

Urgent prescriptions for controlled drugsThe Pharmacy cannot legally dispense controlled drugs without the original copy of the prescription. For this reason the Service Level agreement must state the procedures that must be adopted to ensure:




There is no delay to the administration of medication to the resident All legal and regulatory requirements for controlled drugs are complied with

5.5.2. Receiving an interim supply of medicinesThere are several key actions to perform on receipt of interim supplies of medicines:

Any prescriptions that have been faxed to the pharmacy must be handed over to the driver at the time of delivery before the supply can be made.

Check and sign the driver’s delivery sheet. Note in the case of controlled drugs the person in charge should receive the delivery and do an actual count of the number of CD medicines received.

Controlled drugs should also be booked into the Controlled Drugs register and witnessed by a second authorised person.

Book in stock using the PCS device by selecting the “Book In Stock” functionality and simply scan the barcode on the dispensing label of the items.

5.6. Monthly medication cycle – further information5.6.1. General Requirements

Resident’s regular medicines are usually prescribed on a monthly basis. These regular medicines are referred to “Monthly” medicines. Their ordering, delivery and administration follows a four week cycle.

The following are key requirements for the management of the monthly medicines cycle: Ensure that the records of the medicines for each resident at the care home are an

exact match of the records held on the PCS device and therefore at your Pharmacy. Ensure the timely ordering of requests for prescriptions. Ensure that all items requested have been issued by the surgery and if they have not

what the reasons are. This requires close liaison with the Pharmacy who collect prescriptions on behalf of the care home.

Ensure the proper procedures for receipt and booking in of the medicines. Ensure there is the ability to check issued prescriptions by using the Invalife web

portal and if necessary print copies of prescriptions. Ensure there is the ability to present a full audit trail of all activities involved in the

monthly medication cycle in the event that something goes wrong.

The first day of administering the new supply of the monthly medicines is defined as day 1, of Week 1 of the new cycle. There are 4 weeks/28 days in the Monthly Medication Cycle.

The section below describes the monthly process that is to be followed using the PCS device.

5.6.2. Monthly process using the PCS device

The following steps must be acted up on in a timely manner to ensure the monthly process is efficient:

Step 1 Placing orders on PCS




The first step is the initiation of the order process. The PCS device will prompt that the monthly order is due from the beginning of your medication cycle. The device will continue to prompt this message until the order is sent. It is imperative that the monthly order is sent by Day 8 of your medication cycle.

The PCS device will highlight all medicines that should be accounted for; you are simply required to confirm if an individual medicine is “required” or “not required”. It is essential that the stock levels are correct otherwise you will be supplied with too much or too little stock for a particular resident.

There are items that the PCS device cannot calculate an order quantity. For these items you are also required to manually input the required order quantity. These items include:

Dressings or medicines being self- administered Medicines that have unclear dosages (e.g. Use as directed) Medicines that do not have specific unit of measure (e.g. creams, drops and gels)

To place the monthly order follow the steps below on the PCS device: 1. Before you place your monthly order; make sure all outstanding stock takes are done;

Make sure all PCS Alerts are answered and dealt with

2. Now go into the “Manage orders screen and the Monthly orders tab” 3. Go through the items that need manual ordering and order these if needed.

4. When the order is ready, select “complete order” and synchronise the device 5. A copy of the order you have just placed will be emailed to your home. It can also be

downloaded on the Invalife web portal.

Step 2 Ordering the monthly prescriptionsThe process of ordering of monthly prescriptions is dependent on the repeat prescription request process at the surgery. Some surgeries will give consent to using the monthly summary order reports information transmitted from the PCS device in Step 1. If this is the case then no further action is needed.

Other surgeries insist on the use of the right hand side copy of the prescription often referred to as “Repeat slips”. In this case you are required to complete the “Repeat slips” by using the copy of the order that you have placed on the PCS device (faxed to you after transmission) and ensuring that the same items are ordered on the “Repeat Slips”. The “Repeat slips” need to be sent to the surgery.

Step 3 Collecting your monthly prescriptions and reconciliation against PCS orderIn the majority of cases the Pharmacy will collect the monthly prescriptions on behalf of the care home. At this stage it is important for you to have the ability to check the prescriptions to ensure that what you have ordered on the PCS device has been received by the Pharmacy. The image of every prescription collected on your behalf is available for viewing on the Invalife website.

