Medication

1. Introduction

Adults who use the service should be encouraged, where appropriate and following a risk assessment, to retain and administer their own medication (self-administer) if they so wish. This can give them additional independence and supports them to retain control over their lives.

Other adults, however, may not wish to manage their own medication or have been assessed as being unable to do so without assistance. All staff involved in the care and support of adults who use the service are responsible for ensuring that their medication is managed appropriately, and abiding by service procedures and professional responsibilities. However, the primary responsibility lies with the adult’s GP or other prescriber.

Where an adult does not have mental capacity, staff should follow the Mental Capacity Act 2005 Code of Practice and the supplementary code of practice on deprivation of liberty safeguards (see Mental Capacity and Deprivation of Liberty Safeguards).

The information in this chapter reflects Managing Medicines in Care Home (NICE, 2014) which states that providers should have a care home medicines policy which includes:

• sharing information about an adult’s medicines, including when they transfer between care settings;
• ensuring that records are accurate and up to date;
• identifying, reporting and reviewing medicine related problems;
• keeping residents safe (safeguarding);
• accurately listing an adult’s medicines (medicines reconciliation);
• reviewing medicines (medication review);
• ordering medicines;
• receiving, storing and disposing of medicines;
• helping residents to look after and take their medicines themselves (self-administration);
• care home staff administering medicines to residents, including staff training and competence requirements;
• care home staff giving medicines to residents without their knowledge (covert administration);
• care home staff giving non-prescription and over the counter products to residents (homely remedies), if appropriate.

2. Supporting Adults to make Informed Decisions

All staff should ensure that adults who use the service have the same opportunities to be involved in decisions about their medication as part of their care and support plan, as people who do not live in residential settings. This should include ensuring they get the support they need to help them be fully involved in making such decisions.

The health care prescriber or member of staff from the service should record the adult’s informed consent in their care and support record (see Consent).

Staff should record the circumstances and reasons why an adult refuses a medicine (if they give a reason) in their care and support record and medicines administration record (MAR), unless there is already an agreed plan of what to do in such circumstances. If the adult agrees (if the adult has mental capacity) staff should tell the prescriber about any ongoing refusal.

Prescribers should:

• assume that adults have the capacity to make decisions;
• where there are concerns, they should assess an adult’s mental capacity in line with appropriate legislation (see Mental Capacity); and
• record any assessment of mental capacity in the adult’s care and support record.

Prescribers should review mental capacity when an adult lacks capacity to make a specific decision. How often they do this should depend on the reason why they lack mental capacity; this may fluctuate or may be only temporary, as capacity is both decision and time specific.

Where the adult agrees, families should be able to be involved in decisions about their care and support, including medication. The adult and their family should be given all appropriate information and support in relation to issues concerning their medication, so they can make the decisions best for the adult. This should be provided in a format that is accessible to adults who have additional needs.

3. Medication Administration Procedures

3.1 The role of staff

All medicines, including controlled drugs, must be administered by designated and appropriately trained staff. The registered manager and all care and support staff must encourage and support adults to retain, administer and control their own medication, within a risk management framework, and comply with the service’s procedures for the receipt, recording, storage handling, administration and disposal of medicines.

Each service is required to have a daily procedure / record, which clearly states the member of staff who is responsible at any given time for the:

• security of medicines – including the possession of keys;
• administration of medicines to particular service users;
• recording the administration of medicines.

3.2 Sharing information about an adult’s medicines

See also Information Sharing and Confidentiality, Referrals and Admissions and Transfers and Discharges.

Staff should share accurate information about an adult’s medicines, when they are transferred from one service to another setting (including hospital) and upon discharge.

A discharge / transfer summary should be sent with the adult when their care is transferred from one care setting to another, along with their prescribed medication. The summary should include who is responsible for future prescribing.

On admission or transfer into the service, staff should check that complete and accurate information about an adult’s medicines has been received and recorded.

3.3 Ensuring records are accurate and up to date

Staff should ensure that records about medicines are accurate and up to date. This includes:

• recording information in the adult’s care and support plan;
• recording information in the adult’s (MAR);
• recording information from correspondence and messages about medicines, including emails, letters, text messages and phone messages;
• recording information in transfer letters and summaries about medicines when the adult is away from the home for a period.

