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Administering Medication Safely in Domiciliary Care
Version 1.0 – 03/2020
Learner Resource
Self Study Guide
Administering Medication Safely
in Domiciliary Care
www.ascleader.co.uk
Administering Medication Safely in Domiciliary Care
(Version 1.0 – 03/2020) - i -
Contents
About Self-Study Guides .......................................................................................................................... 1
Introduction ............................................................................................................................................................. 1
Structure and Layout ............................................................................................................................................. 1
Latest Version.......................................................................................................................................................... 2
Introduction ................................................................................................................................................ 3
Learning Aim ............................................................................................................................................................ 3
Learning Outcomes ................................................................................................................................................ 3
Legislation and medication ....................................................................................................................... 4
Classification of medicines ....................................................................................................................... 6
The Safe Handling and Administration of Medication .................................................................................... 8
Why do we have a Policy? .................................................................................................................................... 8
Who does the policy apply to? ............................................................................................................................ 8
Roles, Responsibilities and Duties ....................................................................................................... 10
Service User ........................................................................................................................................................... 10
East Riding of Yorkshire Council Adult Services (Community Wellbeing Teams) .............................. 10
East Riding of Yorkshire Council Business Management and Commissioning ....................................... 11
Domiciliary Care Agency (including Community Support Services) ........................................................ 12
Domiciliary Care Workers (Community Support Service and Domiciliary Care Workers) ............ 14
General Practitioners (GP)................................................................................................................................. 15
Dispensers (including Community, Hospital and GP Dispensaries) ......................................................... 17
Nursing Personnel ................................................................................................................................................ 18
Independence and Choice ..................................................................................................................... 21
Privacy, Dignity and Consent ................................................................................................................ 21
Privacy ..................................................................................................................................................................... 21
Consent................................................................................................................................................................... 21
Mental Capacity Act 2005 .................................................................................................................................. 22
The Five Principles of the Mental Capacity Act 2005 .................................................................................. 22
Administration of Medication ............................................................................................................... 23
What tells a Domiciliary Care Worker how to administer medication?................................................ 23
Barriers to Taking Medication ........................................................................................................................... 25
The Different Forms of Medication ................................................................................................................. 25
Administering of Medication .............................................................................................................................. 26
The 7 Rights of Administration ......................................................................................................................... 26
Before Administering Medication ..................................................................................................................... 27
Refusal of Medication ........................................................................................................................................... 27
What happens if the Service User does not want to take their Medication? .................................... 27
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Covert Medication ........................................................................................................................................... 27
When Required Medication (PRN) .................................................................................................................. 28
What to do if you have concerns about the administration of medication ........................................... 29
Non-Prescribed Medications ............................................................................................................................. 29
Recording Medication Administration ................................................................................................ 30
How does a Service User get a DomMAR? ................................................................................................... 30
Mid-Month Medications ...................................................................................................................................... 31
Hand-Writing Charts ........................................................................................................................................... 31
Hand-Writing Charts – Process ....................................................................................................................... 31
General Procedures for the Administration of Medication ........................................................... 33
Oral Tablets and Liquids ..................................................................................................................................... 33
Buccal Tablets ........................................................................................................................................................ 33
Sublingual Tablets ................................................................................................................................................. 33
Ear Drops ............................................................................................................................................................... 34
Eye Drops ............................................................................................................................................................... 34
Eye Ointment ........................................................................................................................................................ 35
Nasal Drops ........................................................................................................................................................... 35
Nasal Sprays ........................................................................................................................................................... 35
Creams, Ointments and Lotions ....................................................................................................................... 36
Patches .................................................................................................................................................................... 36
Mouthwashes ......................................................................................................................................................... 37
Throat Sprays ........................................................................................................................................................ 37
Nebules ................................................................................................................................................................... 37
Inhalers .................................................................................................................................................................... 38
Ordering, Collecting and Disposal of Medication for a Service User .......................................... 40
Ordering Medication ........................................................................................................................................... 40
Collecting Medications ........................................................................................................................................ 40
What about collecting new medication prescribed during the 28 day cycle?.................................... 41
Disposal ................................................................................................................................................................... 41
Medicines Storage ................................................................................................................................................. 42
Medication Errors .................................................................................................................................... 43
What to do if you identify a Medication Error .............................................................................................. 43
On Completion of this Self-study Guide ............................................................................................ 44
About the Appendices within this Self-Study Guide ........................................................................ 44
Appendix 1 – Competency Record - Tasks in Handling Medication ........................................... 45
Appendix 2 – Competency Record - Administration Techniques ............................................... 47
Appendix 3 – Record of Refresher Sessions for Medication Training for Domiciliary Care
Workers .................................................................................................................................................... 49
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Appendix 4 – Record of Additional Medication Training – including Specialised Techniques50
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About Self-Study Guides
Introduction
Self-Study Guides (SSGs) are flexible learning materials that enable you to develop
your knowledge and skills at your own pace.
Each guide provides information and instructions about a topic, which is supported
with examples, exercises and, if needed, direction to further help or information.
SSGs may be supported by other Learner Resources to support the completion of
additional exercises and activities that help embed learning.
Structure and Layout
Each guide has a common structure and layout that helps ensure consistency and
maintains the quality of the materials.
The following symbols are used to highlight key information or actions:
Information
This symbol highlights information on a particular point, topic or
area.
Key Point
This symbol highlights a key point on a particular topic or area.
Question
This symbol indicates a question.
Activity
This symbol indicates an activity.
Scenario
This symbol indicates a scenario or case study.
Tag
This symbol highlights where you can find more information, help,
support or a resource.
Administering Medication Safely in Domiciliary Care
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Latest Version
Always check you have the latest version of the SSG. The issue number and date
appear on the cover page.
If you have been given this SSG by your Line Manager, Supervisor or Learning and
Development Champion – they will have checked it is the current version. The
Social Care Academy only provide copies of the current version of any SSG.
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Introduction
Welcome to the Administering Medication Safely in Domiciliary Care Self
Study Guide. This guide is for Domiciliary Care staff working in Adult Provider
Services and the Independent Care Sector.
Learning Aim
The aim of this self-study guide is to provide information and guidance to help
Domiciliary Care Workers to administer, record and dispose of medication safely.
Learning Outcomes
By the end of this Self-Study Guide, you will be able to:
State the name of the joint medication policy.
List key legislation and guidance governing medication.
State your role as a Domiciliary Care Worker with regards to medication.
List the Classifications of Medicines.
Understand the barriers that may arise when taking medication.
Help Service Users with their prescribed medication.
Record the administration of medication on the DomMAR.
Understand the different forms of medication and how to administer them.
Store medication appropriately at the Service User’s home.
Safely dispose of any medication, as needed.
Understand when to contact your line manager for advice and support about
questions or concerns about medication.
Understand the importance of reporting errors.
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Legislation and medication
If used correctly, medication can cure illness, relieve symptoms and prevent disease
but if misused can cause injury or worse. The presence of legislation and guidance
allows for the safe administration of medication. There are a number of Acts that
relate to medication and they are regularly reviewed and updated.
