Transcript Session 1 - NHS Borders

Medicines
TrainingManagement
Day for
Managers, Seniors & Support Workers
Why are you here?
• Revised Medicines Management Guidance
implemented by SBC.
• Significant change to current practice –
Service users will now be assessed for the
medication support they require.
 Support Staff will be administering a range
of medicines from original packaging.
 Training required to meet Care Inspectorate
Guidance.
So-why do we need training?
• To learn the right way to administer
medicines
• To be in line with the new Medicine
Management Guidance
• Build confidence
• Equity of access
• So questions can be answered
Today
• Four modules:
–
–
–
–
Policy & Guidance
Medicines and their use
Monitoring & Supporting use
Medicine & Older people
Competency
 A multiple choice questionnaire will be part of
your training to test your knowledge and
understanding. During this training
• A Competency Assessment will be carried out by your
supervisor. In your place of work at a later stage.
 Your Line Manager must advise you before
you can start administering Medicines.
Medicines Management
Policy and Guidance
Session 1
• Policy on medicines
• Medicines and the law
• Medication Assessment and levels of
support
• Self administration
• Administration of medicines
• Awareness of MDS systems
• MAR charts and record keeping
• Medication Errors
• Session 1 Evaluation Exercise
National Care Standards
Standards for each Registered
Service Area:
• Care at Home
• Care Homes
• Support Services (Day Services)
Standards make reference to what service users
should expect from services - includes support with
medication (Workbook Appendix 1)
Page 71 of workbook
Scottish Social Services Council
Codes of Practice
Codes of practice for social service workers
and employers of social service workers
describing the standards and conduct of
practice within which they should work.
Pg 75 of workbook
Activity 1
Page 6 of workbook
The Law
• The law states that anyone can
administer a medicine to another person
if that is in accordance with the
directions of a prescriber.
(The Medicines Act 1968)
On whose authority
am I giving this
medicine
Prescription
written
Support worker
administers
prescription
Support worker
writes in support plan
Support worker
picks up
prescription
Pharmacist dispenses
prescription
Authority to Administer Medicines
• A Medicines Administration Record Chart is
NOT an authority to administer.
• A Palliative Care Medicines chart signed by a
Doctor is an authority to administer.
• Sign the prescription (look at both sides)
when it is picked up and to document this in
the Service user’s support plan.
• If they are not prescribed they may not
legally be administered.
• Document medication on delivery to service
user.
Medicine Management Guidance
 In place to promote the safety and wellbeing
of the service users and ensure safe
practices of all support staff .
 All support staff must be aware and
understand their role and responsibilities
while working with medicines.
Activity 2
Page 8 of workbook
Procedure for Service User
Medicines Management
• See Guidelines
– Appendix 1
– Appendix 2
– Appendix 3, 4, 5
Administration Levels
(Full Details in Workbook)
(See Appendix 2 of guidelines)
• Assessed at Level 1 – Service Users will retain full
control of their medication.
• Assessed at Level 2 – Service Users will maintain
overall responsibility but will require assistance with
prompts to take their medicines and collection of
prescriptions.
Support Worker Tasks at Level 2
•
•
•
•
Reminding the patient to take medicines– prompting
Confirm the reading of labels.
Provide assistance with opening medication
packaging Performing and interpreting blood glucose
monitoring.
Order repeat prescriptions from the medical
practice. The service user must specify the name,
strength and quantity of the medicines to be
ordered.
Collect the prescription from the medical practice,
take it to the nominated pharmacy for dispensing
and collect the dispensed medications from that
pharmacy.
Assessed at Level 3
• Service Users are unable to manage their own
medication and will require their medicines to
be administered.
• Medicines to be administered will be listed on
a specific chart “Medicines Administration
Chart” (MAR).
• The MAR chart is provided by the Pharmacist
who dispenses the medicines.
• The MAR chart is supplied monthly along with
the supply of medicines.
Support Worker Tasks at Level 3
• Only those medicine management tasks that
have been agreed by the service user or
his/her representative and are specified in
his/her support plan may be undertaken.
• Support Staff can Administer those
medications that are listed on the medicines
administration record, including those
contained in a Medicines Compliance Aid
(MCA) filled by a Pharmacist or a Dispensing
Doctor
Level 3 - Support Worker Tasks
• Care at Home Staff are not permitted to
administer “as required” medication for
service users assessed at Level 3.
• In care homes medicines that are prescribed
on an ‘as and when required’ basis may be
administered provided that it is listed on the
medicines administration record (MAR) with
full instructions as to the frequency of
administration and the maximum daily dose.
This should be clearly documented in the
support plan.
Warfarin
• CARE AT HOME STAFF SHOULD NOT ADMINISTER
WARFARIN
• In Care Homes the GP practice may give verbal
instruction over the phone or in person to the
Senior Support Worker on duty and they should
repeat the instruction back to the GP practice to
ensure clarity. This then needs to be recorded in
the Social Care & Health recording notes and in
the Warfarin Dose and INR Recording Form. This
form should be stored along with the service users
MAR record and the MAR record should read “as
prescribed on WD/INR/Form”.
Don’t Forget
•
•
•
•
•
Right Person
Right Medicine
Right Dose
Right Time
Right Route
Those Assessed at Level 4
• Administration requires medical
training and knowledge
Who Does What?
• Relevant training done by all support workers
• Assessment of need – by care
manager/Parmacist
• Support plan – added to by everyone
• Consent – from the service user or their legal
representative
www.sehd.scot.nhs.uk/mels/HDL2006_34.pdf
• Medication Administration Record (MAR)
Chart – pharmacist produces
• Medicines Administration Record (MAR)
Chart – support worker writes on it
SUPPORT WORKER’S RESPONSIBILITY
Wash hands
Service user
Sitting up preferably
Check the service
User’s support plan
And Medicines
Administration Record Chart
or Kardex and get all
The medicines ready
Level 2/ 3
Put medicine
away, check if
They need ordered
Check Identity
Measure and
Give dose(s)
Offer a glass
of water
Sign medicines
Administration
Record if level 3
order
CARE MANAGER’S RESPONSIBILITY
Remember Consent
Service user is assessed by
Support manager
For level of medicines
administration needed
Level 1,2,3, or 4
agreed
Community Pharmacist asked
for MAR chart, if level 3
All instructions will
Need to be very
Clear on the MAR
So they will be
understood
Support plan written
Detailing Support level
And Community Pharmacy
address
Support worker
checks the service
User’s support plan
And Medicines Administration
Record Chart
Administration of Medicines
Preparation