If your care home collects your own prescriptions then it is important that they are available to be collected from your home ASAP and according to the Service Level Agreement with your Pharmacy. Any delay in collection of your prescriptions could delay the supply of monthly medicines for the residents and this could lead to medicines not being administered.




Please note that monthly medication prescriptions must be collected from the care home and should not be faxed to the Pharmacy, unless agreed otherwise with your GP surgery and Pharmacy.

Step 4 Checking of missing prescriptions and discrepanciesIn this step the Pharmacy compares the collected prescriptions with the medicines ordered on the PCS device. The Pharmacy then provides a “monthly outstanding report on day 21” that staff can use to check progress on obtaining residents prescriptions and allowing sufficient time for any discrepancies to be resolved prior to the start of the new cycle.

Note that there will always be prescription requests that will take longer to resolve with the surgery e.g. due to clinical checks with the GP, out of stocks or discontinued items. This is the reason why sometimes deliveries for these “late resolved” medicines are made separate to the rest of the monthly medicines.

Step 5 Dispensing, packaging and deliveryOnce the vast majority of the prescriptions for the care home have been received by the pharmacy, the dispensing process is initiated.

Deliveries are made to the home on a pre-arranged day before the new supply has to be initiated. Although it is preferable that the supply of monthly medication is made as a single delivery, it is accepted that late prescriptions and “owings” will be delivered as they are made available.

Step 6 Booking in your monthly medication supply with the PCS deviceThe monthly medication supply must be delivered in sealed boxes.

The supply for each unit within the home will be packed separately.

Controlled drugs will be supplied separately. Fridge Items and specials will be clearly identified and supplied separately.

You will be required to sign the driver’s paper delivery sheet or electronic device.

The PCS device will book in each item and check it against the monthly order by simply scanning the dispensing barcode. To book in your medication; 1. Synchronise PCS before you start booking in medication 2. From the main menu screen select “manage stock and the Book in tab”

3. Pick up the item you wish to book in 4. Barcode scan the dispensing label and check the quantity is correct

5. Repeat this process until all items have been booked in and the screen is clear 6. Put the stock away into the relevant places

Any items that have not been received or are outstanding can be seen on the screen. Controlled Drugs must be entered into the CD register as well as being booked into PCS.




If there is a discrepancy or an item is damaged or has the wrong quantity in the box, you must report this to the Pharmacy at the time of booking in.

Step 7 New medication cycleTransfer the medicines received in to the appropriate storage compartments in the medicines trolley or store any excess or bulky items in the medicines cupboards. The new medication cycle can now begin on day 1.

5.7. Checking of authorised prescriptions via Invalife web portalOnly members of staff who have the correct permissions have the ability to check authorized prescriptions. There are several reasons for this including:

1. The prescription is the legal document that authorises the supply and administration of the medicines to residents. The medicines have to be administered according to the directions on the prescription. If the prescription has a direction different to the one being administered then technically the administration is illegal. It is therefore very important for the directions on the prescription to match exactly the administration of medicines to the residents.

2. Supplied quantities must match the prescribed quantities. In some situations you may find that you have not received enough medicines to last the whole monthly medication cycle. In these situations you should check the prescribed quantity to see if this was the quantity that was supplied. On occasions, your Pharmacy may be required to owe you items which are in short supply or out of stock.

3. There will be situations where you did not receive the medicine that you were expecting. In these situations you should check the prescriptions to see if the medicine was issued or not.

4. Wrong medicines dispensed. In some situations you may find that you have received a different medicine or strength to what was expected. This may be due to a dispensing error and by checking the copy of the prescription you will be able to determine this.

5. Viewing of prescriptions is also important to ensure that the Pharmacy has made a supply or accounted for every prescription collected from the GP surgery.

The images of prescriptions can be viewed against specific orders placed by the care home and categorized as interim or monthly prescription requests.

These systems therefore allow all the checks to be made whilst ensuring that there are no delays in the medicines supply process.

The Pharmacy should be contacted promptly if there is a perceived discrepancy in the supply or administration instructions of medicines.




5.7.1 The Invalife Web PortalAll members of staff must first register with the Invalife web portal. On Invalife they can access e-learning and be given permission to administer medicines and view patient information if appropriate.

The care home manager will usually have administration rights for determining roles and access of different members of staff.

