Martin Hodgson discusses the new guidance that has been published by the Department of Health on the administration of prescribed medicines by care assistants in care homes.
Administration of Medicines in Care Homes (with Nursing) for Older People by Care Assistants, is written for care home providers, managers and staff. Its intention is to clarify confusion about the role of care assistants in the administration of medication, particularly in care homes which provide nursing. It includes details on the legal background to administration, and safety and quality assurance requirements.
What exactly do the guidelines say and what do care managers have to do to ensure that they are properly implemented?
The legal basis for medicines administration by care assistants
The guidance starts by clarifying the legal background in this area. It states that care assistants are not legally prohibited from administering medicines to residents, providing they are suitably trained and competent and this is kept under regular review by the care home manager.
The advice applies primarily to homes with nursing care, where registered nurses are employed to provide continuous care. However, it states that the legal position applies to both care homes with and without nursing.
The role of the care assistant
The guidance states that care assistants should only administer medicines that they have been trained to give and that this will generally include assisting people in:
taking tablets, capsules, oral mixtures
applying a cream/ointment
inserting drops to ears, nose or eyes
administering inhaled medicines.
The guidance states that:
any care assistant accepting the delegated task of administering or assisting with medicines must take responsibility for ensuring that his or her actions are carried out carefully, safely and correctly — this includes understanding that ensuring the correct dosage is administered is a crucial component of medicines administration for all staff
once a care assistant has accepted the delegated task then he or she is responsible for administering the medicine as per the prescription and within his or her organisation’s protocols and guidance
care assistants need to be aware of their responsibilities if a resident declines to take his or her medicines — these responsibilities should be included in training and in care home policies and procedures.
The role of the registered nurse
Registered nurses in care homes with nursing have a key role regarding the management and administration of medication. The guidance confirms that part of this role can be delegated to a care assistant providing the nurse is confident that the support worker is competent to take on the task.
However, the guidance reminds care homes that, ultimately, the accountability for the overall nursing care of a person rests with the registered nurse and that the legal aspects of care — including delegation, accountability, liability and criminal responsibility — need to be clearly understood by both registered nurses and care assistants.
Where care assistants are involved in medicine administration, the Department of Health reminds nurses and managers that they need to ensure the continuing assessment of care home residents and their medicines to manage their health care needs and to apply the principles of effective medicines management. In addition, the administration of medicines by invasive or specialised techniques, or the administration of controlled drugs, will usually involve a registered nurse, although suitably trained and competent senior support staff may administer certain medicines in such ways when it has been deemed in the best interest of the resident.
Staff training and competence
Care assistants undertaking the role of medicine administration must be appropriately trained and competent.
The guidance sets out what should be included in the training. It states that, as a minimum, training should cover:
the supply, storage and disposal of medicines
the safe administration of medicines
quality assurance and record-keeping
accountability, responsibility and confidentiality.
Care assistants should also be trained in the procedures and policies for reporting any error or incident in the administration of medicines.
Training should highlight issues which are commonly associated with medication administration errors, such as:
administering and managing inhalers and liquid medicines are much more likely to give rise to medication errors than tablets or capsules
antibiotic administration may be particularly prone to error with doses being missed over the course of treatment
allergy and drug sensitivities should be checked prior to administration of medicines
medication administration errors are more common in the morning
interruptions during the preparation and administration of medicines are associated with medication errors.
The guidance states that training should be followed by a formal assessment process to demonstrate competence. This should be repeated regularly as required.
The self-management of medicines in care homes
The new Department of Health guidance also includes further advice on the rights of care home residents to manage their own medication and drugs.
It states that in cases where it is appropriate for a resident to manage his or her own medication, residents should be offered this choice, with appropriate support from staff. Residents in care homes with nursing have the same rights to choose to manage their own medicines, including the right to refuse medication, as people living in their own home or in care homes without nursing.
However, the paper reminds care managers that where a resident does not have the capacity to make these decisions under the Mental Capacity Act 2005, then a best interest’s decision will have to be made on his or her behalf.
Under the Act, a person must be assumed to have capacity unless it is established that capacity is lacking. The paper states that care home staff should therefore regularly assess whether an individual resident has the capacity to make specific decisions about his or her care and treatment, including whether he or she wishes to manage his or her own medicines.
Administration of Medicines in Care Homes (with Nursing) for Older People by Care Assistants was published in April 2016 and is available for download from the Department of Health website. It should be read in conjunction with other evidence-based guidelines, such as NICE guidance [SC1] Managing Medicines in Care Homes, and the NICE quality standard [QS85] Medicines Management in Care Homes.
Last reviewed 8 July 2016