As a Domiciliary Care Worker you should be aware of the legislation and guidance
that governs the safe handling, administration and disposal of medication. For
example:
The Misuse of Drugs Act 1971 (Controlled Drugs) and amendments
This Act regulates Controlled substances.
The Health and Safety at Work Act 1974
This Act requires the control of risk with in the workplace.
Access to Health Records Act 1990
This act establishes a right of access to health records by the individuals to whom
they relate and other persons.
Control of Substances Hazardous to Health Regulations 1999 (COSHH)
These regulations require that any hazards are identified and assessed for risk.
Hazardous Waste regulations 2005
These regulations set out the regime for the control and tracking of hazardous
waste in England and Wales.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
(Part 3) as amended
This Act details the fundamental standards which service providers must meet. The
safe care and treatment standard (regulation 12) includes “The proper and safe
management of medicines”
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Other standards relevant to medicines, such as person-centred care, the need for
consent, good governance and Duty of Candour.
General Data Protection Regulations (GDPR) 2016/Data Protection Act
2018
This modernises laws that protect the personal information of individuals and alters
how businesses and public sector organisations can handle the information of their
customers.
However, you may not be as familiar with the following regulations and documents
Legislation and Guidance – What they are and where to find them…
Care Quality Commission (Registration) Regulations
2009 (Part 4) as amended
https://www.cqc.org.uk/files/care-quality-commission-registration-
regulations-2009
CQC Guidance for providers on meeting the
regulations (February 2015) replaces CQC’S Essential
Standards of quality and safety
https://www.cqc.org.uk/sites/default/files/20150210_guidance_for_pr
oviders_on_meeting_the_regulations_final_01.pdf
CQC Guidance for providers on meeting the
regulations (February 2015) replaces CQC’S Essential
Standards of quality and safety.
https://www.cqc.org.uk/sites/default/files/20150210_guidance_for_pr
oviders_on_meeting_the_regulations_final_01.pdf
NICE ‘Managing medicines for adults receiving social
care in the community’ (NG67, March 2017). This
guidance covers medicines support for adults (aged 18 and
over) who are receiving social care in the community.
https://www.nice.org.uk/guidance/ng67
You may wish to do some further reading to familiarise yourself with these.
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Classification of medicines
The Medicines Act 1968 and amendments also defines three categories of medicines:
General Sales List medicines (GSL) – medication that can be sold in any shop
(e.g. pharmacy, supermarket, corner shop etc.) without a prescription.
Pharmacy Medicines (P) – medicines that can only be sold in a pharmacy under
the supervision of a pharmacist.
Information
These medicines can include some larger pack sizes or different
strengths of some GSL medicines.
For example:
16 Paracetamol 500mg tablets are a GSL medicine and
32 Paracetamol 500mg tablets are a P medicine
Prescription Only Medicine (POM) – medicines which may only be obtained
with a valid prescription. Some Prescription Only Medicines are further
classified as Controlled Drugs (CD POM) which have stringent regulations
regarding prescribing, supply and destruction.
Information
Prescriptions can be written for GSL, P and POM and CD POM
medicines. As a Domiciliary Care Worker you are only allowed to
administer medication that has been supplied by a prescription.
Both General Sales List Medicines and Pharmacy Medicines can be bought
over the counter. They are sometimes referred to as OTC medicines or Homely
Remedies. Some Service Users may arrange to buy OTC or Homely Remedies.
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Question
What are the possible consequences of taking over the counter
medication with prescribed medication?
Activity
Read the two statements below and write down what they might
mean to you as a Domiciliary Care Worker administering medication:
“Anyone can administer a prescription medicine to another person
provided it is in accordance with the directions of a Prescriber”
“Medicines prescribed for a person are that person’s property”
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The Safe Handling and Administration of Medication
The East Riding of Yorkshire Council’s Adult Social Care Services have worked in
partnership with the NHS East Riding of Yorkshire Clinical Commissioning Group, in
consultation with the relevant services, to produce a joint medication policy:
“Administering Medication Safely in the Domiciliary Care Sector” November 2018. The
Policy has been written in line with the Legislation and Guidance surrounding
medication.
Why do we have a Policy?
We a Policy to:
Safely enable, promote and maximise Service Users’ independence.
Give clear guidance.
Unify procedures.
To meet all legal requirements and the Good Practice Standards.
Who does the policy apply to?
The Policy applies to all Domiciliary Care Workers (and staff who are being
redeployed into the Domiciliary Care Sector), including the Independent Care
Sector, delivering care packages commissioned by East Riding of Yorkshire Council
involved in administering medication.
The Policy does not apply to non-commissioned services, i.e. people funding their
own care or receiving personal budgets, unless these are commissioned by the
Council.
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Questions
Find out where the policy is kept in your organisation?
What is the organisation’s procedure for informing you of updates
to the policy or procedures?
Activity
Discuss with your Line Manager, and make brief notes, on the
procedures you will need to follow for the Safe Handling and
Administration of Medication, in line with the Joint Policy.
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Roles, Responsibilities and Duties
Service User
The level of responsibility for medication assumed by an individual Service User will
depend on their ability to manage this aspect of their life.
The Medication Risk Assessment for Domiciliary Care Providers, which includes the
Fullers Self-Medication Risk Assessment tool, (Appendix 1) will identify the level of
assistance required.
If assistance with medication is required then the Service User must provide
Domiciliary Care Agency with access to the prescription, medicine and other
relevant information and if they have capacity consent must be given to assist with
medication.
If support is required for ordering repeat medications, and the Domiciliary Care
Agency has been identified as giving that support, then consideration should be given
to allow the care agency to order medication on-line from the Service User’s GP.
This would require the Service User to allow third party access to their patient
record.
East Riding of Yorkshire Council Adult Services (Community
Wellbeing Teams)
Adult Services workers are responsible for undertaking an Adult Care and Support
Assessment in accordance with The Care Act 2014. If support with medication is
identified as part of the assessment process, Adult Services will undertake the
Medication Risk Assessment and Fullers assessment (or agreed risk assessment).
They will use this Risk Assessment to identify the appropriate support the Service
User needs with their medication (as defined in section 2 – 1.1.7 of the Joint Policy)
and records this in the Care and Support Plan. (The score should guide the decision
as to the support required).
In Community Support Services, Assessment Officers / Team Leaders are also
responsible for undertaking Medication Risk Assessments and Fullers Assessments
(or agreed risk assessments) to help identify a Service User’s care and support
needs.
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It is also their role to liaise with health care professionals as appropriate to confirm
medication requirements, any allergies, special storage or administration details, etc.,
and to complete a domMAR Request Form and send this to the GP, community
pharmacy and / or dispensing practice commissioned by East Riding of Yorkshire
CCG to provide the Medicines Record Chart for Carers Service (Service
Specification B1).
It is important that responsibility for managing medicines is not taken away from the
Service User unless the assessment indicates a need. Independence in taking
medication should be supported where possible.
