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Medication Fact Sheet for Residential Care (Last update 01.05.20)
CQC have provided guidance to residential care providers on how to make sure medication administration and management is safe during the COVID-19 pandemic. This fact sheet highlights the key areas within the guidance, download it here.
Alternatively, you can read the fact sheet here:
During the Coronavirus pandemic (COVID-19) information is changing very quickly as the government and other organisations try to adapt to different ways of working. The virus spread very quickly which has meant that care providers have changed some of the usual ways of working. It’s important to make sure that you can carry on caring for service users safely.
Medication Management is an area that often causes worry and mistakes sometimes happen. The Care Quality Commission have provided guidance on medication for providers on areas that are causing concerns during the pandemic. You need to know what your responsibilities are. This fact sheet will explain what you need to understand working in nursing or care homes. We will cover the following areas;
- Multi-compartment compliance aids (MCAs)
- Re-using named patient drugs as medicines supply
- Delegated tasks
- Access to medicines
- Medicines awaiting return to community pharmacy
- Handwritten medicine administration records (MARs)
- Using sedation to enforce social distancing guidelines
- Controlled drugs as stock
i) How to get the correct medication
Making sure service users get the right medicines at the right time is one of the 6 Rights of Medication.
During the COVID-19 pandemic, it’s important service users can still get their correct medication. You must make sure that;
- All prescriptions are ordered 7 DAYS before they run out.
- You don't order more than usual.
B) Medication Administration Records (MAR)
Medication Administration Records often cause confusion. If you make a mistake, service users may get the wrong medication, the wrong dose or they may get the medication at the wrong time. When CQC carry out inspections they look at MARs to make sure service users are being cared for safely.
During COVID-19, you may have fewer staff or you may not have as many managers working. It’s important however that the information on a MAR is up to date and accurate. Wherever possible, best practice is to have printed a MAR from the Pharmacist. If you are using paper MARs, CQC have said providers must make sure that ;
- If you have to write out a MAR, they must have been written and checked by a person trained and assessed as competent to do so.
- Medicines must be recorded each time medicines support is provided.
- The MAR chart must be filled our for each individual medicine on every occasion
C) Returning Unused Medication
Your medication policy will tell you that it’s important to make sure that medication is disposed of safely and correctly.
If you need to support someone with their medication, the care plan will say what you need to do. Your homes' policy will say what you must do with any unused or out of date medication.
You need to check who is responsible for returning medication to the pharmacy if it’s not clear.
During COVID-19, returning medication is more difficult. You will need to check with the local pharmacy if they will accept it back. It's also worth checking what will happen to the packaging that has service user information on.
i) Disposing of Medication
You must keep the following records if you dispose of medication.
- The date you disposed it
- The name of the Service User
- The name of the medication
- Whether it was a tablet, a liquid, an inhaler etc
- How many /much you disposed of
- The name of the member of staff disposing of the medication
- Its probably a good idea to say which pharmacy took the unwanted medication
- You must not flush it down the toilet or sink or sluice
- There are special procedures for controlled drugs that must be followed
D) Delegated Task
• During your Induction training you will have been told how important it is to only do things that you have been trained and assessed as competent to do. It’s also important to only do things that it says in the care plan and if you aren’t sure about something, to check with your manager first before you do anything.
• There are some activities that care workers may be asked to carry out. Examples might be medication through a PEG tube (percutaneous endoscopic gastrostomy tube) or giving injections for diabetes.
• CQC have reminded care providers that these are ‘delegated tasks’ and must only be carried out by staff who have had training to carry out the task, and they have been assessed as competent.
• Your manager will need to make sure that there are enough staff with these skills if your organisation agrees to take on these delegated tasks.
• It is the healthcare worker’s (e.g. a nurse) responsibility to make sure that when they delegate a task, the care worker understands what they have to do, why they are doing it, what to do if something goes wrong and how to carry out the task.
• You must not agree to do something without first checking with your manager.
i) The Routes of Medication
There are many ways that medication can be administered;
- Buccal - held inside the cheek
- Enteral - delivered directly into the stomach or intestine (with a PEG tube or Jejunostomy Tube)
- Inhalable - breathed in through a tube or mask
- Infused - injected into a vein with an IV line and slowly dripped in over time
- Intramuscular - injected into a muscle with a syringe
- Intrathecal - injected into the spine
- Intravenous - injected into a vein or into an IV line
- Nasal - given into the nose by spray or pump
- Ophthalmic - given into the eye by drops, gel, or ointment
- Oral - swallowed by mouth as a tablet, capsule, lozenge, or liquid
- Otic - given by drops into the ear
- Rectal - inserted into the rectum
- Subcutaneous - injected just under the skin
- Sublingual - held under the tongue
- Topical - applied to the skin
- Transdermal - given through a patch placed on the skinThe government has clear rules You must stay at home’ unless you need to travel for work. This is really difficult for everyone. For service users who don’t have the capacity to understand, this it can be confusing.