Staff should also know what to do with any copies of prescriptions and records of medicines ordered for adults.

Records about medicines must be kept secure  (see also Record Keeping and Document Retention).

3.4 Keeping adults safe

Safeguarding concerns may arise in relation to managing medicines of an adult. This may include the deliberate withholding of medication without a valid reason, incorrect use for reasons other than the benefit of an adult, a deliberate attempt to harm the adult using medication or accidental harm as a result of incorrect administration or a medication error.

Any safeguarding concerns should be reported to the designated safeguarding officer or registered manager (see Safeguarding Adults from Abuse and Neglect and Allegations against Persons in a Position of Trust). In the event  a member of staff does not for any reason think this is possible (as they believe the manager to be involved for example), they should send an alert to the safeguarding adults team in the local authority.

3.5 Accurately listing an adult’s medicines

The service manager or the member of staff responsible for admitting or transferring the adult into the service, should list all their medicines (known as medicines reconciliation) as part of their assessment and development of their care and support plan. The manager should ensure that resources are in place to facilitate this to happen as soon as possible after admission / transfer.

This should involve the following:

• the adult and / or their family members;
• a pharmacist;
• other health and social care practitioners involved in managing medicines for the adult, as agreed locally.

The following information should be available for medicines reconciliation on the day that the adult is admitted or transferred into the service:

• full name, date of birth, NHS number, address;
• weight;
• GP’s contact details;
• details of other relevant for example consultant, regular pharmacist, specialist nurse;
• known allergies and reactions to medicines or other ingredients, and the type of reaction experienced;
• medicines the adult is currently taking, including name, strength, form, dose, timing and frequency, how the medicine is taken (route of administration) and what for (indication) if known;
• changes to medication, including medicines started, stopped or dosage changed, and reason for change;
• date and time the last dose of any ‘when required’ medicine was taken or any medicine given less often than once a day (weekly or monthly medicines);
• other information, including when the medicine should be reviewed or monitored, and any support the adult needs to carry on taking the medicine (adherence support);
• what information has been given to the adult and / or family members.

The details of the person completing the medicines reconciliation (name, job title) and the date, must be recorded.

3.6 Medication reviews

The GP should liaise with service staff and other involved practitioners to identify a suitably qualified and experienced healthcare professional who will be regularly responsible for reviewing each adult’s medication. The frequency of the review should be set out in their care and support plan. Reviews should be at least annually, but may need to take place more frequently depending on the needs of the adult.

Medication reviews must involve the adult and / or their family members wherever possible and others including, for example:

• pharmacist;
• community matron or specialist nurse, such as a community psychiatric nurse;
• GP;
• the adult’s key worker from the service;
• practice nurse;
• social care practitioner.

The following should be discussed during a medication review:

• the purpose of the review;
• any of their medication;
• all prescribed, over-the-counter and complementary medicines that the adult is taking or using, and their purpose;
• how safe the medicines are, their effectiveness and appropriateness and whether their use is in line with national guidelines;
• any monitoring tests that are needed and their frequency;
• any problems the adult has with the medicines, such as side effects, reactions, taking the medicines (for example, using an inhaler) and difficulty swallowing;
• what the adult (and / or their family members, as appropriate) thinks about their medication, including issues of refusal to take medication;
• the adult’s (and / or family members) concerns, questions or problems with
• helping the adult to take or use their medicines as prescribed (medicines adherence);
• any more information or support that the adult (and/or their family members) may need.

3.7 Helping the adult look after and take their medication

Staff should assume that an adult can take and look after their medicines themselves (self-administer) unless a risk assessment completed by service staff has indicated otherwise.

The risk assessment for each adult should consider:

• the adult’s opinions about self-administration;
• whether self-administration may pose a risk to the adult or to others who use the service;
• whether the adult is able to take the correct dose at the right time and in the right way (that is, do they have the mental capacity and manual dexterity for self-administration)
• how often the assessment will need to be repeated;
• how the medicines will be stored;
• responsibilities of staff.

The service must ensure that records are kept when adults are given medication for self-administration, or when they are reminded to take their medicine.

The following information should be recorded on the MAR:

• that the adult is self-administering;
• whether any monitoring is needed (for example, to assess ability to self-administer or willingness to take the medicines as prescribed);
• that medicine has been taken as prescribed (either by observing or asking adult);
• who has recorded that the medicine has been taken.

