Medication

All medicines supplied to an individual client are the property of that client only and must not be used by any other client or put into general stock

 This applies to dressings, surgical sundries and nutritional supplements supplied to an individual client. If medicines received have been supplied by a pharmacy on prescription, a a copy of the  prescription should be available. This copy can then be related to correct receipt of medicines and information transferred to the client€™s MAR or self-administration documentation

It should be held in the client€™s file for auditing purposes

 Bulk Prescribing

  • This is legal in England and Wales only for medicines and dressings (including bandages) that are not POMs
  • GPs who are responsible for 10 or more clients (where the home has 20 or more clients) may in certain circumstances issue a bulk prescription for the treatment of 2 or more clients
  • They may order only medicines and dressings that can be prescribed under the NHS

Care workers  must monitor bulk orders and check for whom they have been prescribed

  • They are not for general usage
  • This method is not suitable for self-administering clients
  • This is not a method of obtaining stock items of non-prescribed medicines
    (homely remedies)

Packaging

In compliance with the Medicines (Child Safety) Regulation 2003, packaging has to be difficult for young children to open

Pharmacists must supply all oral solid dose medicines in child resistant packaging, with limited and specific exceptions

This also applies to all dispensed liquid medicines

  • A specific request by a client or designated member of staff can be made for the medicine not to be dispensed in a child resistant container, if the self-administering client is experiencing difficulties in opening it

Medicines are generally dispensed in the manufacturer’s original pack. When a specific medicine differs unexpectedly in packaging from that received before, the home should check with the pharmacist before dispensing the medicine

Medication Storage of Medicines

Once prescribed medicines have been checked against the prescription, recorded as received and the information transferred to the MAR, they should then be immediately stored securely and at the correct temperatures

 Where and how to store the medicines should take account of the nature of the medicines, the size of the home and number of clients

  • It is not suitable to store any medicines in the kitchen, bathroom, toilet and sluice or next to heaters
  • Medicines and medicinal items should also be stored off the floor at all times

Security

The room must have a lockable door with a lock that no other key fits

There should be no external door leading into the room

Any external window should be suitably secured with bars or lockable roller shutters

  • The key to the medicine room can be held only by a designated member of staff
  • No client should have access to the medicine room unless accompanied at all times by a designated member of staff
  • The medicine room must never be left unlocked and unattended
  • No unauthorised person should have access to the medicine room
  • It should never be used as a staff room

The medicine room should only be used for medicinal products/medicine trolley and nutritional supplements

Temperature should be maintained (16°C – 25°C) for normal storage and be protected from direct sunlight

If a suitable room is not available then a secure cupboard can be used

Medicine Trolley

A mobile medicine trolley should be of suitable construction both in materials and size. (Size will be determined by the size of the home and the quantity of medicines)

A medicine trolley can have two purposes:

  • To transport the current administration rounds medicines with dispensers, etc
  • As the main storage for medicines

If the trolley is to be used to store medicines it must be locked and fixed to a wall when not in use or locked within a secure designated area

Temperature Control €“ Cold Storage

  • As well as temperature, sunlight can affect the properties of a medicine
  • The ideal temperature for the most medicines is 16°C to 25°C
  • There are exceptions €“ e.g. insulin

There should be a separate and secure refrigerator dedicated solely to the storage of €˜cold€™ drugs

  • It should be situated within a secure medicine room, or fitted with a suitable lock (not the kitchen or sluice)
  • The temperature of the refrigerator should be monitored daily, using a maximum and minimum thermometer, and recorded

The refrigerator should be defrosted on a regular basis

  • The normal temperature range is between 2°C and 8°C
  • All staff should be aware of action to take if temperature deviates
  • Medicines that requires refrigeration should have a leaflet determining the minimum and maximum temperature range
  • This information should be available to all staff monitoring the temperature records

Storage of Oxygen

Any home using and storing oxygen must have in place a full risk assessment and all staff must be made aware of the potential hazards and control measures

  • Cylinders must only be moved using a purpose-built trolley
  • Cylinders should be chained or clamped to prevent them from falling
  • They must be stored in a well ventilated storage area (away from combustible materials, sources of heat or ignition)
  • Empty cylinders should never be stored with full ones
  • Oxygen can be kept in a client€™s room, with appropriate safety notices

All rooms where oxygen is used or stored must display the statutory warning notices:

 Compressed Gas. OXYGEN: No Smoking, No Naked Lights.

 In addition to the above safe storage, emergency service personnel should be told about the oxygen storage areas

 Storage of Controlled Drugs

 There are additional standards for the storage of Controlled Drugs (Schedule 2)

  • Controlled drugs should only be stored in a metal cupboard specifically for that purpose
  • No other medicines should be in the cupboard
  • Any MDS containing Controlled Drugs must be stored in the Controlled Drugs Cupboard
  • The metal cupboard can be situated inside the main medicine cupboard (with a separate lock and key)
  • If this is not possible a separate metal cupboard is required

Only authorised or designated staff should hold the keys to the Controlled Drugs cupboard

Medication Record Keeping

The overall responsibility for ensuring the correct maintenance of records and manner in which they are completed is with the Registered Person

It is the duty of each member of staff designated to look after medicines to follow these procedures correctly

  • Records should be completed legibly, accurately and kept up to date (every day)
  • The setting can decide on the style of the records used but each must contain certain information 
  • If the information is held on a computerised system, advice should be sought regarding the Data Protection Act 1998

The various records required are:

  1. Receipt of medicines
  2. Client’s MAR (Medicine Administration Record)
  3. Self-administering client’s record
  4. Disposal of medicines
  5. Controlled drugs

Receipt and Recording of Medicines

  • All prescribed medicines received into the home must be checked against prescriptions and recorded
  • All GSL medicines purchased for clients must also be recorded
  • This recording is required for all medication regardless of the source

The record must show:

  • Date of receipt
  • Name, strength and dosage
  • Quantity received
  • Name of service user
  • Indication if medicines are homely medicines Signature of the member of staff receiving the medicines
  • With a new admission to the care home, written confirmation of the medicine the client is taking should be obtained from an authoritative source