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MEDICATION POLICY FOR HOME SUPPORT

Including the good practice guide for assisting Service Users in their own homes

with the administration of their medication

Revised Version July 2014

Review Date July 2017*

*unless superceded by a full policy revision

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This Medication Policy was first published in April 2003. It was reviewed and revised by a joint Working Group involving Sheffield CCG, Sheffield Teaching Hospitals NHS Trust, In-House Providers and Sheffield Community Care.

Members of the Medication Policy Group and representatives of the Assessment and Care Management Teams contributed to the latest revision. The contribution of these and other stakeholders is gratefully acknowledged

This policy applies to situations where Support Workers are providing services to the Service User in their own home. There is a medication policy for Residential Care and the Joint Learning Disability Service has a Code of Practice used by their staff and agency workers in day care, supported living and other settings for Service Users with a learning disability; see Related Documents in Health and Wellbeing at www.signpostsheffield.org.uk.

The Medication Policy for Home Support complies with the requirements of Care Quality Commission (CQC), the organisation which regulates Service Providers and checks their compliance with this Policy.

This Policy should be read in conjunction with the Mental Capacity Act 2005 and Mental Capacity Act Code of Practice 2007 and the Sheffield Joint Policy on the Prevention and Management of the Use of Restraints . The Medication Policy has been revised taking into account “The Handling of Medicines in Social Care” by the Royal Pharmaceutical Society of Great Britain

This document contains hyperlinks to useful websites and to sections of the Glossary where terms are explained.

Users of the Sheffield City Council Managed Service can access the central glossary of terms on Elma at http://intranet/structure/communities/nbhcc-resources/elma/help/glossary

CONTENTSPolicy Statement Page 4

Section 1 General Principles Page 5Section 2 The Role of The Pharmacist Page 5Section 3 Guidance for Assessors Page 6Section 4.1 The Role of the SW in assisting with

Prescribed medication Page 10

Section 4.2 The Role of the SW in Assisting with Non-prescribed medication

Page 11

Section 5 Dispensing and Storage Page 12Section 6 Administration of Medication Page 13Section 7 Covert Administration Page 15Section 8 Recording Page 16Section 9 Medication Records Page 16Section 10 Day Care Page 17Section 11 Respite Care Page 17Section 12 Changes and Emergencies Page 17Section 13 Dosing Intervals Page 18Section 14 Training Page 18Section 15 Advice to Service Users on Medical Issues Page 18Section 16 Food Supplements Page 18Section 17 Review of the Medication Policy Page 19Appendix 1 Glossary of Terms Page 20Appendix 2 Medication Checklist for SWs Page 24Appendix 3 Disposal of Medication No Longer Required Page 28Appendix 4 Special Dosage Instructions

Variable Dose MedicationSliding Scale Dosage Schedules

Page 26Page 27

Appendix 5 Medication Authorisation Form Page 28Appendix 6 Sample (MAR) Page 30Appendix 7 Non-prescribed medications form Page 31Appendix 8 Comments form for the review of the Policy Page 33Appendix 9 Leaflet for Service Users, relatives and friends Page 34Appendix 10 F15A Page 36

Appendix 12 Body Chart Page 38

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POLICY STATEMENT

The majority of Service Users (SU) take responsibility for administering their own medication and their independence with this task should be enabled wherever possible.

This policy is designed to cover those situations where SU in their own homes are unable to administer their own medication and who require assistance with medication from their Support Workers (SW).

This policy aims to provide guidance to SW and Assessors on the safe Administration and Recording of Medication.

Written authorisation must be obtained from the SU by the Assessor before a SW administers any medication to the SU.

Where a SU appears to lack the mental capacity to give authorisation for this assistance, the Assessor will carry out the assessment of the SU’s capacity to make this decision according to the Code of Practice and local guidance for the Mental Capacity Act and record accordingly. The Decision Making Tool and Assessment of Capacity Recording Tool can be found on the Council intranet  at http://intranet/structure/communities/nbhcc-resources/elma/procedures/continuinghealthcare/assessment

The Assessor will identify the level of assistance required with the administration of medication and will undertake a risk assessment to support independent living. The Assessor will develop an appropriate Care/Service Plan to meet the need for assistance with medication in the ‘best interests of the SU If applicable they will work with any appointed advocate e.g. Lasting Power of Attorney (LPA) and where the Assessor is aware of an Advance Decision will record how the implications of this have been taken into account. The SW shall then administer medication as prescribed by the GP or other authorised prescriber.