Key Point
If a Service User has been assessed as lacking the mental capacity
to make decisions around their care and support needs then
decisions need to be made in the persons best interests.
The best interest decision around taking / administering medication
is made by a health care professional (e.g. GP) and must follow the
statutory principles in the Mental Capacity Act (2005) Code of
Practice.
The Council’s Adult Services (Community Wellbeing Teams) continue to hold
responsibility for ensuring that care and support reviews are conducted whenever
there is a significant change in the Service User’s circumstances. Where there is no
change reviews must take place every 12 months.
East Riding of Yorkshire Council Business Management and
Commissioning
The Business Management and Commissioning Service ensures that regular audits
are carried out to ensure that Domiciliary Care Agency are complying with this
Policy.
They make regular checks to ensure that Domiciliary Care Agencies employ only
domiciliary care workers with appropriate medication training, if involved with
medication support, and maintain up-to-date records of this training and ensure that
associated competency assessments have been completed.
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They also ensure that the agreed and documented level of assistance is provided to
the Service User on a day to day basis.
Domiciliary Care Agency (including Community Support Services)
Domiciliary care providers ensure that the Joint Policy is implemented in their
service / organisation. They must also ensure that training is provide for all
Domiciliary Care Workers. Ideally this should be the face-to-face, but alternative
media may be considered during exception events, such as a pandemic or epidemic.
However, all learning must be in accordance with the Joint Policy and associated
Standard Operating Procedures (SOPs).
A record of all training and competency assessments for the safe administration of
medication must be held by all provider.
Providers will ensure that they provide the agreed and documented level of
assistance to the Service User on a day-to-day basis. Medications must be
administered from the original pharmacy filled container and that this is recorded on
a domMAR by trained and competent person.
Key Points
The Domiciliary Care Agency:
Ensures that if a medication is prescribed mid cycle this is
(in order of preference and risk):
o Ideally, added to the existing domMAR; or
o A second domMAR is obtained; or
o Where the above is not possible (for example Out
of Hours when the pharmacy is closed) the
Domiciliary Care Agency directs the Domiciliary
Care Worker to handwrite a temporary domMAR
chart, ensuring that the care worker follows the
agreed process (see Appendices 3 and 4 of the Joint
Policy).
Ensures that Domiciliary Care Workers are able to
prioritise their visits for people who need support with
time-sensitive medicines (7 Right’s).
Has robust processes in place for handling urgent changes
to a Service User’s medicines from a prescriber, received
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preferably via secure email, safe-haven fax or verbally in an
emergency, including :
o Recording details of the requested change (including
who requested the change, date and time of request
and who received the request.
o Ensuring that a second member of staff is present to
verify transcription/transfer of information in the
request.
And where instructions are given verbally:
o Reading back the information that has been
recorded to the prescriber requesting the change to
confirm it is correct (including spelling of the
medicine).
o Ensuring that a second member of staff is present to
verify the information, e.g. by speakerphone.
Providers will monitor and review the service provided via regular audit of domMAR
charts and they inform the Adult Services Community Wellbeing Team of any
significant change(s) that may trigger the need for a review.
All incidents and ‘near-misses’ must be recorded appropriately and used as a learning
tool to improve the service. An example of incident reporting form is available in
Appendix 8 of the Joint Policy. Providers will takes responsibility for resolving
problems and investigating incidents. Where necessary specialist support should be
involved in these investigations and learnings disseminated to all parties.
Providers will also take responsibility for reporting to the Care Quality Commission
(CQC) and Safeguarding, where appropriate.
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Domiciliary Care Workers (Community Support Service and
Domiciliary Care Workers)
Domiciliary Care Workers should only assist with medication where they have
completed the appropriate training and they are competent to do so. This includes
support with opening bottles and passing inhalers, etc.
It is the responsibility of Domiciliary Care Workers to follow the Care and Support
Plan and administer / record medication in line with the Policy using a domMAR
chart or handwritten chart as appropriate.
If there is any doubt about the capacity of the Service User then the care worker
should not administer the medication. The Domiciliary Care Worker should
immediately contact their Supervisor or Line Manager for further advice. The
person’s GP or appropriate professional should also be contacted.
If the Domiciliary Care Workers have any concerns about the administration of
medication to a Service User they should report these to their Supervisor or Line
Manager and document in the Care and Support Plan, ensuring that the concern is
logged in the Domiciliary Care Agency’s incident reporting system.
Domiciliary Care Workers should not undertake any duties which fall within the
responsibility of the Nursing service (e.g. sutures or catheter removal) or primary
medical services.
Domiciliary Care Workers must not make any clinical decisions or judgments, e.g.
increase or change of dosage, regarding the administration of medication. If there is
any change of circumstances relating to a Service User’s medication, the Domiciliary
Care Worker must report it to their Supervisor, Line Manager, a health professional
or a nominated person (e.g. next of kin).
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General Practitioners (GP)
GPs have a duty of care for all of their listed patients to provide general health and
medical care or refer for specialist health care or social care.
In looking after an individual’s health and wellbeing, the GP or other non-medical
prescriber will prescribe medication to their patient to prevent, treat or relieve
medical conditions. It should be noted that individual Service Users might also
receive medication prescribed by specialists who might have been supplied to them
in hospital. Within primary care, other professionals may be involved in prescribing
for Service Users, such as; dentists, suitably qualified nurses, pharmacists or
physiotherapists.
Key Points
GPs should record details of the Service User’s medicines
support and who to contact about their medicines (the Service
User and their Domiciliary Care Agency) in their medical
record, when notified that the person is receiving medicines
support from a social care provider. This information is
available on the domMAR request form.
The details should be immediately obvious to anyone accessing
the patient’s record by adding an alert, reminder or pop-up
box. Such support should be Read coded:
o SystmOne: XaN5J – needs domiciliary care work to
administer.
o Emis Web: 8BML – needs domiciliary care worker to
administer.
Prescribers should communicate any changes to a Service
User’s medication, e.g. when stopping or starting a medicine,
by:
o Informing the Service User and their named contact.
o Providing written instructions of the change or issuing a
new prescription.
o Informing the Service User’s supplying community
pharmacy and DCA.
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Any changes in medication, where there is a need to avoid
delays in treatment or avoid confusion, should be made
preferably by secure e-mail or safe-haven fax.
GP Practices should consider identifying at least 2 members of
the administration team to be responsible for managing the
prescription process for domiciliary care patients requiring
domMAR charts.
GP’s should provide clear written directions on the
prescription to show how each prescribed medicine should be
taken or administered, including:
o What dose should be administered?
o For ‘when required’ medicines when there is no
alternative: What the medicine is for?
o What exact dose should be administered (for example,
avoid 1 or 2 tablets) unless the person can direct the
Care Worker to the dose needed?
o For external medicines, on what area of the body to be
applied.
o The minimum time interval between doses.
o The maximum dose to be taken in a 24 hour period.
Review medication at least annually or sooner if needed and
communicate any changes as above.