The internet address https://www.invalife.com will take you to the Invalife web portal. Users are required to register and indicate which organisation they want to be linked to. They are then provided with a verification email confirming their login details. The care home manager then enables the user access to the following list of information and facilities detailed below, if appropriate:

Records of resident’s medicines which can be checked and any discrepancies can be communicated to the Pharmacy

To print a summary of the resident’s medicines in the case of emergency admission in to hospital, or an urgent visit by an out of hours GP, or on discharge from the care home.

Advanced features including:o Viewing of Monthly and Interim orders (also available on the PCS device)o Viewing of items returnedo Clinical Management Reports (CMR) which provides a thorough review of the

resident’s medication therapy including items administered.(being developed)o Current and Previous Month’s administration records (MAR)o Daily report of how medicines have been managed

Care Home Managers should ensure that Invalife Web Portal is accessed at least every week to review the following:

Number of missed doses for residents. The reasons for missed doses Percentage of medicines administered using barcode validation. Performance of staff by exception in terms of medicines administrations Progress of the care home in terms of the medicines management cycle. Report any issues to the allocated Quality Assurance Manager (or equivalent)

<<Insert Company Name>> Quality Assurance Manager (or equivalent) are required to also monitor the performance of each care home using the Invalife web portal and to act appropriately to improve medicines management in the care home.

5.8. Communicating with the Pharmacy All changes to a resident’s therapy must be communicated to the Pharmacy preferably using the PCS device. This will ensure that the medicine records at the Pharmacy are correct and accurate at all times.

5.8.1. New Resident Registration requirements When new residents come in to the home their up to date and accurate medication details must be inputted directly on to the PCS device.

https://www.invalife.com/




6. Special considerations

6.1 IntroductionIn this section a number of policies relating to specific medicines management issues are detailed. These include:

• Promoting independence, informed consent and freedom of choice• Data protection and confidentiality• Evidencing and demonstrating quality of Medicines management to inspectors• Reducing the risks of medicines management in care homes and overcoming

common issues

6.2 Promoting IndependenceCare homes are to be regarded as the place of residence for people where they can carry out all activities independently in a supportive environment. This philosophy should also apply to their medicines and residents should be encouraged to take responsibility for some or all of their medicines.

All residents will be given the choice to act independently and take responsibility for some or all of their medicines. There will be an assessment of the appropriateness to self-administer and the level of support required.

6.3 Informed consent and freedom of choiceEvery resident has the right to know and understand the treatment that they are being given and the right to choose to take the medicine and treatment. The resident’s GP should deal with the issue of consent to treat. However there will be occasions when the resident may ask for more information on medicines.

All members of staff at the care home should have access to drug information in the form of a British National Formulary as well as the patient information leaflets provided with the dispensed medicines.

6.4 Confidentiality and data protectionConfidentiality is an important aspect of care in any organisation. This policy states that only staff members who are trained and or appropriately qualified in administering medicines can have access to resident’s personal and medicines records. This information can also be shared with other care providers such as your Pharmacy , GPs and social workers if appropriate. Resident’s issues and details should not be shared with anyone who is not directly involved in the care of that resident.

The Data Protection Act requires that resident’s details are secure. Therefore the PCS device and all paper administration plans and management information reports must be locked away when not being used.

The Invalife website portal has a number of features that ensures data is secure and access is only provided to authorised personnel. These include:

1. An established process for registering and verification of the person2. Unique PIN number for each person




3. A process where the care home manager can accept the person in to the organisation and set their access level in terms of ability to view resident’s information. In addition the care home manager has the ability to determine the period of access.

4. Access to patient sensitive information requires a further two factor authentication5. All patient sensitive information emailed is encrypted.

6.5 Care home inspections and medicines – see section 1.3 for further guidance

For Care Homes in England

The Care Quality Commission refers to Regulation 12 of the HSCA 2008. This lists the expectations of care homes in relation to medicines management. Care homes should also be aware of the new inspection process introduced from October 2014 involving the new Key Lines of Enquiry model. Further information can be obtained directly from the CQC website – ‘How we inspect and regulate’.(see section 1.3 for further details) For Care Homes in Wales

The Care and Social Services Inspectorate Wales has published Standard 17 on minimum standards for medication in care homes




6.6 Residents Medication Reviews by GPs or PharmacistsAll residents should have their medication reviewed by their GP or Pharmacist at least every twelve months or sooner if required and in accordance with their care plan requirements. Care home staff should seek the advice of the GP for more frequent reviews if it is deemed to be in the best interest of the resident.

