Care staff are often called upon to deliver medication in health and social care settings.
This can be alongside busy jobs and competing demands from the people being cared for, and it can be a challenge making sure staff get it right.
There are a number of key areas staff need to ensure they understand when administering medication, and it’s useful for them to have reminders of this alongside any training given, to keep refreshing best practice.
Controlled and uncontrolled drugs
Controlled drugs are dealt with under the Misuse of Drugs legislation and have to be dealt with differently to uncontrolled drugs. Examples of controlled drugs are morphine patches, and benzodiazepines e.g. diazepam.
There are specific storage and administration requirements for controlled drugs, so it’s important for staff to know if a drug is controlled, and what to do with it.
Your organisation should have a medication policy, and there should be a specific section on controlled drugs, who will administer them, how they are administered, where they will be stored, how they will be disposed of and who has access to them.
Our Safer Management of Medicines course will talk you through everything you need to know about controlled drugs.
Different routes of medication
There are a number of ways medication can be given. Most patients take their medication orally, in tablet or liquid form.
However, medication can be given in many different ways. Common routes of medication in health and social care include:
Transdermal – Through a patch, for example a pain relief or a smoking cessation patch.
Topical – Often used in social care – such as a cream applied to the skin
Rectal – Medication inserted into the rectum through a suppository or enema.
Otic – Administered by drops into the ear
Ophthalmic – Placed in the eye through drops, a gel or an ointment
These are some common ones which are often found in social care settings such as residential care and nursing homes. There are a number of other routes of medication which we’ll cover on the course.
The seven Rs
This is a really good reminder for staff to get medication administration right.
The 7 Rs are what health and social care staff should run through before administering any medication to a resident or service user.
Right to refuse
Essentially a staff member is checking that they have the right drug and dose based on a person’s records. They also need to check that the person in front of them is also the person the medication is for.
A good way of doing this is to have a recent photograph with the medication administration record (MAR) chart, and check this against the person in front of them.
The person administering also needs to check the medication label and MAR chart to make sure they are giving the medication at the right time of day.
Some medication, for example, needs to be given exactly every four hours, so it’s important to check timings before administering.
The right route is checking that the resident should be receiving the medication orally or topically, and making sure that is what they are administering.
Again this should be on the GP’s label which should have been printed or copied onto the MAR chart.
The staff member needs to make sure they also have the right MAR charts for the person they are giving medication to.
So checking name and DOB for example against a care file. Charts are sometimes made up in advance, so it’s important that the staff member is checking the chart in front of them before administering.
Finally, the resident has a right to refuse to take their medication. Sometimes medication is given covertly but this is in exceptional circumstances and only with prior involvement from a GP, and after the associated capacity processes and best interest decisions. Otherwise, if a person refuses medication, this should be documented and medical or management advice sought.
Documenting medication administration correctly
We’ve talked about the importance of documenting administration correctly. This is for a number of reasons. The health and care regulator, the Care Quality Commission (CQC) will check the documentation on inspection, and this could affect the rating that your organisation receives.
In controlled drug use, incorrect documentation can also lead to breaking the law.
On a more day to day level, as shifts change and different people are trained to give medication, having a strong documentation system will benefit both staff and residents.
Lots of pharmacies offer a computerised MAR chart administration system; otherwise, clear recording in black pen, using an agreed coding system, is key.
You will then be able to demonstrate to the relevant authorities such as your local commissioners and to CQC that you understand medication administration and you are getting it right.
People do make mistakes, and sometimes a medication error may happen. It’s important that your staff feel able to admit when they’ve made a mistake.
Your policy should cover what happens in the event of an error, but at the very least either the person’s GP or NHS 111 should be contacted to ensure there will not be an issue if a dose is missed or given incorrectly.
This advice should also be recorded in the person’s notes.
In the case of incorrectly completed documentation, often re-training will be key to ensuring your staff get it right in future and understand the importance of doing so.
Accessing the right training
Training is crucial in the safe administration of medication. Well-trained staff understand why it’s important to get medication right, will document correctly and will support their colleagues in taking the time to administer safely.
Our Safe Administration of Medicines course can be taught as an open course, or brought to your care setting. In addition if your clients use peg feeding, we would recommend them partaking in that course as well to discuss and practice the specifics around enteral tube feeding
Taught by registered nurses, staff will learn about their responsibilities, about medication errors, infection control and risk assessment, how to administer medication, and ensure correct documentation and disposal of medication.
For more information, or to arrange a course for your staff, contact us on 01782 563333 or email [email protected]