An adult who is self-administering should be issued with a safe, lockable space for their medication. Suitably trained and designated staff can access the medication with the adult’s permission, unless it is suspected that the lockable space is being used for other purposes than for that which is intended or that it has been tampered with.

A record of medication for self-administration should be kept, with the adult’s agreement .

Where people are self-administering insulin or any other medication with a syringe, a ‘sharps box’ must be provided.

If concerns arise about the adult’s ability to self-administer, the registered manager and other relevant staff, together with the person and a family member as appropriate, should discuss the issues and agree how much responsibility they should undertake. It may be useful for the adult to self-administer for a trial period with closer supervision. It may become necessary, however, for staff to immediately remove medication during that period if the risks become too great. Staff should check whether or not they have taken their medication as prescribed, and a decision made and recorded as to whether or not they are able to self-administrate in the long term.

Self-administration should be reviewed every six months, in conjunction with the adult, their family, and involved professionals, or sooner if there are concerns, as outlined above.

When a person is assessed as no longer able to safely administer their own medication, staff should explain that they will take responsibility for the administration according to the doctor’s instructions. Such situations will need to be managed sensitively.

Likewise if a person voluntarily decides they no longer want to self-administer, staff should take responsibility for medication administration.

If an adult expresses any concerns about any aspect of their medication, a referral should be made to the doctor or relevant health care professional to discuss it with them.

Certain medical conditions such as asthma, require immediate access to medication. In these circumstances, self-administration should be encouraged.

3.8 Self-administration of controlled drugs

The service should ensure that the adult should have information about the process for self-administration of controlled drugs, including information about:

• individual risk assessment;
• obtaining or ordering controlled drugs;
• supplying controlled drugs;
• storing controlled drugs;
• recording supply of controlled drugs to adults in the service;
• reminding adults to take their medicines (including controlled drugs);
• disposal of unwanted controlled drugs.

3.9 Prescribing medication

GP practices should ensure there is a clear documented process for prescribing and issuing prescriptions for patients in residential homes. The process should include:

• issuing prescriptions according to the patient’s medical records;
• how a medicine should be used, including how long the adult should take the medicine, how long the medicine will take to work and why it has been prescribed;
• record of the prescribing in the GP’s patient record and the care and support plan, required changes should be made as soon as possible;
• any additional information the adult and / aor staff may need about how the medicine should be taken;
• required tests for monitoring;
• prescribing the right amount of medication for the 28-day supply cycle if appropriate, and any changes that may be needed for future prescribing;
• monitoring and reviewing ‘when required’ and variable dose medicines;
• issuing prescriptions when the order is received from the residential home.

Service staff should update the adult’s MAR so that it contains accurate and up to date information about medication.

Prescribers should only use telephone, video link or online prescribing prescribing) in exceptional circumstances.

They should be aware that not all service staff have the training and skills to assist with any assessment and discussion of the adult’s clinical needs.

The should send written confirmation of the instructions to the service as soon as possible.

Staff in the service should:

• ensure that any change to a prescription or the prescription of a new medicine by telephone is supported in writing (by email for example);
• before the next or first dose is given ask that the prescriber changes the prescription;
• update the MAR and the care and support plan as soon as possible (usually within 24 hours) with any changes to medicines made by remote prescribing, including the name of the prescriber and their contact details.

The service should ensure that any text message received about an adult’s medicines is properly recorded.

3.10 Ordering medicines

Staff must ensure that medicines prescribed for adult are not used by anyone else, including other adults who use the service.

The manager should ensure staff have dedicated time to order medicines and check delivery.

Where possible, there should be two members of trained and experienced staff to order medicines, although it can be done by one member of staff. Wherever possible it should be done by the same members of staff each week.

The registered manager should choose one main pharmacy to dispense medications for adults, to ensure close working and continuity. People who self-administer their own medication, however, are able to choose who dispenses their medication.

To reduce additional pressure on GP surgeries used by the service, all requests for repeat items should be made at the same time each week – which is agreed with the surgery.

