Medication Awareness

Introduction:

This course is designed for Care Workers who may be required to administer medication. Any nurse who is on the Nursing and Midwives Council (NMC) register must administer medication under the NMC guidelines.

Course Contents:

Medication and the Law – An introduction

Legislation – Acts relating to your work practice

Policies and Procedures

Prescriptions Medication

Administration Records

Routes of Administration

Types of Medication

Controlled Drugs and Classes of Drugs

Common Side Effects

Disposal of Medication

Overdose

Dealing with Sharps

Important Information:

Make sure that you read all of the information and completed all quizes and the assessments at the end before submitting. When you have submitted and completed the course, you will receive a certificate of completion via email to the email address given on ordering or used to purchase this course via the www.asptd.co.uk website.

MEDICATION AWARENESS

Introduction to the Legal Aspects

Important Information:

To legally administer medication, individuals will need to have been trained and assessed for competency in the workplace before they administer any medication to the individuals they care for. By completing this course, you will gain an awareness of medication handling and administration and this course does not qualify individuals. This course is ideal for those who wish to gain an awareness or for those who administer medication as part of their role and want to do refresher training. 

Any individuals who are involved in the administration of medicines MUST adhere to particular rules and regulations whether they are a doctor, nurse pharmacist or a person administering to others.

Acts and regulations relating to medicines are there to protect you and the individuals that you look after.

The misuse of medicines can be extremely dangerous and errors can occur due to a lapse in concentration and will cause harm if handled inappropriately.

There is a great deal of law that as carers we need to comply with and for that reason you are going to go through some of the legal aspects that have an impact on the way we work.


Medicine Act 1986

Misuse of Drugs Act 1971

Misuse of Drugs (Safe Custody) Regulations

The Health and Safety at Work Act 1974 (HASAWA)

Access to Health Records Act 1990

Data Protection Act 1998

First Aid Regulations

Reporting of Injuries and Dangerous Occurrences Regulations (RIDDOR)

Control of Substances Hazardous to Health Regulations (COSHH)

The Human Rights Act

The Human Medicines Regulations


Medicine Act 1968

The 'Medicines Act 1968' was the first piece of comprehensive legislation on medication in the UK. It is the combination of this piece of legislation and various statutory (secondary legislation) on medicines produced since 1968. This piece of legislation provides the legal framework for the production, distribution, importation, manufacture, prescription, supply and administration of medication. This act governs the supply of medicines to care homes.


Under the Misuse of Drugs Act 1968, it divides medication into three categories:


Prescription only medication (POM) – these medicines can only be obtained with a valid prescription that is written by a doctor, dentist or nurse prescriber.


Pharmacy only medication (P) – these medicines can only be bought from a pharmacy providing the sale is supervised by a pharmacist.


General sales list medication (GSLM) – these medicines can be purchased from any shop and includes complementary / homeopathic remedies. They usually contain herbs and natural products. They can be potent and should be treated the same as other medications.

Misuse of Drugs Act 1971

These pieces of legislation regulates the medications that have the potential for addiction and therefore may make it illegal to manufacture, supply or possess.

These pieces of legislation are concerned with controlled drugs and categorises them into five categories:

Schedule 1 – these drugs are stringently controlled and are not administered for medical use. Examples cannabis and raw opium.

Schedule 2 – Illegal to possess without a valid prescription. Examples opiates such as morphine and major stimulants and amphetamines.

Schedule 3 – Illegal to possess without a valid prescription. Example Temezepam.

Schedule 4 – can be legally possessed providing they are in the form of a medical product. Example benzodiazepines such as diazepam.

Schedule 5 – contain drugs that are considered to pose minimal risk of abuse. Examples cough mixtures and pain relief.

Misuse of Drugs Safe Custody Regulations 1973

This Act state that all schedule 2 (eg, opiates) and some schedule 3 (eg, temazepam) drugs should be stored in a cabinet or safe, locked with a key.