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Dispensers (including Community, Hospital and GP Dispensaries)
Dispensers have a professional responsibility to supply medication prescribed by GPs
and other recognised prescribers and in a timely manner.
The medication must be of a suitable quality and comply with legal and ethical
requirements for the packaging and labelling.
Key Points
Additionally, pharmacists have a responsibility to ensure that a
patient or carer receives appropriate information and advice to
support them in gaining the best effect from any medicines
supplied. This will include annotating the domMAR on the best
time of day to administer the medication, for example; morning,
lunch, tea, evening, which will need collaboration with the
Domiciliary Care Agency to fit within the care call window.
Upon receipt of a domMAR Request Form, community pharmacies
/ dispensing practices and local hospitals participating in the NHS
England – Local Enhanced Service are to produce the domMAR
chart in accordance with the prescription. The Service User
record should be marked accordingly so future dispensing is
accompanied by a domMAR chart.
For a mid-month medication, for a Service User who the pharmacy
is aware already has a domMAR in place (in ascending order of
risk):
The original DomMAR should be returned to the pharmacy
and the mid-month medication added.
Where it is not possible for the original domMAR to be
brought into the pharmacy, they will provide a second
domMAR chart and write ”Supplementary Chart” on the
front of the chart to ensure that the carer is aware that this
is an additional chart for the same person.
Liaise with the patient or carer to, ensure that the new
medication is collected in time, or delivered by the
pharmacy where there is an agreement to do so.
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Dispensers should also:
Check if any changes or extra support may be helpful for example by
checking if the person’s medication regimen can be simplified, if any
medications can be stopped or if there are any formulation changes needed.
Liaise with the prescriber where prescription details are ambiguous and do
not give sufficient information to the carer to safely administer the
medication.
Supply a Service User / Patient information leaflet for every dispensed
medication in line with the Human Medicines Regulations 2012.
Provide ongoing advice and support about a person’s medicines including
non-prescribed medication.
Complete an incident form when necessary and appropriate, e.g. where a
Domiciliary Care Agency has been informed that there is a medicine to
collect and they have not done so in an appropriate timescale.
Nursing Personnel
Nurses provide nursing and clinical care to individual Service Users, e.g. caring for
wounds, pressure sores and the change of dressings or with invasive procedure such
as injections and bladder irrigations and matters relating to feeding tubes.
During the above provision, monitor the health status of the individual and report any
change in circumstances to the GP.
Key Points
Specialist nurses, e.g. stoma nurses, palliative care nurses or
continence advisors will similarly provide nursing and clinical care
to individual Service User and support to their family.
These specialist nurses will support and educate the Service User
and carers in coping with their particular condition and assist them
in dealing with equipment or the drug treatment or therapy
necessary to the condition.
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Key Point
There may be some instances when some procedures normally
carried out by nurses can be done by carers. These are classed as
Specialised Techniques (see Section 2 – 1.3.3 of the Joint Policy)
and would require additional training, it would also be specific to
the Service User and carer. The health care practitioner would
need to train the carer to undertake the task, e.g. administering
insulin or simple wound dressing.
Activity
Discuss with your Supervisor or Line Manager, and make notes on
your role and responsibilities as a Domiciliary Care Worker.
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Activity
Who is responsible for providing general health and medical care
to a Service User?
Who obtains and records the Service User’s consent to administer
medication?
If you, as a Domiciliary Care Worker, have a concern about a
Service User’s medication:
Who do you report your concern to?
How do you report your concerns?
Do Care Providers have the responsibility to facilitate the training
of Domiciliary Care Workers and to keep records of staff training?
(Circle the correct answer) YES / NO
Can an Unpaid Carer only retain responsibility for evening
medication, where Paid Care Workers are responsible for Morning
and Lunch Time Medication?
(Circle the correct answer) YES / NO
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Independence and Choice
It is important to remember that your Service Users are individuals and should be
treated as individuals; if two people have the same diagnosis, for example, a stroke,
they will likely have very different needs. Regulation 9 of the CQC Fundamental
Standards states that “an individual must have care or treatment that is tailored to their
individual preferences”.
Some Service Users may be able to self-medicate and others may be able to
administer their own tablets but need help applying creams. Whatever the situation,
we need to be mindful that if the person can manage their medication then they
should be allowed to do so without interference, but only intervening if we feel the
person is at risk.
Privacy, Dignity and Consent
Privacy
The Domiciliary Care Worker should maintain confidentiality of Service User
information and only share information on a ‘need to know basis’, in line with data
protection legislation.
Another CQC regulation which applies to medication is dignity and respect. An
individual must be treated with dignity and respect at all times whilst receiving care
and treatment – this includes promoting privacy, treating people as individuals and
giving individuals the support they need to remain independent.
Consent
An individual (or their advocate) must give their consent before any care or
treatment is given to them and they have the right to withdraw that consent at any
time.
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Mental Capacity Act 2005
The Mental Capacity Act affects what happens with medication.
The Five Principles of the Mental Capacity Act 2005
The Mental Capacity Act is underpinned by five principles, which are explained in the Mental
Capacity Act Code of Practice. These are:
A presumption of capacity - every adult has the right to make his or her
own decisions and must be assumed to have capacity to do so unless it is
proved otherwise - you must not assume someone lacks capacity because
they have a particular medical condition or disability.
The right for individuals to be supported to make their own
decisions - a person is not to be treated as unable to make a decision unless
all practicable steps to help them do so have been taken without success.
Every effort to encourage and support people to make the decision for
themselves. If you establish lack of capacity, it is important to involve the
person as far as possible in making decisions.
Individuals must retain the right to make what might be seen as
eccentric or unwise decisions – what seems eccentric to us may feel very
different to the individual – you cannot treat someone as lacking capacity
because of this.
Best interests – everything you do for or on behalf of a person who lacks
mental capacity must be in their best interests.
The least restrictive intervention - anything done for or on behalf of
people without capacity should be an option that would cause less restriction
to the person’s basic rights - as long as it is still in their best interests.
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Administration of Medication
What tells a Domiciliary Care Worker how to administer
medication?
The Care and Support Plan sets out the help care workers give to a Service
User, including help with administering medications. Care Workers can only
administer medication to a Service User if it is written in the Care and Support Plan.
The Care and Support Plan may require the Worker to administer some or all of the
Service Users medication. For Example, a Worker may be required to administer
only a Service User’s creams / ointments whilst the Service User is able to
administer their own oral medication, such as; tablets or liquids.
Key Points
If you have a concern about a Service Users ability to handle their
own medication you should report this to your Line Manager and
make a note in the daily diary sheets.
The Label contains lots of important information for the care worker. The
information on the label should be the same as the information on the domMAR
label for each item.
Key Points
There is only one exception and this is the date the medicine was
dispensed. This date can sometimes differ by a few days and this is
down to the dispensing process. If the dates differ by more than 5
days then you should contact your line manager before
administering the medication)
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The Service User may be well informed about their medication as they may have
been taking it for quite some time, however Care Workers should ensure they have
also read the medication label and Care and Support plan to confirm the information
the Service User has given them.