Requests for repeat prescriptions should allow enough time between ordering and receipt by the service of the medication, as the prescription has to be ordered, signed by a prescriber, sent to the pharmacy, dispensed and delivered by the pharmacy. If medicines are packed in a Monitored Dosage System (MDS) time should be allowed for the pharmacy to pack the medication. It is the responsibility of the service to ensure that all adults have sufficient medication as ordered by the prescriber.

The registered manager or designated responsible person (DRP) should see the prescription forms before they are submitted to the pharmacy for dispensing, unless the pharmacy collects the prescriptions directly. If an item on the prescription was not originally requested then ‘not dispensed’ should be written in the margin of the prescription next to the item. At this stage the reverse of the prescription form should be signed and details of payment or exemption completed unless prior arrangements have been made with the nominated pharmacy.

Medicines delivered to the service should be checked against the order record to make sure that all medicines ordered have been prescribed and supplied correctly. Records should be kept of medicines ordered and received. If the medicines received from the pharmacy differ from those received for the same person previously, a member of staff must check this against the prescription with the pharmacist.

If there is a change to a person’s medication the service should inform the pharmacy, who will then confirm the changes with the surgery.

3.11 Requests for emergency supplies of prescription medication

There may be times, when a service requires an emergency supply of a prescription medicine for an adult. Staff can either:

• request an urgent prescription from the surgery. The service should confirm with the surgery how it will be delivered to the dispensing pharmacy. The service should also confirm with the pharmacy how they will receive it – whether they will deliver or the service needs to collect it;
• Otherwise the pharmacist may be able to respond to an emergency request for a prescription from the GP, providing they receive a prescription within 72 hours and it is not a schedule 2 or 3 controlled drug (apart from any exceptions).

3.12 Receiving, storing and disposing of medicines

3.12.1 Storage of medicines

Storage for adults who self-administer

For adults who are self-administering their medication, the service should assess with them their requirements for storing their medicines and should provide appropriate storage that meets their needs.

People who self-administer can hold their own individually dispensed supply of controlled drugs in their personal lockable non-portable cupboard in their room.

Storage for all other medication

In relation to medication for all other adults who use the service and to whom the service administers their medication, medicines for internal use should be stored in a locked cupboard, trolley or room. Medicines for external use should be stored in a separate locked cupboard or physically separated from internal medicines on separate lower shelves in the main medicines cupboard.  The decision of where to store medicines should take into account the size of the service and the nature of the medicines to be stored. Keys should be kept separate from other keys and not be part of any master key system and be held by the service manager or DRP at all times.

Controlled drugs must be stored in a locked cupboard / safe, made of metal to a defined gauge, with suitable hinges, a double locking mechanism and fixed to a solid wall or floor with rag bolts. The security of the location must be considered when planning such storage. The controlled drugs cupboard should not be used to store anything else. The keys to the controlled drugs cupboard / safe must be kept separate to other keys and should only be accessible to authorised staff.

Refrigerated medication

A separate, dedicated lockable refrigerator should be available or a small lockable container which can be stored in a refrigerator whose temperature is checked daily with a maximum / minimum thermometer. The normal range is between two and eight degrees centigrade; any variation from this should be reported to the service manager immediately. If this occurs the service should contact a pharmacist to check information on individual products, as some of the medication may need to be destroyed and replaced. The refrigerator must be cleaned and defrosted regularly.

3.12.2 Storage of oxygen

Oxygen that is prescribed by a GP or other specialist will be fully explained by the prescriber. This will include how to use the oxygen and any risks that may be encountered due to power failures or travelling for example. The service must undertake a risk assessment as soon as oxygen has been prescribed, including the  information given by the prescriber and the pharmacist. Service staff must receive appropriate training in how to support an adult who is prescribed oxygen.

The service should discuss storage and administration with the supplying pharmacist. In summary, oxygen cylinders should be stored safely under cover and not subject to extreme temperatures. This should be a dry, clean, well ventilated area away from highly flammable liquids, combustibles and sources of heat and ignition. A statutory warning notice should be displayed in any room/area where oxygen is stored, stating: ‘Compressed gas. Oxygen: No Smoking. No naked lights.’

In the case of fire, after adults, visitors and staff have been evacuated from the premises, it is the responsibility of the manager or DRP, to inform the fire brigade officer that oxygen cylinders are present in the building and where they are located. This will usually include the storage area, as well as the adult’s room.

