Learner's workbook: Safer medication in care settings, Slides of Medicine

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Learner’s workbook:

Safer medication

in care settings

Acknowledgements

This work has been undertaken as part of a task group. We would like to thank all the individuals and organisations that have freely contributed and given permission for the use of their materials. This workbook draws upon training materials developed by the Medicines Management Team of Shropshire Country PCT.

My Medicines

My Choices

This is a charter that helps you to understand your rights

about the medicines you take and says what help you

should get from your doctor, pharmacist and care staff.

• I am informed about all my medicines and fully involved in decisions concerning them and how I take them.
• My family or representative is, with my permission, also informed of decisions involving my medicines.
• My doctor, pharmacist and care home staff work together to make sure I receive my medicines safely. These people will always act in my best interests.
• It is assumed that I can look after and take my own medicines and I know I can always ask for help from the care staff.
• I can agree that the home can manage my medicines.
• My medicines are kept in my room or wherever else I want to keep them.
• My care home keeps records of my medicines and makes sure the staff caring for me are aware of any changes.
• All staff helping me with my medicines are trained and competent. If my health changes, my medicines will be reviewed.
• My doctor will check I am on the right medicines at least twice a year. They will also be checked when I am admitted to my care home or on my return following a stay in hospital.
• I know that I can ask my doctor to review my medicines at any time.

This workbook is designed to help you to develop safer professional practice in working with medicines for people in care settings. Whatever your role (whether it is working in a residential care home, providing support in someone’s own home, working in a GP surgery or a pharmacy), you can improve and develop your practice so that medicines are administered more safely and drug errors are reduced. It will also support you to understand how to work with colleagues in other settings to provide a better service to people who are taking medicines. The key underlying principle in relation to medicines is that people are free to choose how they wish to administer their medicines. Do not forget that medicines belong to the person for whom they are prescribed, not to a care setting or to the staff. Under no circumstances should one person’s medicine be given to another resident. If people wish to retain all their medicines and take them themselves without any involvement of care staff, it is their right to do so. If they wish to retain their medicines, but to have support from care staff to administer them, then that should be their choice to make. This is about supporting the use of medicines – not telling people what to do.

What can you achieve?

Qualifications in England, Wales and Northern Ireland are part of the Qualifications and Credit Framework (QCF). Qualifications are identified by two factors:

The units in this workbook are at Level 3 which is similar to A levels. Each unit has a certain number of credits. Each credit represents about 10 hours of study and learning time. Qualifications are identified through size (ie the number of hours work involved)

• Qualifications with one to 12 credits are Awards
• Qualifications with 13-36 credits are Certificates
• Qualifications with more than 37 credits are Diplomas

You can keep hold of credits you have achieved and put them towards a larger qualification at a later date if you want to.

This workbook will support you in demonstrating the necessary knowledge and skills to achieve the Learning Outcomes in the Qualifications and Credit Framework unit.

Level Size

What is the workbook for?

Learning outcome 1

This will contribute towards achieving Learning outcome 1 from Unit HSC 3047.

Understand the legislative framework for the use of medicines

in social care settings

The assessment criteria for this outcome are that you can:

1. Identify legislation that governs the use of medicines in social care settings

2. Outline the legal classification system for medicines

3. Explain how and why policies and procedures or agreed ways of working must reflect and

in corporate legislative requirements

Legislation for administration of medicines

There are several pieces of legislation that govern how medicines can be prescribed, dispensed and administered, but a brief outline of the key Acts includes:

The Medicines Act 1968

This is the basis for the licensing, sale, supply and manufacture of medicines. It lays down that medicines can only be dispensed by a pharmacist after they have been prescribed by a qualified person such as a doctor, dentist or vet. Some healthcare professionals can also prescribe after they have undertaken specialist training and achieved a qualification. Possession of prescription drugs without a prescription is an offence under the Act. Categories of medicines covered by this Act will be examined in more detail in a later section. The Act has been amended and added to over time.

The Misuse of Drugs Act 1971

This Act is designed to control the use of dangerous or potentially harmful drugs such as opiates (drugs derived from opium). It designates these as ‘controlled drugs’ and lays down restrictions about how they must be stored, recorded and administered. This Act is designed to prevent the misuse of controlled drugs.

