The safe administration of medication is a vitally important area for providers of adult social care services, both in care homes and in domiciliary care settings.
Here are 10 top tips for getting medication administration right.
Be aware of regulatory requirements
Service providers in England must comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Under the regulations, the safe administration of medicines is considered a key element of care.
For instance, Regulation 12: Safe Care and Treatment includes a requirement for the “proper and safe” management of medicines. Sufficient medicines must also be made available to meet service users’ needs and ensure their safety.
The regulations are enforced by the Care Quality Commission and form part of their inspection and rating regime and “key-question” test.
Be aware of best practice
A range of best practice guidance is available. Care organisations should be aware of it and use it to inform their policies and training.
Key guidelines for the care home sector, SC1: Managing Medicines in Care Homes, were published by the National Institute for Health and Care Excellence (NICE) in March 2014. In March 2017, NICE also published guidelines for the home care sector, NG67: Managing Medicines for Adults Receiving Social Care in the Community.
In December 2018, the Royal Pharmaceutical Society published updated professional guidance on The Safe and Secure Handling of Medicines. Social care settings are not specifically covered by the guidance. However, many of the key principles will apply.
A full list of best practice can be found here.
Have clear policies and procedures in place
Where relevant to the service, medication management policies and procedures should cover:
the administration of medication by staff
the self-administration of medication by service users
recording medication administration
the disposal of unwanted medication.
Policies and procedures should be carefully considered and regularly reviewed in order to ensure that the highest standards are being attained at all times.
Support self-administration wherever possible
Many service users will be able to manage their medication safely and effectively. Wherever possible, and where they wish to do so, service users both in domiciliary care and in care homes should therefore be supported to self-administer their own medication.
Follow these tips.
Agree the level of support required with the service user and enter this into their care plan.
Promote people’s independence wherever possible.
Offer help such as reminding the person it is time to take their medication.
Support the use of aids such as monitored dosette boxes pre-filled by the pharmacist.
Monitor the service user for any problems.
Be sure staff know how to give medicines correctly
Where staff are involved in administering medicines they must ensure that they do it right.
The NICE guidelines for both domiciliary care and care homes specify that social care providers should have “robust processes” in place for care workers who are supporting people to take their medicines by administering them.
Processes should include the “6 R’s” of administration:
right of the person to refuse.
Staff administering medication should follow these good practice tips:
be certain of the identity of the service user to whom the medication is being given
check that the label on the medication is clear and unambiguous and relates to the service user in person
check the dose and the expiry date
check that the service user is not allergic to the medication
check that they have not already had the dose of medicine
give the medication directly to the service user, where necessary, with a glass of water
keep clear, accurate, signed records of all medication administered.
Staff should not:
give medicines prescribed for one person to anybody else
alter or modify a bottle or packet label
crush or dissolve drugs unless instructed to by a doctor or pharmacist.
Any queries should be directed to the person’s GP or pharmacist.
See our How to Administer Medication guide for a fuller list.
Have a policy covering PRN medication and over-the-counter remedies
Most medication is prescribed with clear instructions of how much should be taken and how often. PRN medication is prescribed to be given “as necessary” or “when required”.
Specific instructions for administering PRN medication should state clearly what the medication is for and the circumstances in which it should be given. Staff should be trained to understand this information. Records should be kept of all PRN medication given.
Over-the-counter medicines are those that can be purchased for minor ailments without a prescription. An example is paracetamol.
Service users in domiciliary care may have their own store of such medicines. Care homes may keep a limited stock of “homely remedies” which can be given to residents as required.
Care staff should:
always follow the directions on the packet
do not exceed the recommended dose and frequency instructions
record any administration.
Over-the-counter medication and homely remedies are intended for short-term use only. Service users whose symptoms persist should see their GP.
Know what to do if someone forgets to take or stops taking their medicines
If a service user refuses to take a prescribed medication, care staff should discuss the issue with them. Staff should ensure that the person has sufficient information on which to base their decision. Where they still refuse the medication this should be recorded and the prescriber informed. Where the person lacks capacity, the best interests’ requirements of the Mental Capacity Act 2015 should be followed.
Staff should never try to force someone to take medication or alter the treatment programme of a service user, such as giving a double dose where one was missed earlier.
Know what to do if someone suffers an adverse drug reaction
An “adverse drug reaction” or ADR is a response to a medicinal product that is noxious and unintended. Examples include side-effects.
Adult social care staff should be trained to recognise such reactions and take appropriate action.
All social care staff involved with service users should voice any medication-related concerns they might have to an appropriate person, such as the person’s GP or pharmacist.
Know what to do if an error occurs
Having well-trained staff and effective procedures in places will minimise errors. However, we are all human and mistakes in medicines administration do happen.
Service user safety is a key consideration. Wherever necessary, medication errors should be reported to the prescriber and their advice followed. Care providers should investigate incidents and make any necessary changes to their policies and procedures. The emphasis should be on learning from mistakes and preventing them from happening again.
Organisations should maintain an open “no blame” policy which encourages staff to report medicines errors without delay.
A Serious Incidents: Medication Errors Reporting and Investigation Form is available on Croner-i.
Ensure staff are properly trained
High standards of training in medicines administration are vital in avoiding errors and ensuring that service users have access to the medication they need as and when they need it.
Social care staff should be made aware of their organisation’s policies and procedures on medication. This includes new staff. In England, care staff should complete the Care Certificate which includes a standard for medication administration.
Training may be available through local community pharmacies or through certified programmes established by local authorities, NHS Trusts and commissioners.
Providers should ensure that a care worker is not only appropriately trained but is also competent. This is best achieved through appropriate skills checks, refresher training, appraisal and supervision.
Croner-i contains a Safe Administration of Medication in Adult Residential Care — Training Presentation which can be used for raising awareness about medication issues.
Last reviewed 4 February 2019