The cabinet should be made of metal and fixed to the wall or floor. A designated person at the practice should be nominated as responsible for the CDs and appoint key holders. The keys should be kept in a safe place and no unauthorised members of staff should have access to the keys, eg, a locum. For home visits doctors should carry CDs in a lockable bag.


Health and Safety at Work etc Act 1974

Under the Health and Safety at Work etc Act 1974 it is the employers’ responsibility to reduce the risks as far as reasonably practical and to ensure risk assessments are provided.


It is the responsibility of the employee to protect the health and safety of the service user by minimising infection control whilst administering medication.


You should protect yourself and the service users by the wearing of personal protective clothing; practicing good universal precautions and hand washing; safe disposal of waste; and reporting of any untoward incidents.


Key Fact:

In the United Kingdom anyone can legally administer prescribed medication to another person. This includes prescription only medication and controlled drugs.   This administration must be in accordance with the prescriber’s directions. (The Commission for Social Care Inspections 2005).

Access to Health Records Act 1990

This Act defines who may see medical records. The individual may see their own medical reports but no one else may see them without permission from that individual. This includes next to kin and friends.

Under this piece of legislation service users are entitled to access their medical records and this includes medication records.

Other Legislation

The Data Protection Act 1998:

This applies to any organisation which keeps personal records on computer. They must:

Be secure

Allow the individual access to their records 

Record only relevant information

Be used and disclosed for stated purpose

COSHH Regulations 1999

This requires all employers to take all reasonable measures to protect their employees from any potentially dangerous substances or materials that they come in to contact with whilst at work.

One of the most hazards to be found in the workplace is the use, handling and the storage of hazardous substances.

COSHH Regulations was introduced to help guide employers on how to safely control the use of hazardous substances and to reduce the risk that may potentially cause harm.

Hazardous Waste Regulations 2005

This Act defines household and industrial waste and includes medicines that are no longer required. For instance, care homes with nursing in England and Wales must use a clinical waste company to dispose of unwanted medicines. Other care homes can return medicines to the supplying pharmacy for destruction.


Personal Protective Equipment Working Regulations (PPEWR)

This advises on the selection of personal protective equipment and clothing worn or held by people at work to protect them against risks to their health and safety.

PPE should only be considered after risk assessment when the risk from a specific hazard cannot be controlled effectively in any other way.

Guidelines for Best Practice

Care Quality Commission has produced guidance called, ‘Guidance for providers on meeting the regulations’.

NICE National Institute for Health & Care Excellence have produced guidance called, ‘Managing medicines in care homes’

Royal Pharmaceutical Society of Great Britain have produced guidance called ‘The Handling of Medication in Social Care’

Website links for further reading


Managing Medicines in Care Homes: 

https://www.nice.org.uk/guidance/sc1


The Handling of Medicines in Social Care:

http://www.rpharms.com/support-pdfs/handling-medicines-socialcare-guidance.pdf?

Policies and Procedures

The organisation will have various different policies and procedures in place to help employees in the event of any incident. All care staff should be aware of their existence and should become familiar with the information. This information is there to protect and guide everybody.

If you are not sure where these are kept or have any problems understanding any of the information, you should address this with your manager.

The National Minimum Standards require that the registered person should ensure that policies regarding the following are put in place:

  • Receipt 
  • Recording 
  • Storage 
  • Handling 
  • Administration 
  • The Disposal of Medicines

This will promote the safety and well-being of the individuals cared for in the organisation and also makes staff aware of safe practices.

Key Fact:

“A good policy should be uniquely written for your workplace and should be able to guide you through exactly what to do from the ordering of storage, administration and finally the disposal of medicines.”

The Medication Process

Prescribing

Medication will be prescribed by a GP or other healthcare profession qualified to prescribed, i.e. Nurse Practitioner. 

Dispensing

On receipt of a prescription, the medication will be dispensed by a pharmacist and then given to the individual. 