Assessment activity 1

Write down all the key points for each piece of legislation on separate pieces of paper.

Then write down the different Acts listed above also on separate pieces of paper. Pick

one at random from each pile and match them up so that you have the right key point

with the right legislation.

If you can do this with a colleague, you can do it as a quiz instead where one person calls

out a key point and the other has to say which Act it comes from.

Complete the table below to show how you have matched them up.

Legisiation Key points

The legal classification system

The Medicines Act 1968 classified medicines into three categories:

• Prescription only medicines (POM); available only from a pharmacist if prescribed by a doctor or another registered practitioner licensed to prescribe. This covers all controlled drugs and groups of medicines such as antibiotics, anti-depressants and anti- psychotics, medicines for conditions such as diabetes and heart disease, asthma medication and inhalers, some opiate based pain killers and medicines like paracetamol in large quantities (eg packs of 100).
• Over the counter or pharmacy medicines (OTC or P); available only from a registered pharmacist but without a prescription. These must be provided with a pharmacist on the premises, but not necessarily prepared by a pharmacist. These include medicines such as those containing codeine, decongestants containing pseudoephedrine, anti-diarrhoea medication such as Loperamide, Aspirin and antibiotic eye drops. These medicines also include smaller packs of paracetamol (eg packs of 32) and Ibuprofen up to 400mg.
• General sales list (GSL); medicine that may be bought from any shop without a prescription and without the need for a pharmacist. This includes analgesics, such as Ibuprofen up to 200mg, antacids, antiseptic gels and ointments for cuts and grazes, creams for haemorrhoids and cold and flu remedies. General sales list medication only includes packets of up to 16 paracetamol tablets.

Controlled drugs (CDs)

These are powerful medicines that are usually prescribed for serious conditions and pain relief. They are the subject of abuse when taken without a medical reason. They include drugs such as diamorphine, fentanyl and methylphenidate. They require additional safety precautions and requirements for their storage, administration, records and disposal are laid down in the Misuse of Drugs Act Regulations 2001.

These drugs are very powerful and as well as being very beneficial to people for whom they are prescribed, they are open to being misused. The additional precautions are necessary, not only because they are highly dangerous if given to the wrong person or in the wrong dosage, but also because many CDs are valuable to criminals who supply illegal drugs.

The requirements for residential care settings do not apply if people are being supported in their own home. In residential provision:

• Secure storage is required for CDs
• Hard bound registers are recommended for CD record keeping
• It is recommended good practice that there is a second member of staff as a witness when CDs are administered
• Special arrangement must be made for the disposal of CDs

Find out more

www.nhs.uk - NHS choices has further information about the medicines in

the different classifications

www.mhra.gov.uk - the Medicines and Healthcare Products Regulatory

Agency has more information about classifications and includes updates on any changes of classification

www.rpharms.com - the Royal Pharmaceutical Society has further

information and greater detail about the classifications

Assessment activity 3

Complete the table by giving two examples of each classification

Prescription only medicine (POM)

Over the counter/pharmacy (OTC/P)

General sales list (GSL)

Policies and procedures must reflect legislation

The legislation that governs medicines should be the basis for all the workplace policies and procedures.

Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 states that:

‘The registered person must protect service users against the risks associated with the unsafe use and management of medicines, by means of the making of appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines used for the purposes of the regulated activity’

Medicines policy

All care establishments should have a medicines policy to give care workers and nurses’ guidance on procedures for medicines management including:

• Storage and ordering/disposal procedure
• Medicines error/incident management
• Covert medicines/consent
• Non prescribed medicines
• Administration of creams and nutritional supplements
• PRN medicines (medicine taken occasionally as required)

The CQC outcomes that are required to be met in all care settings make it clear what is expected in relation to the management of medicines.

This is Outcome 9:

People who use services:

• Will have their medicines at the times they need them, and in a safe way
• Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf.

This is because providers who

comply with the regulation will:

• Handle medicines safely, securely and appropriately
• Ensure that medicines are prescribed and given by people safely
• Follow published guidelines about how to use medicines safely.