The Patient Information Leaflets (PIL) can be found in original medication
boxes or attached to the side of the medication bottles. It is important to read the
Patient Information leaflets when you are administering new medications for the first
time as they contain information on how to administer the medicine, possible side
effects, storage requirements, contra- indications etc.
The Domiciliary Care Worker’s Supervisor or Line Manager – if you are
still unsure how to administer a medication it is important that you contact your
Supervisor or Line Manager, who may than contact the Pharmacy or Doctor for
further advice.
The Joint Policy “Administering Medication Safely in the Domiciliary Care Sector” – this
explains how care workers are allowed to administer medication in Domiciliary
Care.
Directions on how
to use the medicine
10ml Chloramphenicol Eye drops
One drop to the left eye four times a day
Store in a Fridge
Mr Eryc Example 1-01-2010 Patients /
Service Users
Quantity, Name of
Medicine, Formulation
Warnings or
special
requirements
Date medicine was
dispensed
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Barriers to Taking Medication
The following are some of the key factors you will be aware of that can impact on an
individual being either willing or able to take their medication:
Illness Stigma
Immobility Poor literacy skills
Poor dexterity Language barrier
Poor eyesight Learning Disability
Poor living conditions Lack of understanding
Choice Individual values
Views of others Poor communication
Side effects The timing of the medication
Taking multiple medications Swallowing difficulties
Forgetfulness/Confusion Nausea
Fear/anxiety Taste
Delirium Fear/anxiety
Changes in colour Changes in shape
The Different Forms of Medication
The following are some of the forms of medication you will be familiar with. The
bold print highlights some of the invasive forms of medication you are not allowed to
administer without additional training as they are Specialised Techniques and should
be individualised to specific Service Users.
Tablets Patches
Liquids Nebules
Creams/ointments/lotions Preventer inhalers
Ear drops Suppositories
Eye drops Injections
Eye ointments Mouthwashes
Nasal drops Throat sprays
Nasal sprays Pessaries
The above list is not exhaustive. Domiciliary Care Workers are not allowed to
administer invasive forms of medication, examples are noted above in bold, without
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undertaking additional Specialised Techniques (Level 3 Training), individualised to
specific Service Users.
Administering of Medication
Care Workers can only administer medication from original boxes and bottles
prepared by the Pharmacy or Dispensing Practice and must record the
administration on a Domiciliary Medication Administration Record.
The reason being that should a medication be refused, spat out or dropped then it
may not be easily recognisable by the Care Worker and hence lead to errors in
documentation and confusion for the care worker.
Key Point
Under the Joint Policy:
Care Workers are not allowed to administer medication
from a Monitored Dosage System.
The 7 Rights of Administration
Administering medication is all about common sense and remembering the 7 Rights
of Administration. These are:
The right Service User receives
The right medicine
At the right dose
Via the right route
At the right time
With the right documentation
And the right to refuse.
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Before Administering Medication
Before administering medication, always:
Ask the Service User if they are ready to take their medication.
Check that Service User name is correct on domMAR.
Check that Service User name is correct on containers.
Wash and dry hands.
Get together any equipment needed to help with medication.
Ask Service User to sit upright - the Service User should be in sitting upright
before help with oral medication is given. If this is not possible then the
carer must report this to their Supervisor or Line Manager who can ask
advice from the Service User’s GP, Community Pharmacist or PCT Medicines
Management Team.)
Refusal of Medication
What happens if the Service User does not want to take their Medication?
If a Service User does not want to take their medication, even after encouragement,
then their refusal must be recorded on the medication administration record as a
refusal. In addition, you should also inform your Supervisor or Line Manager
Try and find out why they do not want their medication but under no
circumstances should a Service User be forced to take their medication and
medication should not be given covertly, except where a Best Interest Meeting has
been held.
Sometimes a person may refuse their medication because they are simply not ready
to take it and if approached again later in the Domiciliary Care Workers visit are
then happy to take their medication. Consider aspects about barriers to taking
medicines.
Covert Medication
This is the “hiding of medication from individuals in food or drink in order that the
medication can be given without the person’s knowledge or consent”.
This is quite different to just mixing with food to aid swallowing:
There may be a different procedure for each medication.
It would need to be reviewed regularly.
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The Domiciliary Care Worker should ensure the legal framework is in place
before administering as if it is not then this potentially ‘deception’ and there
is the potential for assault.
Key Point
Covert medication would only be needed in cases where, without
the medication, there would be a serious risk to the person’s
health and only after a Best Interests Meeting has taken place.
Key Point
There is the potential for assault and also possible problems with
the medication, for example, stopping it working or altering the
release.
When Required Medication (PRN)
The prescriber must:
Give the reason why the medication is needed, for example, for pain relief,
anxiety, etc.
Always state the maximum does in 24 hours.
Avoid giving a choice of dose (for example, 1 or 2), if possible.
The use of PRN as a direction should only be used when there is no alternative. The
Service User’s Care and Support Plan will give details of the PRN medication. This
medication should be recorded on the DomMAR when ‘not required’ as ‘N’.
If a choice of dose is given (e.g. 1 or 2 tablets or 5ml or 10ml) then the carer would
need to indicate the dose administered on the domMAR.
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What to do if you have concerns about the administration of
medication
You should also make a note in the diary sheets and on the domMAR what your
concern was and the answer your line manager gave you.
Key Point
Any concerns about the administration of medication should be fed
back to your Supervisor / Line Manager before you administer the
Service User’s medication.
Non-Prescribed Medications
If Service User asks for support with non-prescribed medication refer to your
Supervisor or Line Manager who will give guidance as to your services /
organisations procedures for this.
Any procedures need to include contact with GP or Pharmacist to ensure non-
prescribed medications are safe to be taken with the individual’s prescribed
medication and robust procedures and guidance will be in place for staff to follow.
Robust procedures and guidance must be in place in your organisation for staff to
follow and this must be audited regularly.
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Recording Medication Administration
Care Workers must keep a record of the administration of medication to Service
Users.
The Domiciliary Medication Administration Record (domMAR) is used to
record the administration of Medication to Service Users by Care Workers working
for or on behalf of the Council. The domMAR is prepared by Community
Pharmacies, Dispensing Practices and Hospitals under an Enhanced Service provided
by NHS ERY.
How does a Service User get a DomMAR?
Adult Services Community Wellbeing Teams or Community Support Services
Assessment Officers / Team Leaders use the Fullers Assessment tool during the
Service User’s assessment of need and if medication administration is required
complete the domMAR request form and send to the Service Users normal
pharmacy.
Community Pharmacies, Dispensing Practices and Hospitals prepare DomMARs via
an NHS Enhanced Service – under the Standard Operating procedures. Duplicate
prescription labels are applied to the domMAR and are made tamper evident at the
time of dispensing the prescription. Community Pharmacies, Dispensing Practices
and Hospitals cannot give out copy labels.