Generally, medical treatment or treatment by a GP to which the SU has been unable to consent is lawful in the case of an adult who does not have the capacity to give authorisation on their own behalf where there has been an assessment of lack of capacity and it is considered to be in the ‘best interests’ of the Service User.

All providers must ensure compliance with this document. Sheffield City Council will undertake periodic audits to ensure practice complies with the Medication Policy.

1. GENERAL PRINCIPLES

1.1 All medicines are potentially harmful if not used correctly, and care must be taken in their storage, administration, control and safe disposal.

1.2 It is the responsibility of the Assessor to obtain authorisation from the SU and to make the initial assessment of whether the SU has the capacity to give this authorisation.

1.3 Authorisation must be given by the SU in writing (see Appendix 5 Medication Authorisation Form) before SWs may assist with the administration of medication, unless the Assessor has concluded, following an appropriate assessment, that the Service User lacks the capacity to so authorise and it is in the best interests of the Service User to receive assistance. The Assessor will note this on the Medication Administration Authorisation Form and record the reasons and circumstances of the ‘best interests’ decision and who was involved in making this decision.

1.4 Authorisation will be noted on the SU’s Care/Service Plan.

1.5 SWs must only administer medication following authorisation by their line manager where the authorisation of the SU has been obtained or where the Assessor has completed an assessment identifying it is in the best interests of the SU to receive assistance. See 1.3

1.6 SWs must report any concerns relating to a SU's medication to their line manager.

1.7 Where a SU has responsibility for their own medicines, and the SW is concerned about the SU’s ability to continue to manage their own treatment, the SW must report this to their line manager.

1.8 In the circumstances described in 1.7, the line manager is responsible for arranging a further assessment of the SU’s need for assistance with their medication.

2. THE ROLE OF THE COMMUNITY PHARMACIST

2.1 Pharmacists are responsible for the supply of medicines and appliances prescribed by a Doctor, Dentist, Nurse Practitioner or other authorised prescriber.

2.2 Pharmacists can provide advice to SUs and, with their permission, to their families and workers involved in their care on the proper use, storage and disposal of medicines.

2.3 SUs may be using medicine and appliances supplied by a hospital pharmacy, emergency medical service or dispensing doctor.

2.4 Pharmacists keep computerised records of the medication that their regular SUs receive on prescription. These records provide useful information and can indicate potential drug interactions.

2.5 The Pharmacist will maintain a patient medication record in the pharmacy for all patients obtaining their regular prescription medication from the pharmacy.

2.6 It is advisable to arrange for prescriptions to be dispensed at the SUs regular pharmacy. The Pharmacist will be contacted by the Assessor to supply a (MAR) chart.

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2.7 Many Pharmacists offer a collection and delivery service for medicines. SWs should contact their line manager if a SU has difficulty in obtaining prescriptions from their doctor or in arranging for medicines to be dispensed and collected from the pharmacy.

2.8 Pharmacists can advise on the use of alternative packaging of medicines. As an alternative to receiving formal care services an appropriate compliance aid or reminder chart may enable a SU to retain responsibility for their own medication.

2.9 SWs should contact their line Manager if they consider that in seeking to maximise their independence a SU would benefit from use of an appropriate compliance aid.

2.10 Doctors and dentists may issue private as well as NHS prescriptions.

2.11 In addition to doctors and dentists, there are other authorised prescribers on the NHS. A limited range of medicines may also be supplied in accordance with a Patient Group Direction (PGD) which permits the supply of medication in defined circumstances without a prescription.

2.12 The dispensing Community Pharmacist is the first point of contact for queries about medication by SWs, Care Coordinators, Assessors and family carers.