All providers have to comply with these standards and regulations, so the policies and agreed ways of working in the settings must take these into account. For example, there will be a policy on the safe handling of medicines in all care settings, there will also be a clear procedure to be followed if there is a medicines error. There will be clear policies and procedures about all aspects of medicines including handling, storage, administration and record keeping. If the policies and procedures did not comply with the outcome required by CQC, the setting would be at risk of failing to achieve the outcome.

If you look at the outcomes required by CQC, you can see that they are designed to make sure that the law is complied with as well as ensuring that people experience high quality services that meet their needs.

For example, the law states that medicines can only be provided in particular ways depending on their classification – the outcome requires that medicines are ‘prescribed and given by people safely’.

Care settings can make sure that they are complying with the legislation by looking carefully at their policies and procedures and checking them against the legal framework for medicines.

They can also look at outcome 9 from CQC and check that the practice in the setting means that they are meeting the outcome.

It is important that everyone who works in a care setting understands the legal requirements, so safe handling of medicines should be part of the induction for all new members of staff and everyone should have regular updates and further training before actually administering medicines.

Assessment activity 4

You need to explain to your assessor how and why practice and policies in the setting

in which you work must follow legislation, regardless of whether your workplace is a

pharmacy, a residential care home or a GP surgery. You can write your explanation

in the box below, or if you are going to explain this verbally to your assessor using a

presentation or discussion, you can use this space to make notes. Remember that this

is an explanation, so do not just describe. Make sure you use words such as ‘because’,

‘therefore’, ‘as a result of’, ‘so that’, ‘in order to’.

Notes

There is an appendix to this workbook that lists the medicines that you are most likely to come across in a care setting. It also tells you:

• The generic names
• The brand names
• The conditions they are used to treat
• Issues that indicate caution
• Contra-indications
• Possible side effects

You will not need to know all of the medicines listed in the table, but make sure that you know about the ones that you use regularly in your care setting.

Key terms

Contra-indications – reasons that mean a particular medicine should not be prescribed for an individual. It can be because of a medical condition, or a physical condition such as age, a lifestyle choice such as being a heavy smoker or known allergies or reactions to particular drugs.

Medicine names

There are literally thousands of different names for medicines, some of which are brand names and some of which are generic names.

Generic names are based on the main ingredient and names may often sound similar. For example a group of antibiotics that all work in a similar way (penicillin, amoxicillin, flucloxacillin, ampicillin) have names that sound alike.

A very common medicine that is known by its generic as well as brand names is Paracetamol, which is the generic name, but it is also sold under brand names such as Panadol and Calpol.

The British National Formulary (BNF) contains information about all the medicines that are prescribed in the UK. Prescribers use it to check information such as appropriate dosage, side effects, interactions with other medicines and the contra-indications. Whilst it is helpful to have a current BNF in the workplace it is available online. It contains helpful information about medicines so it is useful to look at it.

Complementary or alternative medicines

In addition to the classifications of drugs covered by the Medicines Act, there are also other remedies that people may choose to use.

Homeopathic medicines

These work on the principle of ‘like treating like’. They often use substances that would be harmful in large doses, but if taken in minute doses, it is thought that they can stimulate the body to heal itself. The medicines are usually herbal in origin and can use substances that would be poisonous if the quantities were not so tiny.

Herbal remedies

Many people will take herbal remedies. These are not classed as medicines, so are not governed by the Medicines Act, they are usually sold in health food shops, although they are also available in many pharmacies. For example, Evening Primrose Oil is popular for helping women with pre-menstrual tension, Cod Liver oil is believed to be beneficial to relieve bone and muscle pain associated with arthritis and many people will take Echinacea to ward off colds and flu. Herbal remedies can cause reactions with prescribed medicines, so it is important that the prescriber is informed if a person is taking herbal remedies.

Assessment activity 5

Answer each of the questions. If you are working with others you can do it as a quiz and record your answers.

**1. What are the classifications of medicines?

2. If someone has a throat infection, which classification is their**

medication likely to come from?

3. What type of medicine would you expect to be prescribed for

a throat infection?

• Antacid
• Antibiotic
• **Anti-coagulant

4. If someone has arthritis, what medicine would you expect to be**

prescribed for pain?

• Laxative
• Decongestant
• Analgesic