Key Point
Community Pharmacies, Dispensing Practices and Hospitals can
only provide the domMAR once they have received the domMAR
request form.
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Mid-Month Medications
Key Point
If a prescription is given mid-month, then the domMAR should
be taken to the Pharmacy/ Dispensing Practice with the
prescription to obtain the medication and update the
domMAR.
If this is not possible the pharmacy may provide a second
domMAR and it should be labelled 2 of 2 to indicate this is a
second chart.
If this is not possible then the carer may be directed to
handwrite the medication onto the chart following a safe
procedure.
If it is necessary for care workers to do this you would be
directed to do so by the Supervisor / Line Manager.
Information
It is not permitted for Community Pharmacies or Dispensing
Practice to issue copy labels for a medication for a care
worker to apply to a domMAR.
Hand-Writing Charts
This may be necessary due to:
New mid-month medication where there is no other option
Change in dose following hospital discharge
Hand-Writing Charts – Process
The following applies when hand writing a chart:
Confirm the need for a hand-written chart with the Supervisor / Line-
Manager.
The Supervisor / Line-Manager will direct only trained carers to handwrite
the chart.
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Copy exactly the medication labelled by the pharmacy including any warnings,
such as;. take after food, store in the fridge, etc.
Use 2 spaces on the DomMAR if needed (but hatch out one of them so that
administration can only be recorded the once).
Write in black ink and initial the domMAR.
The next carer going in will need to check entry and initial.
Some organisation allow their carers to send a photograph of the entry to be signed
off in the office.
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General Procedures for the Administration of Medication
You will already be familiar with the followings generic procedures for administration
but they will act as an aide-memoire for you when out working in the community.
Specific information on the administration of a medication can be found in its
Patient Information Leaflet.
Oral Tablets and Liquids
1. Medications should be handled as little as possible.
2. Measure out correct amount of liquid or remove tablets from a bottle or
pushing out of a foil (blister) strip onto a small plate for the Service User to
access.
3. Dispersible or soluble tablets should be placed in a suitable amount of water
according to the Patient Information Leaflet.
4. Administer medication to the Service User as laid out in the Support Plan.
5. As each medication is administered it should be recorded on the domMAR.
Buccal Tablets
1. Read the patient information leaflet for specific information about
administration.
2. If the Service User suffers from a dry mouth, ask the Service User to moisten
the area where the tablet is to be placed with their tongue or a little water
before they apply the tablet.
3. The tablet should be placed high up between the upper lip and the gum, to
either side of the front teeth.
4. The tablet should not be placed under the tongue, chewed or swallowed
Sublingual Tablets
1. Read the Patient Information Leaflet for specific information about
administration
2. If the Service User suffers from a dry mouth, ask the Service User to moisten
the area where the tablet is to be placed with their tongue or a little water
before they apply the tablet.
3. The tablet should be placed under the tongue.
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Ear Drops
1. Ask the Service User to put their head to one side - left hand side if drops
are to go in right ear or right hand side if drops are to go in left ear
2. Shake the container gently and remove container top
3. Place the number of drops stated on the label into the ear canal – squeeze
the container gently if needed.
4. Ask the Service User to keep head to one side for 2 minutes to allow the
drops to get into the ear.
5. Wipe the end of the nozzle with a clean tissue, replace top and store
container upright.
6. Repeat steps 2 to 4 for the other ear if asked for on the label.
Ear Drops should not be used longer that directed by the Doctor and should be
disposed of four weeks after opening, as they may become contaminated.
Eye Drops
1. Ask Service User to put their head back slightly
2. Shake the container gently and remove container top
3. Gently pull lower eyelid downwards and outwards
4. Place one drop in the space between the lid and the eye. Squeeze the
container gently if needed. Do not let the dropper touch the eye.
5. Ask the Service User to close their eye for 1 – 2 minutes to allow the eye
drops to be absorbed.
6. Repeat in the other eye if stated on the label.
7. Replace the top and store container upright.
8. If there are two or more different types of eye drops to be given at the same
time, wait 5 minutes before giving the next type of eye drops.
Eye drops should not be used longer than directed by the Doctor and should be
disposed of four weeks after opening, as they may become contaminated. (Eye drops
may also come in Minims which are single dose vials).
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Eye Ointment
1. Ask Service User to put their head back slightly
2. Remove container top.
3. Gently pull lower eyelid downwards and outwards
4. Place about ½ cm e.g. in the space between the lid and the eye. Do not let
the container touch the eye.
5. Ask the Service User to blink a few times to allow the ointment to work all
over the eye.
6. Repeat in the other eye if stated on the label.
7. Replace the top.
Nasal Drops
1. Ask Service User to gently blow their nose and then to tip their head
backwards slightly.
2. Shake the container gently and remove container top.
3. Ask the Service User to close one nostril by gently pressing their finger
against it.
4. Place the number of drops stated on the label into the open nostril.
5. Ask the Service User to sniff gently to allow the drops get into the nostrils.
6. Repeat in the other nostril if stated on the label.
7. Wipe the nozzle with a clean tissue, replace top and store container upright.
Nasal Sprays
1. If the spray is being used for the first time press spray several times into the
air until an even spray is seen.
2. Ask Service User to gently blow their nose and then to tip their head
forwards slightly.
3. Shake the container gently and remove container top.
4. Keep the container upright, hold the container so that your thumb is
underneath the container and your middle and fore finger are either side of
the nozzle.
5. Ask the Service User to close one nostril by gently pressing their finger
against it.
6. Keep container upright and insert tip of nozzle into open nostril then spray
once.
7. Repeat another spray and in other nostril if stated on the label
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Creams, Ointments and Lotions
In this section we are talking about Creams, Ointments and Lotions that are being
prescribed for a medical condition and not being used as part of the daily personnel
care for example moisturisers.
1. Check that the label states where the cream or ointment has to be applied
and how often.
2. Put on plastic disposable gloves if provided by your employer.
3. Shake container gently if needed and remove top from the container
4. Gently rub in the cream, ointment or lotion as stated on the label.
5. Replace cap and store as stated on the label.
6. Wash and dry hands.
To ensure that creams, ointments and Lotions appear on the domMAR they must be
prescribed every month. Whilst every effort is made to ensure quantities prescribed
are adequate for 28 days there is the possibility that some excess creams, ointments
and lotions, if this is the case contact your line manager.
Patches
1. Check that skin is clean and dry before applying patch.
If the skin does need to be cleaned, wash with water only and dry thoroughly.
Do not apply a patch straight after a bath or shower, wait until the skin is
cool and dry.
2. Tear the pack open with your fingers along one edge and remove patch. Do
not throw way the opened pack as this can be then be used when disposing
of the patch that you remove from the Service User’s skin.
3. Remove used patch from skin and place in opened pack.
4. Peel the backing off the new patch.
5. Place the patch (sticky side to the Service User’s skin) onto the skin with the
palm of your hand and hold for 30 seconds making sure it sticks well to the
skin.