The PCS device and the Invalife web portal can help care home staff and Pharmacists to identify residents who can benefit most from medication reviews and also to provide a list of issues to be considered.

The Invalife web portal can be used to print out a clinical summary of all the potential medication related issues that the resident’s GP should consider.

If adverse effects of medication are observed this shall be an issue documented in a care plan, written in the resident’s notes and the prescribing doctor contacted immediately to review the medication. If the prescribing doctor is not available then another doctor shall be contacted.

It is the responsibility of the staff in charge of the unit/ home to document adverse effects of medication and to contact the doctor to report adverse effects.

If chronic adverse effects are observed then the medication should not be given until the situation is discussed at length with a doctor.

It is the ultimate responsibility of the Home manager to ensure that a resident’s medication regime is reviewed in full at least every twelve months.

It is essential that any dosage changes are inputted directly on the PCS device in the normal way to ensure that the PCS device is updated.

7. Procedure for dealing with medication errors

7.1. Medication errorsMedication errors are almost never the result of a single, isolated human error. Instead, they result from multiple small breakdowns in the systems for managing medication. For this reason this policy makes a requirement for all medication errors to be investigated by the care home manager. The learning from these errors must be communicated to all appropriate members of staff.

If a medication administration error occurs the following steps must be carried out: The incident must be reported to the care home manager immediately for prompt and

urgent investigation and action and the safety, best interests and wellbeing of the resident remaining paramount at all times

The medication error should be documented on a medication incident form and a copy should be stored with the resident’s care plan.

The care home manager should seek the advice of a pharmacist from the supplying Pharmacy or the care home Quality Assurance Manager (or equivalent) as to the seriousness of the medication error and the effect on the resident.




The resident’s GP should be informed promptly and the actions recommended must be implemented and documented.

The need to report the error to CQC/CSSIW should be discussed with the care home managers line manager and where necessary it should be reported to the CQC/ CSSIW central telephone line and local compliance team as per local contractual arrangements.

If the medication error is suspected to be a result of a dispensing error or a failure in service delivery, this should be immediately reported to the issuing Pharmacy. The Pharmacy will carry out an internal investigation and respond to the care home manager within the agreed timescales contained in the SLA of receiving news of the incident. Attempting to conceal any error within the care home may result in a disciplinary action against individuals.

The following are strategies that care home managers should implement to reduce the risk of occurrence of medication errors:

Ensure that staff administer medicines using the PCS device to scan the barcode on the medicine label

Lighting in medication dispensing areas must be adequate Members of staff who administer medicines must be protected from interruptions

and distractions Ensure room temperature in medication storage areas and the refrigerator are kept

within safe guidelines Ensure medicines are arranged in a manner that fosters efficient workflow Ensure all handwritten prescriptions are legible Ensure the PCS device contains the correct information by synchronising the

device regularly Ensure all changes to medication therapy are communicated to the Pharmacy Ensure wherever possible that residents are aware of all medicines they are

prescribed, and the rationale for their prescription Ensure all medications and the PCS device and management reports via the

Invalife web portal are checked routinely Ensure that every medication error is individually analysed by the Home Manager

to determine the root cause of the error, regardless of the outcome. Ensure that medication rooms are tidy, clean and well organised with minimal

overstocks.

8.0 Staff Training for medicines administration and assessment of competenceThere are a number of e-learning courses available on the Invalife website. These are resources that are available for care home staff to learn and understand the best use of PCS for managing medicines.

All care homes are expected to appoint a medication lead person called the ‘PCS lead’ for the purposes of acting as an ambassador for medication management and as a lead in supporting and coaching nurses and carers in their ongoing personal development in medication management and administration as well as inducting and training new or existing staff to medicines management.

The manager can set the roles of nurses and carers who have not completed the necessary training or have not undergone the periodic refresher training so that they are not allowed to administer medicines using the PCS device.




All staff must have a refresher training every 2 years to ensure they are aware of any new regulations or practices or procedures.

Despite the requirement for all staff to receive regular training regarding the administration of medicines, <<Insert Company Name>> recognises the issue that staff may not necessarily become competent after attending the course.

All staff who are responsible for administering medication shall be required to undertake a competency check at least once a year by the Home Manager or designated senior member of staff. Care home managers may also request competencies to be re-assessed following incidences and concerns about performance.

Under no circumstances are members of staff to administer medication unless they have received suitable training and have successfully completed the required competencies.