3.13 Administering medicines to adults

Staff who administer medication to adults should consider the six R’s of administration:

• the right adult;
• the right medicine;
• the right route;
• the right dose;
• the right time;
• the adult’s right to refuse.

3.13.1 As required medication (PRN)

When a prescriber is prescribing ‘when required’ (PRN) medicines, staff should be informed of the following:

• the reasons for giving the ‘when required’ medicine;
• how much to give if a variable dose has been prescribed;
• what the medicine is expected to do;
• the minimum time between doses if the first dose has not worked.

Staff should ensure they offer PRN medication when needed and not just during ‘medication rounds’.

They should check with the prescriber if there is any confusion about which medicines or doses are to be given.

Staff should record PRN medicines have been given in the adult’s care and support plan as well as on the MAR.

PRN medicines should be kept in their original packaging.

3.13.2 Taking medication

Service staff, the prescriber and pharmacist should agree with the adult the best time for them to take their prescribed medication.

The manager should consider ways of minimising disruption during times when allocated staff are administering medicines, so as they receive as little interruption as possible. This may include:

• having more staff on duty during such times;
• reviewing the times for administering medicines (for example, administering once daily medicines at lunchtime rather than in the morning, if the prescriber agrees that this is appropriate);
• avoiding planned staff breaks;
• ensuring fewer distractions for staff administering medicines.

Staff should ensure that adults do not miss their medication if they are having a meal or are asleep.

3.13.3 Medication Administration Records (MARs)

Paper based or electronic MARs should:

• be legible;
• be signed by staff;
• be clear and accurate;
• be factual;
• have the correct date and time;
• be completed as soon as possible after administration;
• avoid jargon and abbreviations;
• be easily understood by the adult, their family member or carer.

MARS should include:

• the full name, date of birth of the adult;
• the adult’s weight
• details of medicines the adult is taking, including the name, strength, form, dose, how often it is given and how it is given (route of administration);
• known allergies and reactions of the adult to medicines or their ingredients, and the type of reaction experienced;
• when the medicine should be reviewed or monitored (as appropriate);
• any support the adult may need to carry on taking the medicine;
• any special instructions about how the medicine should be taken (such as before food).

A new, hand written MAR should only be produced in exceptional circumstances. It should be created by a member of staff who is appropriately trained and experienced in managing medicines, and has designated responsibility for medicines in the service. The new record should be checked for accuracy and signed by a second trained and skilled member of staff before it is first used.

Staff should ensure that all information included on the MAR is up to date and accurate. They may need support from the prescriber and the supplying pharmacy to do this.

Staff must record the administration of all medication, including the date and time, on the relevant MAR, as soon as possible and ensure that they:

• complete the MAR only after the adult has taken their prescribed medicine;
• complete the MAR before moving on to administer to the next adult;
• recognise that mistakes are less likely if one member of staff records administration on the medicines administration record rather than two staff recording;
• record PRN medicines only when they have been given, noting the dose given and the amount left (where possible), to make sure that there is enough in stock (if not request reordering) and reduce waste;
• record when and why medicines have not been given;
• correct written mistakes with a single line through the mistake followed by the correction and a signature, date and time (correction fluid should not be used).

Where a health professional visiting the service administers medication to an adult, they should make their record of administration also available to service staff. This should also be recorded in the adult’s care and support plan, it should be communicated to other staff and a note made on the service MAR. Where appropriate, the health professional should be encouraged to see the adult with a member of staff responsible for administering medicines to them for at least part of their visit.

Staff administering medicines should cross-reference to the adult’s MAR, when a medicine has a separate administration record (for example, ‘see warfarin administration record’).

Staff should make appropriate records of controlled drugs that have been administered to adults. Staff responsible for administering the controlled drug and a trained witness should sign the controlled drugs register. The staff member administering the drug should also sign the MAR.

Staff should ensure the adult has the medicines they require when they are away from the service (for example, visiting relatives for a few days or longer). Details of the medicines taken should be recorded in the adult’s care and support plan.

3.14 Administering emergency medication

The administration of emergency medication may only be undertaken by trained and approved staff, and as detailed in the adult’s care and support plan.