6. Throw away used patch.
7. Wash and dry hands.
8. If a patch falls off the skin before a change is due follow steps 1 to 8 and
record in diary sheets and contact your line manager
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Mouthwashes
1. Some mouthwashes cannot be swallowed. If this is the case the label will
state ‘FOR EXTERNAL USE ONLY’ or ‘DO NOT SWALLOW’.
2. Get a container ready for the Service User to spit the used mouthwash into.
3. Pour out the required amount of mouthwash to be used.
4. Pass this onto the Service User and ask them to rinse around their mouth for
about a minute.
5. The Service User should then spit out the mouthwash into a container.
6. If the Service User complains that the mouthwash is stinging their mouth
then you can add an equal volume of water.
Throat Sprays
1. Pull out the spray tube in accordance with the directions in the Patient
Information Leaflet.
2. Hold the container in your hand and put fore finger on the top.
3. If the spray is being used for the first time press spray several times into the
air until an even spray is seen.
4. Ask the Service User where their mouth or throat is sore and spray at that
area.
5. Repeat for how many sprays are needed.
6. Wipe tube with a clean tissue.
7. Push spray tube back in and store container upright.
Nebules
1. Hole the nebule upright and twist off the top.
2. Pour the contents of the nebule into the container.
3. Ask the Service User to place mask on face.
4. Switch on the nebuliser.
5. When all of the liquid has been used (after about 5 minutes) switch off the
nebuliser.
6. If there is more than one nebule to be given at one time put them into the
nebuliser at the same time.
7. Remove the container; wash in water and leave to dry.
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Inhalers
Key Points
Care workers can only help Service Users with Inhalers used to
prevent worsening of an existing condition.
1. Commonly known as Preventers, this type of inhaler has a
regular dosing pattern.
2. There are 2 levels of support Care Workers can be asked
to offer:
a. To remind the Service User to use the inhaler and
to pass the Service User the inhaler,
3. To administer the inhaler via a spacer for a Service User
who cannot self-administer after all options of inhaler types
have been excluded.
4. Any concerns should be fed back to your line manager.
The process for assisting the Service User with an MDI inhaler and a spacer device
for administration is as follows:
1. If spacer device requires assembling carer would do so following directions in
Patient Information Leaflet (PIL).
2. Take mouthpiece off inhaler and shake device.
3. Fit onto spacer.
4. Press down once on top of inhaler to release medication.
5. Ask Service User to breath out first.
6. Pass device to Service User to place in, or for mask-type spacers over, own
mouth (with inhaler still attached).
7. Ask Service User to take in one slow deep breath or 2-3 normal breaths to
make sure medication gets into the lungs.
8. If second dosage / puff is required wait one minute and repeat process.
9. Wash the spacer once weekly by following the directions in the PIL and
record in the support plan.
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Key Points
The Service User must be able to operate their reliever inhaler in
the absence of a carer.
If a Care Worker has any concerns over the ability of a Service
User to use their reliever inhaler they must report this concern to
the line manager.
Key Points
In an emergency situation where the Service User is
suffering breathing difficulty the Domiciliary Care Worker
should call 999 and follow the directions given.
Inform your Supervisor / Line Manager as soon as possible.
Record on the domMAR / Diary Notes as soon as possible.
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Ordering, Collecting and Disposal of Medication for a
Service User
Service Users requiring help with medication will normally have medication
prescribed over a 28 day period. The Community Pharmacy or Dispensing Practice
will try to ensure that medications are synchronised so that they are all dispensed at
the same time rather than at different times throughout the month.
These Service Users will also have a Domiciliary Medication Administration
(domMAR) record that is prepared by the Community Pharmacy or Dispensing
Practice at the time of dispensing their medication.
Key Point
The Service User’s Care and Support Plan should clearly state
whether the Care Worker is responsible for the Ordering and
Collection of Medication and domMAR for a Service User
Ordering Medication
If service / organisation are responsible for the ordering of medication for the
Service User, then it must be ordered in enough time to prevent the Service User
from running out of medication.
Doctors Surgeries generally need three working days to produce a repeat
prescription and then the Community Pharmacy or Dispensing Practice may need a
further two days to prepare the prescription and the domMAR.
The domMAR has a prompting arrow to remind care workers to reorder 14 days
before the end of the 28 day cycle.
Collecting Medications
When collecting medication, for a Service User who requires help with
administration, a domMAR should be supplied at the same time as the monthly
medication. If a domMAR is not available the Domiciliary Care Worker should first
ask the Community Pharmacy or Dispensing Practice about the domMAR and if this
does not resolve the problem contact your Supervisor / Line Manager.
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If as a Domiciliary Care Worker you are collecting medication on behalf of a Service
User who self administrates some of their medication and has some administered by
Domiciliary Care Workers then a domMAR is still required.
However if the Service User self administrates all their medication and all that the
Domiciliary Care Worker is doing is collecting the bag of medication to give to the
Service User then a domMAR is not required and the collection noted in the Diary
notes.
What about collecting new medication prescribed during the 28 day cycle?
The domMAR should be taken with the prescription to the Community Pharmacy or
Dispensing Practice to be updated at the same time as dispensing the medication.
Key Point
It is not permitted for Community Pharmacies or Dispensing
Practice to issue copy labels for a medication for a care worker to
apply to a domMAR.
Disposal
If there is an excess of medication in a Service Users home contact your Supervisor /
Line Manager to arrange disposal.
Carers should only dispose of medication where there is no other option - the
Service User / family should make arrangements for disposal at the pharmacy where
possible. Medicines are a Service User’s property and consent should be obtained
and recorded prior to disposal. If there is no other option, medicines to be disposed
of should be listed in the Diary Notes and taken to the local Community Pharmacy.
Key Points
Individual tablets should be placed in a small container or envelope
and clearly labelled ‘medications for return and destruction’.
The container or envelope should then be kept separate from the
medication to be administered and arrangements made to return
to the community pharmacy at the end of the month.
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If the medication is kept in safe storage then the container or
envelope should be placed in the locked box.
Key Point
If a tablet has been dropped prior to administration and disposed
of the Care Worker should administer a fresh tablet to the Service
User and then report their actions to their Supervisor / Line
Manager as this may mean that there is a shortage of medication to
complete the 28 day period.
Medicines Storage
Medications should be kept in a safe place, away from children, and should be stored
off the floor. They should be stored below 25 o C although some medications will
need to be stored in a fridge. If fridge storage is necessary it will state this on the
label. A box of medication will always have the storage temperature on it, either 2 -
8 degrees C or Below 25 degrees C. 2 - 8 degrees C would need to be stored in a
fridge.
If secure storage is required this should be stated in the Service User’s Care and
Support plan.
Key Point
Once in someone’s own home Controlled Drugs are treated the
same as any other medication.
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Medication Errors
A medication error is defined as, “a mistake made in the prescribing, dispensing,
ordering, delivery, storage or administration of medication that leads to a Service User
receiving the wrong medication, unintentionally missing a dose or being at risk of harm”.