All completed competency forms are to be kept within the individual’s personnel file for inspection by Regulatory bodies or by the Company.

Please note for the receipt of a certificate of course completion, the e-learning courses must be successfully completed.

9.0 DAMAGED MEDICINES

Anyone becoming aware of a damaged medical product (e.g. damaged/broken in transit) shall contact the supplying pharmacy as soon as possible. Such medicines must be stored separately and safely while awaiting further instructions. Prompt actions should be taken to ensure continuity of medication for the resident. Examples of damaged medicines are:

Split capsule Damaged bottle Broken tablets Pierced container/Seal broken

10.0 REPORTING ADVERSE DRUG REACTIONS / PROTOCOL FOR MEDICATION RECALL ALERTS

Serious or unusual reactions, which may be due to the prescribed medication, must be recorded and reported to the GP. This will be done initially verbally, but following discussion with the GP or home manager may result in submitting one of the yellow cards at the back of the BNF or on line via www.yellowcard.gov.uk. An extreme adverse reaction may require reporting as a serious/ critical incident.

If a medication recall is issued, notification will be given to the home, these must be actioned immediately.

The person in charge should check if it affects any of the medication within the home

They should remove any affected medication from the medication trolleys and stock cupboard

http://www.yellowcard.gov.uk/




It should be stored in the returns cupboard, and entered onto a new page of the returns book.

Pharmacist to be contacted for collection When talking to the Pharmacist they will advise as to how to obtain replacement

or alternative medication Pharmacist will need to be informed which residents are affected Person in charge to inform the GP’s of affected residents Person in charge to document in the affected residents care plans Home Manager to be informed and action to be taken to inform all other relevant

staff as a matter of priority

N.B. Information will be circulated by the MHRA. When drug alerts are received, all Authorised Persons must sign to say they have read and understood them. The alerts must then be kept on file at the home.

All care homes must be registered on line for receiving drug and device safety alerts from the MHRA.

The care home manager is required to keep records of the receipt of all safety alerts and actions taken as a result of the alerts.

11.0 DAY CARE & RESPITE SERVICE USERS / USING FACILITIES WITHIN A CARE HOME

a) These service users accessing day care will normally be responsible for the care and administration of their own medicines. The PCS device should not be used for day service users. Procedures are those set within a local protocol and may include the xxxxxxx policy for self-administration of medicines if applicable under a risk assessment process. The best interests of the residents should be taken at all times and appropriate discussions held with family members and the GP if appropriate.

b) Where it is agreed that suitable trained and competent staff take responsibility for the administration of medicines, then the xxxxxMedication Policy applies. This includes ensuring the administration is recorded on paper MARR sheets and the medicines stored securely and full compliance in line with xxxxx Medication policy for completion of MARR sheets must be adhered to. If medication is brought into the home in unsuitable containers with illegible instructions then again in accordance with policy, staff must check with the appropriate GP prior to administration.

c) When residents in the home are regularly attending other day centres or day hospitals, the help of the pharmacist or doctor should be sought to obtain suitably packed medicines.

d) When residents attend other day centres, the administration of medication at that time becomes the responsibility of the other day centre staff.

e) It is recommended that residents receiving short term residential respite care at the




home should use a paper based MAR system in place of PCS if the duration of stay is for less than seven days.

12.0 UNPLANNED OUTINGS

Where medication is needed for a resident for administration later in the day and who is leaving the home temporarily, the original pack (s) should be taken from the home with the individual and a ‘Short Term Leave’ document completed and retained at the home and the appropriate code recorded on the PCS device. The Home Manager or authorised person must ensure that suitable arrangements are in place for the safe storage and correct administration of the medication to the resident whilst the resident is away from the home. This may include the use of a paper MAR produced from the on line service and given to the resident or carer and checked and filed safely on the return of the resident to ensure there has been full compliance of medication administration. Administration on the residents return must be recorded on the PCS device

13.0 HOLIDAYS AND PLANNED OUTINGS FOR RESIDENTS

When a resident has a planned holiday, arrangements must be made by the Authorised Person or an appropriately qualified Nominated Person and the pharmacist, ensuring the safest means of administration for the resident. The home manager must ensure that a suitably trained and competent person in medication management accompanies the residents on any arranged outing. This trained person must also ensure that arrangements are made for the safekeeping of the medication and the suitable administration and recording of medication to residents whilst away from the home. The PCS device must have the correct entry code to acknowledge the absence of the resident whilst away from the home.