If there is no suitably trained member of staff available to administer the medication, the senior manager should be contacted; this may be the person on-call. Advice should be sought from the prescriber. Options may include contacting the local ambulance service to administer medication, particularly if this may prevent the adult being admitted to hospital.

An emergency is defined as a life-threatening situation.

Prior written consent must be sought from the adult or their representative if they are likely to need emergency medication to control any medical condition that requires urgent attention (see Consent).

Wherever possible, the adult’s preference concerning the gender of the member of staff administering emergency rectal medication, for example, should be respected.

If an emergency situation should arise in a public place or during transporting the adult to another location, staff should first call the emergency services and then the service manager.

3.15 Giving non-prescription and over the counter products to adults (home / homely remedies)

Home remedies are used to treat minor ailments without needing to contact the adult’s GP in the first instance. Conditions which may be treated with home remedies include:

• indigestion;
• mild pain;
• cough;
• constipation;
• diarrhoea;
• mild skin conditions.

A list of home remedies that can be administered to adults in the service can be drawn up with the local pharmacist. It should include specific details for staff such as:

• indications for use;
• name of medicine;
• dose and frequency;
• maximum dose and period of treatment;
• cautions.

The adult’s MAR should clearly state whether they should be given home remedies, and if there are particular medicines they should not be given. For example, paracetamol should not be given as a home remedy if they are already receiving it as prescribed medication.

Only designated staff can administer home remedies, following discussion and authorisation by the service manager.

MAR sheets should contain a section for recording the administration of non-prescription medication, and the member of staff administering the home remedy should record it in the relevant section.

A home remedies stock record must be maintained, and checked regularly, particularly expiry dates.

Treatment with a home remedies should not continue for more than three days without medical assessment. The adult’s GP should be contacted for advice.

If there is any concern about any contra-indication with an existing medication, staff should contact the designated pharmacist or the adult’s GP.

Home remedies should be stored in a strong, safe and secure place.

3.16 Covert Administration of Medication

See also Mental Capacity, Consent and Deprivation of Liberty Safeguards.

Service staff should not give medicines to an adult without their knowledge (covert administration) if they have capacity to make decisions about their treatment and care.

Where the adult does not have mental capacity, prescribers and service staff should ensure that covert administration only takes place in the context of existing legal and good practice frameworks to protect both the adult who is receiving the medication and the service staff administering the medicines.

Staff should ensure that the process for covert administration of medicines to adults includes:

• assessing mental capacity;
• holding a best interest meeting involving service staff, the prescriber, the pharmacist and family member / representative to agree whether administering medicines without the adult knowing is in their best interests;
• recording the reasons for presuming mental incapacity and the proposed management plan;
• planning how medicines will be administered without the adult knowing;
• regularly reviewing whether covert administration is still needed.

What covert medication is given and why must be recorded as a condition of a DoLS authorisation. If there is an appeal against the DoLS authorisation by the resident or their representative, the Court of Protection will want to see the reason and purpose for giving covert medication.

3.17 Auditing of medication

The manager must ensure that practices for the management of medicines are systematically audited to ensure that they are safe, and any action is taken where necessary.

Ongoing assessment and audit and identification of risks by staff is necessary to ensure that the service meets the needs of each adult, as well as their safety.

3.18 Disposal of medicines

When disposing of medication, staff should promptly dispose of:

• medicines that exceed requirements;
• medicines no longer required;
• expired medicines (including controlled drugs).

All unused medication, including refused and spoiled doses should be returned to the pharmacist for safe disposal and should not be used for other adults in the service.

The service should keep records of all medicines that have been disposed of or are waiting for disposal. Medicines for disposal should be stored securely in a tamper-proof container within a cupboard until they are collected or taken to the pharmacy.

3.19 Identifying, reporting and reviewing problems or issues

It is acknowledged that mediation mistakes may occasionally happen for various reasons. Every member of staff, however, must report any errors immediately to the manager / DRP.

The senior member of staff on duty should report any suspected adverse effects from medicines to the prescriber or another health professional as soon as possible. This is normally the GP, or the out of hours service.

The adult’s family, social worker or other care manager (where there is one) the local authority safeguarding adults team and the Care Quality Commission must be notified of any error if the belief is, following consultation with their GP, that the error could have led to harm or injury. See also Duty of Candour.