Receipt of Medication

Medication is received by the individual once dispensed by the pharmacist.

Administration

Medication is administered to the under the individual by a person who is trainer and able to do so. Remember, the Medicine Act 1968 is the legislation which allows third parties to administer on behalf of an individual.

Storage

Medication should be stored appropriately, i.e. a residential care home will need to store medication in a locked metal cabinet which is either affixed to the wall of chained up in a locked room. 

Disposal

Medication should be disposed in the proper way. You should never throw any medication away in the bin, flush down the toilet or pour down the sink. Ask your local pharmacist for disposal kits and return any unwanted medication. 

Recording

Any medication received for an individual you care for should be recorded. A care home for instance will have a separate book to record receipt of medication other than the MAR sheet. Two people should record this, one to witness. 

Check your company's policy on medication handling and administration and be mindful of the processes of your own organisation.

Prescriptions

Stop and Think:

Before moving to the next page, make a list of all the information you would find in a prescription. 

Prescriptions

Information will include:

  • Name, age and D.O.B of Individual prescribed to 
  • The Address of the Individual 
  • Patient Number 
  • Medication, strength and dose 
  • Quantity of medication 
  • Name and address of GP 
  • Date of Prescription 
  • Prescription must be signed

Important Points to Remember:

Prescriptions should be written legibly in ink or otherwise so as to be indelible

They should be dated, should state the name and address of the patient, the address of the prescriber, an indication of the type of prescriber, and should be signed in ink by the prescriber.

The age and the date of birth of the patient should preferably be stated, and it is a legal requirement in the case of prescription-only medicines to state the age for children under 12 years.

If you are responsible for a service user you will have to sign the back of the prescription and tick the exemption box and proof of exemption may be asked for.

Medicine that has been prescribed is the property of the individual it was prescribed to.

Under The Medicine Act 1968 it states that each medicine that has been prescribed can only be given to the named person and must be labelled as supplied.

This clearly shows that it must not be treated as stock and be administered to anyone else. This also applies to dressings and catheters.

How Prescribing can Go Wrong

Stop and Think:

Before moving to the next page, make a list of the different reasons for how you think prescribing can go wrong.

One example can be:

Inadequate knowledge about drug indications and contraindications

How Prescribing can Go Wrong

Inadequate knowledge about drug indications and contraindications 

Not considering individual patient factors such as allergies, pregnancy, co-morbidities, other medications 

Wrong patient, wrong dose, wrong time, wrong drug, wrong route 

Inadequate communication (written, verbal) 

Documentation - illegible, incomplete, ambiguous 

Mathematical error when calculating dosage 

Incorrect data entry when using computerized prescribing e.g. duplication, omission, wrong number

Things to Remember

Identify the medicines that need to be ordered – these tend to be repeat prescriptions.

Request the prescription from the surgery – Normally 28 days (7 days in some instances).


Check the prescription against the old MAR chart – checking for errors or any changes in dosage or medication.

Call the surgery if any errors are found – the sooner the better.


Send the prescription to the pharmacist, make sure that it is signed and exemption claimed. Again check for any errors with the pharmacist before administering.

Record the quantity and write the amount on the MAR Chart. There may be balances that have been carried over from previous months.


The SIX Rights of Medication Administration

The Six Rights When you are giving medication, regardless of the type of medication, you must always follow the six rights.

 Each time you administer a medication, you need to be sure to have the:

1.Right individual 

2.Right medication 

3.Right dose 

4.Right time 

5.Right route 

6.Right documentation

 

Verbal Orders

Key Fact:

“A GP may change the dose of a medication through the 28 day cycle, if they need to do this then they may well do it verbally but by doing this, the GP will not need to write a second prescription. You should have a written protocol for this to record the information correctly.”