E) Multi-Compartment Compliance Aids
- These are sometimes known as Blister Packs.
- Pharmacies are short staffed like every business during the COVID-19 pandemic.
- Supplying medication in blister packs takes a pharmacist a long time. During the COVID-19 pandemic, you may find that the pharmacist may not supply medication in multi compartment compliance aids. Your service user will be given medication in the original packaging.
- You can administer from original packaging.
- You must follow your policy and procedure.
- There will need to be a risk assessment in place if the service user previously had Blister packs and now has original packaging.
- The MAR will need to be up dated with all the medication, dosage and times clearly documented.
- Your training will have explained how to safely administer medication from original packaging.
- If the service user is self managing their medication and not have blister packs is going to reduce their independence, its important to discuss this with the GP.
- Do not leave medication in cups or pot, this is secondary dispensing and may lead to medication errors, and possible safeguarding issues.
i) The 6 Rights of Medication Administration
A mnemonic to remember this is Patients Do Drugs Round The Day
- Right Patients
- Right Drugs
- Right Dose
- Right Route
- Right Time
- Right Documentation
F) Re-Use of Resident's Medication Aids
DHSC and NHS England and NHS improvement have issue a Standard Operating.
Procedure to relax the rules during COVID-19 so that certain medication can be re- used once the following has thought
- No other stocks of the medicine are available in an appropriate timeframe (as informed by the supplying pharmacy).
- There is an immediate resident need for the medicine.
- No suitable alternatives for an individual resident are available in a timely manner i.e. a new prescription cannot be issued, and the medicine(s) supplied against it in the conventional manner quickly enough.
- The benefits of using a medicine that is no longer needed by the person for whom it was originally prescribed or bought, outweigh any risks for an individual resi- dent receiving that unused medicine.
- The medicine must be checked against the criteria that it is safe to re-use.
- Where no registered healthcare professional is on site, registered healthcare professionals (can perform that check (this may be done virtually) and confirm that the medicine is suitable for re-use.
- If the medicine suitable for re-use is a controlled drug, then it must remain in the control (possession) of an organisation authorised to do so.
- You must read the full document as this is a snap shot.
i) Controlled drugs as stock in care homes
‘‘The CCG medicines optimisation teams are central to this action. CCGs will work with providers and healthcare partners to en- sure rapid access to end of life medicines for people in care homes.’’ - CQC April 2020
The CQC have issued a statement of this which can be read here in full on their website.
F) Mental Capacity Act- Important points
- Every adult has the right to make his or her own decisions. You must assume they have the capacity to do so unless it is proved otherwise.
- You must not assume someone lacks capacity because they have a particular medical condition or disability.
- A person is not to be treated as unable to make a decision unless all possible steps to help them do so have been taken without success.
- You should try very hard to encourage and support people to make the decision for themselves.
- If someone lacks capacity, it is important to involve the person as far as possible in making decisions.
- A person must not be treated as unable to make a decision just because he or she makes an unwise decision.
- People have the right to make decisions that others might think is unwise.
- Everyone has their own values, beliefs and preferences which may not be the same as those of other people.
- Anything you do or decide for or on behalf of a person who lacks mental capacity must be in their best interests.
- When making a decision or acting on behalf of a person who lacks capacity, you must consider if there is a way that you can give them as much freedom as possible and that it protects their rights and if you need to act on their behalf in the first place.
G) Using Sedation to enforce Social Distancing Rules
- The government has clear rules 'You must stay at home' unless you need to travel for work. This is really difficult for everyone. For service users who don’t have the capacity to understand, this it can be confusing.
- We have an Easy Read Fact Sheet in the QCS Resource Centre that you can use to explain to the Service User why they need to stay at home.
- If a service user is refusing to stay at home you must tell your manager.
- Using sedation to keep them at home is not good practice.
- Your manager can speak to the community mental health team for advice.
i) My service user has a headache, can they take paracetamol during COVID-19?
- Check what your ‘over the counter medication’ policy and procedure says.
- Check with the service user’s doctor or pharmacist to make sure it isn’t going to cause a problem with any other medication they take.
- Tell you, manager, if you have to support the administration. It will need to go on a MAR chart.
- Make sure the service users take the correct dose. And they do not take too many in 24 hours.
- If the symptoms don’t go away after a 48 hours contact the GP.
- Remember that some people may not always have a cough or temperature with COVID-19, tell your manager asap.
I) Handwashing Techniques to Stay Healthy
Follow these five steps every time.
- Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
- Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
- Scrub your hands for at least 20 seconds. How long? Hum the “Happy Birthday” song from beginning to end twice.
- Rinse your hands well under clean, running water.
- Dry your hands using a clean towel or air dry them.
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