I am a care worker working nights and my manager says its ok to wake people at 5am to give them their medication, is this legal?

Answered by Philippa Shirtcliffe

Sadly this is a question that we get asked all too frequently. In fact Sheila Scott, who has now retired from QCS, answered this question in 2017 and you can read the response here. In terms of whether this is legal, I think it is far wider than is it legal. It is a question of dignity, of choice, of consent and capacity. We have discussed this question with our team of specialists at QCS and Barry Price’s comments were very much about walking in the shoes of your resident. If you were in a deep sleep dreaming of your loved ones, your past or your life dreams and aspirations coming true. A feeling of deep joy and relaxation. Then suddenly you wake with a shaking hand on your shoulder shouting your name often in a rushed tone. “Are you in pain” “Do you want some pain relief” “Time for your Meds”. What would be your response and how would it make you feel?

Staff are taught and I’m sure you are no different with medication training administration the 6 R’s of administration: right resident, right medicine, right route, right dose, right time, resident’s right to refuse.

In routine planning you will have a medication support plan, medication risk assessment, mental capacity assessments and best interest decisions in place for those who do not have capacity. But how many of these plans state “what to do if……. they are asleep?

And that is the key. Staff teams follow medication training, policies, and procedures tighter than any other policy due to the Blame culture within social care and we all know someone who has made a medication error (Including me, more than one). As a result, our documentation needs to be very clear as to what the staff need to do. NICE in guidance in November 2020 also state that providers should have in place a Process for making sure medicines are used safely and effectively including “what to do if the person is having a meal or is asleep”.

There is no real reason that would approve waking people up for a medication round because it suits the needs of the administrator or its meds round time. Obviously there may be a case such as antibiotics that state every 8 Hours but even these after discussion with a prescriber can be varied to protect an individual’s dignity and choice. Even with this there is flexibility as there is significant research about the healing benefits of sleep, interrupting to give medication may do more harm than good.

If you search on the CQC website you will see that they take very negative view on this in inspection reports and do focus on medication during inspections in great detail.

So finally: in answer to your question. It is not illegal, but it is poor practice and if it isn’t be done for the right reasons, it is a safeguarding issue. That then does become a legal issue.