Any verbal dosage change should be recorded at once and it must include the following:

  • The date and time
  • The doctors name
  • The name of the individual
  • The name of the medicine
  • The new dose and frequency
  • Any new instructions
  • The name of the person who recorded the information

Important Things to Do:

  • Always remember to repeat any information back to the GP and confirm it 
  • Record that information on the MAR Chart 
  • Sign, date and strike out the old dosage as the new information will be the new entry 
  • Ask for a fax as added confirmation 
  • Always check with and inform the manager before making any changes to any medical records

If unsure of any contradictions of any new medication or any ongoing medical treatments there are other points of references that may be useful:

  • The British National Formulary (BNF) 
  • The product information leaflet 
  • The MIMS the Monthly Index of Medical Specialists (pharmaceutical prescribing reference guide published in the UK since 1959) 
  • The guide to drugs and medicines 
  • The Internet

The Medication Administration Record (MAR)

A MAR chart is the record that shows drugs have been administered to a patient. The carer signs each time a drug or device is administered to a patient. Carers administrating medication in the care home setting should be suitably trained and competent to do so.

Stop and Think!

Before moving to the next page, think about and make a list of all of the information that should be included on a MAR chart and make a list of what this should contain.

The Medication Administration Record (MAR)

Information would include:

  • Name of the Individual 
  • Name and address on the home 
  • Any Allergies (if known) 
  • Start date of the MAR chart 
  • Sequential page numbers (1 of 2 or 2 of 2) 
  • Name, strength, dosage and formulation of medicine 
  • Quantity of medicine received and date 
  • Signatures of two members of staff receiving the medication

With new service users, you should check all the medication to make sure that it is in their current medicine regime.

Check this by:

  •  A discharge prescription from the hospital 
  • A repeat prescription brought in by an individual 
  • The pre-admission assessment by another healthcare professional

If the information as mentioned before in not available then the GP should be contacted.

Do not rely on an individuals’ word on any medication they may bring in if they have no written confirmation to support it.

Key Point: If a service user dies then all medication and records must be kept for 7 days as a coroner may wish to see them in the event of an unexplained or suspicious death.

Routes of Administration

The Various Routes of Administration

Parenteral route

Enteral route

Intradermal

Transdermal

Subcutaneous

Intramuscular

Intravenous

Endotracheal

Inhalation

Sublingual Injection

Intracardiac

Sublingual

Oral

Rectal

Peripheral Veins

Intraosseous

IV push

Drip

IV piggyback

Actions

Contraindications

Micro drip set

Bolus

Quiz: Match the definitions to the routes of administration

  • Ingestion
    this is solid dose tablet or capsule or liquids and oral solutions and syrups. Taken in the mouth.
  • Topically
    this means creams, ointments and gels that are administered directly to the skin.
  • Infusion
    this is when fluids are given over a period of time (for example 12 hours).
  • Transdermal
    this is patch medication and used in the treatment of many areas, example, hormone replacement therapy (HRT) fentanyl patches and nicotine patches.
  • In to a Vein
    This is done by trained nurses.
  • Instillation
    this medication that can be instilled (drip liquid into something drop by drop) Into the ears, eyes and nose.
  • Vaginally
    pessaries are formulated to be administered via this route. You should be fully trained to administer this way.

Types of Medication

There are so many different types of medication available today and many have more than one function.

Example:

Aspirin is not just used to help relieve pain but it is also used as a blood thinner.

You must also understand classification of medication, this means that it is broken down in to parts.

POM – Prescription only medicine

P – Pharmacy only medicine

GSL – General Sales List

CD – Controlled Drug

Website links for Further Reading:

Types and Forms of Medication 

Drug Index A-Z

Controlled Drugs

Under the Misuse of Drugs Act 1971, there are certain restrictions on how they are prescribed, stored and how records are kept of controlled drugs.

They must be stored in a metal cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations Act 1973.

A CD register must be bound with pages numbered.

Administration must be recorded by 2 people, one administering, and one to witness.

This also has to be recorded on the MAR Sheet

Examples of CD are: Temazepam, Morphine and Diamorphine.