Wash hands,
MAR

is important
chart, - look at the time of day it is
Medicines – select the ones needed
Administer,
Record
Put
remember to offer a drink
– exactly what you administered and when
away – making sure that those needed are ordered
Wash
hands – washing hands is the thing that has been
shown to reduce transfer of infection the most.
Important points to note
• If you are unsure about the service user’s identity or there is a
discrepancy with medicines or the instruction is not clear then
do not administer - contact your line manager immediately.
. Do not handle medication: disposable gloves should be worn as an
extra precaution when administering cytotoxic medication.
• Push tablets out of blister packs directly into a medicine pot or
other receptacle used for this purpose.
• You must not administer medicines which are not prescribed on
the MAR chart.
• You must report immediately if medication that should have
been administered previously has been missed by another
worker.
• You must report immediately if when administering you notice a
missing signature on the MAR
What Does a Medicines
Administration Record Chart look
like?
1
2
3
B
J
S
IG
J
O
L
J
S
1
T
J
S
IL
N
IG
J
O
Aspirin
Dispersible
75mg Tablets
Take one in the
morning
B
J
S
IG
J
O
Lisinopril 20mg
Tablets
Take one in the
morning
B
J
S
IG
J
O
Paracetamol
500mg Tablets
Take two four
times a day
L
T
N
L
T
N
B
L
T
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
This is what
some
Of the
Medicines
Administration
records look
like.
Others will be
similar.
Activity 3
Page 19-22 of workbook
Administering Tablets or Capsules
• Tap from the container, or pop out of
the blister, into a lid or small cup or the
service user’s hand
• Should not be touched by your bare
hands
• Service user should be offered a half
glass of cool, but not too cold, water to
help with swallowing
SOLUBLE/DISPERSIBLE
ORAL FORMULATIONS
• Take the dose from its original container
• place in a third of a tumbler of cold water and
allow to dissolve
• swirl the solution gently in the glass to ensure
adequate mixing
• hand to the client to drink and offer a drink
after the dose has been taken
• SUBLINGUAL FORMULATIONS - under tongue
• BUCCAL FORMULATIONS – between cheek
and upper teeth
LIQUID ORAL DOSE FORMULATIONS
Only one liquid bottle should be open at any one
time.
§ shake the bottle
§ measure the correct dose – How?
§ offer the medicine to the patient
§ when using an oral dose syringe empty the syringe
slowly onto the tongue, or towards the cheek
AVOID ‘SQUIRTING’ INTO THE BACK OF THE
THROAT
§ clean the neck of the bottle with a clean damp
tissue before replacing the cap
TOPICAL (EXTERNAL)
FORMULATIONS
• use only as often as instructed
• apply only to the areas of the skin for which
it has been prescribed -support plan
• use the smallest quantity that will easily rub
into the skin
• use only for as long as instructed and return
partly used tubes to the Community Pharmacy
for safe disposal at the end of the treatment
period
APPLICATION OF EXTERNAL
PREPARATIONS
• Look at Patient Information Leaflet (PIL)
• wear disposable gloves
• Transfer quantity required to gauze or clean
tissue and re-seal tube
• Apply to affected area rubbing in if needed
• Dispose of gauze and gloves in sealed
polythene bag in the general waste.
EYE PREPARATIONS, Drops
• Tilt the head back and gently pull down the
lower lid asking the client to look up
• Bring the dropper close to the eye
• Gently squeeze the dropper allowing the
prescribed number of drops to be placed inside
the lower lid
• Ask the client to close the eye and then blot
away any excess solution with clean cotton wool
• Replace the cap on the container immediately
after use
• May Cause blurred vision – falls risk
Eye Ointments:
•
•
•
•
Tilt head back
Gently pull down lower lid
Apply half an inch of ointment
Ask service user to close eye and blink
several times
• May cause blurred vision – falls risk
• Replace cap immediately after use
• Expiry of eye products
Ear Preparations
• Tilt head to one side
• Place prescribed number of drops/
applications in the ear
• Keep head tilted for several minutes
• Have cotton wool or tissue to absorb
any run off
Nasal Drops
• Ask client to blow nose
• Tilt head back or ask client to lie down
• Ask service user to breath through
mouth
• Place prescribed number of drops in nose
• Ask service user to keep head back or
remain lying down for several minutes
• Tasting the drops is no cause for concern
Activity 4
Page 19, 23-25 of workbook
Mistake? What do you do?
•
•
•
•
•
•
•
•
Anyone can make a mistake
Reporting - no blame culture, near misses
Documentation
Learning from Audit
Wrong drug
Wrong dose
Wrong strength
Wrong time
Activities 5,6 & 7
Page 19, 26-28 & 29-30 of
workbook
Alcohol & medicine
What do you do?
MCQ’s