What to do if you identify a Medication Error
If a as a Worker you are aware of having made an error in administering medication
or notices that an error has been made, e.g. by another person, the pharmacy or the
prescriber, you should report it immediately to your Supervisor / Line-Manager.
If unable to contact the manager do not delay in seeking medical advice from the
Service User’s GP / appropriate healthcare professional, such as; pharmacist or A&E.
Key Points
1. Details of the error should be recorded on the DomMAR
or in the daily diary. Medication errors must not be
treated as trivial - ALL errors must be reported.
2. Your line manager will complete an accident / incident
form.
3. The Domiciliary Care Agency must apply the harm table to
determine whether a safeguarding concern needs to be
raised and where this has serious consequences for a
Service User you must make a Safeguarding Referral.
This may also result in appropriate further training and
competence testing. It is important that all errors are recorded
and the cause investigated to learn from the incidents and prevent
a similar error happening in future.
The CQC guidance on Statutory Notifications Regulation 20 –
‘Duty of Candour’ covers any event which adversely affects the
wellbeing or safety of any Service User. It states that the service
provider must be open and transparent with individuals about their
care and treatment and if something goes wrong they must tell the
individual what has happened, provide support, apologise
(preferably in writing) and make a log of the error.
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On Completion of this Self-study Guide
Once this self-study guide has been completed Domiciliary Care Workers will be
allowed to administer medication to Service Users via the following routes:
Oral.
Ear drops.
Eye drops.
Eye Ointment.
Nasal drops and nasal sprays.
Mouthwashes and throat sprays.
Medication to be applied to the skin (e.g. creams/ointments/lotions and
transdermal patches).
Nebules .
Inhalers used to prevent worsening of an existing condition, known as
preventers but only in line with the guidance in this document and the joint
policy “Administering Medication Safely in the Domiciliary Care Sector”.
About the Appendices within this Self-Study Guide
The following items are included as appendices to this Self-Study Guide for use
reference and use as required:
1. Competency Record - Tasks in Handling Medication.
2. Competency Record - Administration Techniques.
3. Record of Refresher Sessions for Medication Training for Domiciliary Care
Workers.
4. Record of Additional Medication Training – including Specialised Techniques.
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Appendix 1 – Competency Record - Tasks in Handling
Medication
Objective Process Care
Workers
Signature
Line
Manager
Signature
Date
Order prescriptions
from the Service User’s
doctors.
Demonstrate understanding of
ordering process.
Demonstrate ability to order
prescriptions in plenty of time.
Arrange collection of
prescription from the
doctor’s to the
pharmacy.
Demonstrate understanding of
collection services offered by
pharmacies.
Demonstrate understanding of the
importance of using the same
pharmacy for all prescriptions.
Collect prepared
medication and
Domiciliary Medication
Administration record
chart (DomMAR) from
the pharmacy.
Demonstrate understanding of
importance of DomMAR for
recording help with medication.
Demonstrate understanding of the
importance of collecting the
medication and domMAR in good
time so that medication does not
run out.
Store medication
appropriately at the
Service User’s home.
Demonstrate that medication is
stored correctly.
Check fridge items are stored
correctly.
Recognise when it is
necessary to contact the
care workers line
manager about
medication
Demonstrate knowledge of
procedure to be follow when care
worker has a concern about a
Service User’s medication.
Demonstrate the ability to give a
line manager clear information
about a concern regarding
medication.
Demonstrate the correct
documentation of concerns about
medication.
Recording accurately the
administration of
medication on the
domMAR.
Check procedure for recording
the administration of medication
On the domMAR
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Return of a completed
domMAR to Care
Provider for Storage.
Demonstrate knowledge of the
procedure for returning a
completed domMAR to the Care
Provider for Storage.
Recognising the types of
medication
administration that care
workers cannot do
without further
specialized training
Demonstrate knowledge of the
types of administration techniques
that Care Workers are allowed to
perform having completed
Medication Training for
Domiciliary care Workers.
Demonstrate an understanding
that there are some Specialised
Administration Techniques that
will require further training before
a Care Worker is allowed to
perform.
Dispose of any
medication as needed
Demonstrate an understanding of
why medication may need to be
disposed of.
Demonstrate knowledge of the
procedures for the disposal of
medication.
Medication Training for Domiciliary Care
Workers Completed
Date
Care Worker Name (Block Capitals)
Signature
Line Manager (Block Capitals)
Signature
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Appendix 2 – Competency Record - Administration
Techniques
Objective Process Care
Workers
Signature
Line
Manager
Signature
Date
Administering oral
medication to a Service
User.
Demonstrate the correct
procedure to administer tablets.
Demonstrate the correct
procedure to administer soluble /
dispersible tablets
Demonstrate the correct
procedure to administer liquids.
Demonstrate the correct
procedure to administer sachets.
Demonstrate the correct
procedure to administer buccal
tablets.
Demonstrate the correct
procedure to administer sublingual
tablets
Administering
medication via the eye
Demonstrate the correct
procedure to administer eye drops
from bottles and Minims.
Demonstrate the correct
procedure to administer eye
ointment.
Administering
medication via the ear
Demonstrate the correct
procedure to administer ear
drops.
Administering
medication via the nose
Demonstrate the correct
procedure to administer nose
drops.
Demonstrate the correct
procedure to administer nasal
sprays.
Administering
medication via the skin
Demonstrate the correct
procedure to administer creams.
Demonstrate the correct
procedure to administer
ointments.
Demonstrate the correct
procedure to administer lotions.
Demonstrate the correct
procedure to administer Patches.
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Administering
medication via
mouthwashes
Demonstrate the correct
procedure to administer
mouthwashes.
Administering
medication via a throat
spray
Demonstrate the correct
procedure to administer throat
sprays
Administering
medication from nebules
Demonstrate the correct
procedure to administer nebules.
Assisting to administer
medication via inhalers
Demonstrate an understanding of
the limitations for care workers to
assist to administer via inhalers.
Demonstrate the correct
procedure to assist to administer
medication via inhalers.
Medication Training for Domiciliary Care
Workers Completed
Date
Care Worker Name (Block Capitals)
Signature
Line Manager (Block Capitals)
Signature
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Appendix 3 – Record of Refresher Sessions for Medication
Training for Domiciliary Care Workers
Name of Care Worker:
Refresher
course due
(mm/yy)
Refresher
course
completed
(dd/mm/yy)
Course Provider / Tutor
Name and Signature
Care Workers
Signature
Line manager
Signature
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Appendix 4 – Record of Additional Medication Training –
including Specialised Techniques
Name of Care Worker:
Date Title
Description of Training and Objective
Trainers name Qualification
Observation of Practice
Trainer
Signature
and Date
Care
Worker
Signature
and Date
Line
Manager
Signature
and Date
Date Title
Description of Training and Objective
Trainers name Qualification
Observation of Practice
Trainer
Signature
and Date
Care
Worker
Signature
and Date
Line
Manager
Signature
and Date
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Administering Medication Safely in Domiciliary Care
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