Ask Sheila England

Sheila will try to answer as many of your English Social Care questions as possible, giving priority to frequently asked questions and questions regarding current events and trends.

How can I help a service user self-manage their medication while maintaining theirs and others safety?

Dear Sheila,

Firstly thank you for all the advice you and your team impart, evaluable in this sector.

I have a question on CD medication. Our home follows standard procedures and polices, however recently we have a new residents who has asked that she retain her Tamazepam in her room. She prefers to take the medication when she is ready to go to sleep and says this is not always at a set time. We have said that staff can work around this, and that she need only ring her call bell for assistance, however the resident would prefer that we left the medication so that she could take when she would like without the need to ring staff.

The resident has capacity to self medicate and we have relevant risk assessments and consent forms in place, however, our normal procedure would be to hold the CD drugs in our CD cupboard in the treatment room and then administer them as per the prescribed administration information. time and the MAR sheet.

Policy indicates that as a care home we need to ensure safe and precise practice when receiving, handling and administering all medication and in particular robust processes around CD medication.

Our dilemma is that we feel it would be person centred for the resident and relieve her anxiety around this if we could work to provide a lockable cabinet to store the Tamazepam in her room, however we would then need to ensure robust process to check and sign across (?) we cannot find any information that indicates that this meets requirements in a care home setting.

Our reflective thoughts in discussion with the resident and their family are that, as a residential care home we work to maintain independence and to foster a safe, home like person centred environment

The residents and thir son have expressed the view that when living at home, the pharmacy delivered the same medication and she then administered them at home herself each day at a time she felt comfortable with just before he went to sleep. They feel our regulations and procedures seem to detract from this.

We have checked NICE guidelines and with other providers, however as yet have not been able to find any information in this respect.

Are you able to advice, I fear we are so absorbed with policy that we may miss the true meaning of person centred care for this resident and assisting them to retain their independence and feel at home, however I also need to maintain the safety of the resident (and other residents) as well as keep my staff team safe and sure in their administration.

Many thanks Sheila

I look forward to your advice.

Regards

Ann Stuart

General Manager
St Wilfrids Care Home

Dear Ann,

Thank you for your question. Quality Compliance Systems (QCS) has recently reviewed its policy on Controlled drugs so I asked Philippa Shirtcliffe our Clinical Lead who was responsible for the review of the policy for her comments and this is what she said:

"Our new Controlled Drugs policy covers this scenario under recording and self-managing with the risk assessment process being important rather than the classification of the medicine. Staff should assess whether the Resident understands:

·       Why the medicine is prescribed
·       How much and how often to take it
·       What may happen if he or she does not take the medicine or takes too much

Sensible precautions are important to make sure that controlled drugs are not stolen from the Resident. The home does not need a CD cupboard in each bedroom; however, a lockable cupboard or drawer is essential. The person must agree to keep the medication safe and locked away when not in use and not leave it lying around where it could be taken by someone else. The arrangements must be monitored and reviewed on a regular basis.

The risk assessment process places responsibility on the person who keeps the controlled drug. Through monitoring and review of the risk factors, the home should identify that controlled drugs are not left lying around where they could be taken by someone else. There is no need to keep a record in the CD register when the person is wholly independent. That is, he or she is responsible for requesting a prescription and collecting the controlled drugs personally from the pharmacy.

If the person does not arrange the supply and collection of controlled drugs but relies on the home to do so, there should be clear records including:

·       Receipt from the pharmacy
·       Supply to the person
·       Any subsequent disposal of unwanted controlled drugs

These records should be made in the CD register.

In terms of delivering person-centred care, the ability to support someone who has the capacity and the wish to self-manage their medication should be encouraged by the home and if there are any concerns the Community Pharmacist should always be able to give advice ."

I am grateful to Philippa for this comprehensive response.

Best wishes.

Sheila


What would you like to ask Sheila?

Sheila Scott OBE from National Care Association (NCA). Care is Sheila’s life; she possesses a strong command of the issues facing the care sector informed by her long career as a nursing professional, the owner and manager of a care business and as a leader in the care sector.

Sheila will try to answer as many of your questions as possible, giving priority to frequently asked questions and questions regarding current events and trends.

Please note that Sheila can not offer answers to matters requiring legal advice. If your matter concerns a specific service provider, please contact the CQC.







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