The error must be recorded on the MAR sheet. It must also be recorded in the adult’s care and support plan. The supplying pharmacy should also be informed, where the adult or their representative agrees that this information can be shared. Errors should be also reported as incidents using the service’s accident / incident reporting system.

Errors should be dealt with constructively by the service manager. In such circumstances, the manager must meet with the member/s of staff involved. The why the mistake occurred should be understood, and where relevant action should be taken to prevent any possible recurrence. The manager should discuss the guidance with the member of staff to ascertain their level of understanding. Where it would be beneficial to share learning with other staff from the incident, this should be done in a manner that does not breach confidentiality for either the adult or member of staff.

Managers must differentiate between incidents where there was a genuine mistake, where the error resulted due to pressure of work for example, or where practice was reckless and also where there were attempts to conceal the incident. A comprehensive investigation should be conducted, before any action is taken in line with disciplinary procedures or reporting to professional bodies.

3.20 Arrangements for short periods away from the service

Where adults are going to be away from the service for a short period of time such as an outing with relatives or service staff, the DRP must arrange for medicines to be taken in their containers and given to the adult / family member or a delegated member of staff for administering and safekeeping during the trip.

The following information should be given to the adult and / or their family members when the adult is temporarily away from the service:

• the medicines given;
• clear directions and advice on how, when and how much medication they should take;
• time of the last and next dose of each medicine;
• contact details for any queries about the adult’s medicines, such as the service, supplying pharmacy or GP.

The medication release records sheet must be completed by a designated member of staff, and countersigned by a second member of staff, whenever medication is given to relatives for visits / overnight stays. The form must be completed at both the start and end of the period. It must be retained in the service for monitoring and audit purposes. It may be agreed in the care and support plan that staff should contact the adult or their carer each day they are away, to remind them to take their medication.

3.21 Medication arrangements for adults receiving short term care

All of the above information applies to adults receiving short-term care, as to those in longer term or permanent care.

An assessment must be made to determine what level of assistance, if any, is required by adults who self-administer, who are admitted to the service on a short term or respite basis.

A record of all medication brought into the service by the adult should be made between the adult / their family, and their key worker and retained on the adult’s file. An individual has the right to refuse to disclose this information but no assistance with medication can be given by the service in these circumstances.

Staff need to ensure that adults are aware of the service’s arrangements for storage requirements.

3.22 Emergency admissions

In the case of emergency admissions, particular attention must be given to determining what medication, if any, the adult is currently taking.

If no information is available through the family or worker in a partner agency, the service manager must contact the relevant health professional / GP to confirm the details in writing of the medication prescribed before undertaking any administration. This must be recorded on the relevant MAR chart and the adult’s care and support plan.

3.23 Staff training and skills

Service managers must ensure that only designated staff, who have completed the necessary training and are assessed as competent, administer medicines. They must also ensure that staff who do not have the skills to administer medicines, despite completing the required training, are not allowed to administer medicines.

The service must ensure staff have access to a recognised learning and development programme so that they can gain the necessary skills for managing and administering medicines. All staff (including registered nurses) involved in managing and administering medicines should successfully complete any training needed to fulfil the requirements for their role.

Service managers should ensure that all staff who manage and administer medication, have an annual review of their knowledge, skills and competencies relating to this responsibility. Managers should also identify any other training needs of staff responsible for managing and administering medicines.

4. Further Information

• Medicines and Healthcare Products Regulatory Agency;
• NHS Choices;
• NICE Evidence;
• Patient.

Health professionals may also use the:

• British National Formulary (BNF); 
• Clinical Knowledge Summaries;
• Electronic Medicines Compendium.

5. Definitions

• Controlled drugs: medicines with a potential to be abused, for which special legal precautions are necessary. A current list is available from the Home Office or individual queries can be made to the community pharmacist.
• Home/homely remedies: medicines that can be obtained without a prescription (also known as ‘over the counter preparations’), which the service can buy from community pharmacies following consultation with appropriate medical professionals.
• MAR: Medication Administration Record, which details each individual administration of medicine to an adult. Some larger community pharmacies, such as Boots, supply their own forms which the service can use.
• MDS: Monitored Dosage System which is medication supplied by the pharmacy in pre-measured doses.
• POM: Prescription Only Medication.
• PRN: to be taken as required.