The original packs provided by the pharmacy should accompany the resident.

A short term leave document or equivalent should be completed, with one copy given to the resident and another retained in the resident’s file

When staff are accompanying residents on holiday, they should take the current original medication packs and a paper copy of the most recent MAR sheet with them but can only administer the medication if they are suitably trained and competent to do so. The Home Manager must be satisfied that appropriate arrangements are in place for the safe keeping and administration of medication to the resident whilst they are away from the home including the determination of competence of any relatives or friends involved in caring for the resident.

The care home must also conduct a stocktake of medication when the resident leaves the home and a further stock take of medication on their return.

14.0 MEDICINE FOR RESIDENTS WHO LEAVE THE HOME

When the resident leaves the home, arrangements are to be made with the resident and pharmacist for medication that has been prescribed to be taken with the resident




and /or for the resident to be given their repeat prescription in order to obtain future medication and t ensure continuity of supply.

When to Retain Medicines after Discharge

Medicines are to remain in the home for at least seven days and stored separately when a resident is:

a) Admitted into hospital as an emergency.b) Admitted into hospital as a planned admission (unless the hospital

requests the medications to accompany the resident). c) In the event of death.

Hospital Admission

A copy of the current up to date MAR sheet, obtained from Invalife or via PCS fax back, must accompany the resident for all hospital admissions. This includes appointments and emergency admissions. Some hospitals are asking on occasion for the medicines to be brought into them even if not a planned admission; NB This should be on request only and not regular practice and the Home Manager or authorised person must determine if medication is required to be sent along with the resident or retained at the home. The PCS device must have the appropriate code entered to acknowledge the absence of the resident

15.0 REPEAT PRESCRIPTIONS / SPECIALS MEDICATION

Repeat prescriptions should be ordered in accordance with the agreed service level agreement with xxxx Pharmacy and to ensure that all prescription requests are submitted on time to the GP surgery using duplicate MAR sheets or the prescription repeat slips and made available to xxxx Pharmacy within the agreed timescales in order to ensure timely delivery of the monthly medication prior to the start of the new medication cycle.

The GP may on occasions prescribe a medication which has to be manufactured specifically for a resident. This type of medication is called a ‘Special’ and will typically take longer to be obtained than standard medication. Authorised staff must check the availability and delivery times of this type of medication with the Pharmacy Provider to ensure there is continuity of medication for the resident and that the wellbeing of the resident is not compromised.

16.0 EMERGENCY EVACUATION OF THE HOME

If the home is evacuated for a short period of time, then authorised staff must make every effort to ensure that all medication trolleys are locked and medication rooms left secure as long as these actions do not compromise the safety of staff or residents. Medication rounds should be resumed when the fire officer or other authorised person deems it safe to return to the building.

For longer periods of time and where access to residents medication is compromised, the Home Manager should in the first instance contact the appropriate GP surgeries to inform




them of the situation and to then contact the local main Pharmacy provider to request urgent MAR sheets for all residents and arrangements then made for the surgery to produce emergency prescriptions for these residents. Arrangements should then be agreed with the Pharmacy provider as to the best means of supplying this medication to residents as promptly as possible. In some situations, and where the return to the home is indefinite, this may require the co-ordination of deliveries of medication to residents across a number of temporary sites. The Care Home Emergency plan must include arrangements to meet all of these scenarios along with contact details of the GP and main Pharmacy Provider.

17.0 ARCHIVING OF PAPER MARR CHARTS AND PCS ELECTRONIC RECORDS

There is no formal regulatory guidance relating to the archiving of monthly medicines records for residents. CQC and CSSIW local inspectors may offer guidance to care home managers in terms of best practice. As a guide only, paper MARR charts should be kept for a minimum of 3 years in case of legal or regulatory requests from e.g. coroner’s office. Ultimately, the length of time that records are stored should be agreed by the care home organisation and stated in the medicines policy.

PCS medicines electronic records are maintained indefinitely by Invatech. Care home Managers should contact a member of the Invatech support team should they require access to archived records.

18.0 FAILURE TO COMPLY WITH XXXXX MEDICATION POLICY

Non-compliance with xxxx Medicines Policy could result in abuse or neglect for the residents in the care home. Any failure to comply with xxxxx Medicines Policy could result in disciplinary action and dismissal and will be dealt with accordingly.

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