You can access the NHS Choices website by clicking here for more on what controlled drugs are.

Common Side Effects

The following are a list of common side effects

Drowsiness 

Being less alert 

Tiredness 

Difficulty in concentrating 

Slurred or impaired speech 

Mood swings

Tremors 

Shakes

Stiffness 

Swelling 

Vomiting 

Diarrhoea 

Headaches 

Rashes 

Slowed reaction times 

Decreased physical coordination

Remember:

Each medication has their own side effects therefore it is important to familiarise yourself with the side effects when a new medicine is prescribed to an individual you care for.

You can find this out by referring to the BNF or product information leaflet.

Below is a website where you can read up on the side effects of any medicine:

https://www.drugs.com/sfx/fluoxetine-side-effects.html

Anaphylaxis

Anaphylaxis is an acute allergic reaction to an antigen (e.g. a bee sting) to which the body has become hypersensitive.

For more on the types of medications for anaphylaxis, you can access the following website:

http://www.anaphylaxis.org.uk/hcp/medication/

Key Fact:

Anaphylaxis can lead to cardiac arrest and can even cause death. 

Overdose

In the care sector, errors do occur. They must be dealt with promptly.

Do not attempt to cover it up!

Have a think about the procedures that you must take if you believe someone has taken an overdose. 

Actions to take:

Ring 999 or 112 

Stay calm 

Keep them awake 

Do not walk them around 

Give the paramedics a list of the medication you think may be relevant 

If they stop breathing, start your first aid training

If an individual has intended to harm themselves, ongoing treatment may be required, this may involve the support of:

  • Care Manager and Staff 
  • The GP 
  • A Psychologist 
  • A Pharmacist 
  • Family and Friends 
  • An advocate

By working as a team a service user will receive the correct treatment and support.

Disposal of Medication

Before disposing of a medicine, staff should check whether it is still needed, whether it's within its expiry date and what the shelf-life is once opened.

Care homes especially should keep records of all medicines (including controlled drugs) that have been disposed of or are waiting to be disposed of.

Medicines waiting for disposal should be kept in a locked cupboard until they are collected or taken to the pharmacy.

Liquid waste should be placed in a special bin, do NOT pour down sinks or toilets.

All medication no longer required should be logged in the return book.

Dealing with Sharps

When dealing with sharps disposal, you should be vigilant and pay attention to what you are doing, a lapse in concentration could result in a serious accident.

Needles and syringes must be placed in a “sharps box” after use. This will reduce the risk of stick injuries and cross contamination.

Always remember to wash your hands before and after dealing with any medication or treatments.

Assessment

  • I need to be aware of the Medicine Act 1968.
  • I do not need to be concerned about the Misuse of Drugs Act.
  • Some people take medication to enable them to live their lives.
  • Medication has no impact on preventing disease.
  • Medication is sometimes taken to ensure normal body functions.

Assessment

  • Tablets are a form of medication that is taken
  • Drops, sprays and ointments are considered medication.
  • I do not need to be aware of the contents of a MAR sheet.
  • I should be observing for signs of side effects and other symptoms .
  • An anaphylaxis reaction cannot kill someone

Assessment

  • Anaphylaxis describes a serious allergic reaction.
  • Anaphylaxis can lead to a cardiac arrest.
  • There is no need to ensure you give the right dose of medication.
  • If you make a mistake with medication you must report it immediately.
  • You should ensure medication is taken at the right time.

Assessment

  • There is no need to sign the MAR sheet.
  • There is no need to check for known allergies.
  • Accurate and detailed recording is important with regard to medication.
  • There is no need to check the expiry date of medication
  • You should always read the label on medication.

Course Completed

Well done on completing this course!

Providing you have passed all of the assessments within the course and the status shows 100% complete you will receive a certificate of completion within the next 48 hours.

If you do not receive the certificate within this time, please email us at [email protected] 

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Best Wishes

E-Learning Team

E-Lrn (Learning and Resources Network)


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