3. GUIDANCE FOR ASSESSORS

Assessment and Initiation of Pharmacist Support

3.1 IntroductionAll providers of Home Support Services to Sheffield residents have agreed to adopt a common policy in relation to the management of medicines for SUs who, following assessment, are considered to require support with the administration of medication. This guidance forms part of the Medication Policy and it should be read in conjunction with the Policy and its appendices, which are referred to in this guidance.

3.2 The Medication Policy3.2.1 The Policy and Good Practice Guide address a number of issues relating to the administration of medicine. Core features of the Policy and Code of Practice include:

Clarity relating to the circumstances in which SWs can administer medication to SUs

Clarity over what types of medication may be administered by SWs (and what cannot be administered – See page 10, 4.1.6)

The adoption of common medication records (MAR charts)

The involvement of Community Pharmacists (and Secondary Care Trust pharmacy services) in supporting the Medication policy and code of practice and issuing MAR charts

A common induction programme for all Home Support staff, both in post and new recruits.

3.3 Medication Administration Records3.3.1 A common medication recording system is a core feature of the Policy and Good Practice Guide. A SU who requires administration of medication will be issued with a (MAR charts) (Appendix 6) by their Pharmacist to cover the duration of the prescription. The Pharmacist will enter some basic patient details on the MAR chart and will also provide details of the medication in the form of duplicate labels affixed to the MAR chart

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in the position indicated or as a computer generated chart. This may differ from the standard MAR chart though the content is essentially the same. However the key/codes that need to be documented when medicines are not administered may differ.

3.4 Role of the Assessor3.4.1 It is the responsibility of the Assessor to determine if help with medication is required and they (or the agency/provider) should obtain the SU’s authorisation for this assistance. The authorisation will be confirmed using the Medication Administration Authorisation Form given in Appendix 5 of this Policy.

3.4.2 Written authorisation for the administration of the medication must be obtained from the SU before a SW may administer medicines.

3.4.3 Details of authorisation must be kept on the SU's file and copies should be given to the SU and to the Service Provider. Authorisation must be reviewed and reaffirmed at least annually, or before this time if circumstances change. E.g. admission to hospital. The Local Authority Assessment Team Manager is responsible for ensuring that reviews are conducted annually.

3.4.4 Where a SU appears to lack the capacity to give authorisation for this assistance, the Assessor will carry out the assessment of the SU’s capacity to make this decision according to the Local Guidance and Code of Practice for the Mental Capacity Act. The Assessor will identify the level of assistance required and will undertake a risk assessment to support independent living. The Assessor will develop an appropriate Care/Service Plan to meet the need for assistance with medication in the best interests of the SU and keep records of the reasons and circumstances of the ‘best interests’ decision and who was involved in making this decision. Under the Mental Capacity Act different people may be required to act as a decision maker, depending upon the decision to be taken.

3.4.5 Where the SU is assessed as lacking capacity to authorise the administration of medication, the Assessor will seek to establish if any Advance Decisions have been made by the SU, if an Enduring Power of Attorney, Lasting Power of Attorney or Deputy is in existence and whether the SU’s previously expressed wishes and feelings have been identified and recorded.

3.4.6 In the above situation, the Assessor will state on the Authorisation form how it has been determined that the SU lacks capacity, and how it has been determined and that medication should be administered as prescribed.

3.4.7 Where authorisation is refused, medication must not be administered by SWs.

3.4.8 Where the Assessor considers that refusal to authorise the assistance with medication will place the SU at risk, the refusal should be reported to the SU’s doctor or other member of the GP practice team.

3.4.9 Where it is felt that refusal of authorisation by a SU is not made of their own free will, it may be appropriate to refer to the Safeguarding Adults Procedures.

3.4.10 The Assessor will note on the service procurement document where it is necessary to limit access by the SU to their own medicines and complete the appropriate risk assessment according to the Sheffield Joint Policy on the Prevention and Management of the Use of Restraints. The issue of safekeeping could also apply to the MAR charts and the Care Plan and these should be addressed and recorded in the assessment, Care Plan and service procurement document. This information will be transferred by the Care Coordinator/Line Manager on to the Care/Service Plan.

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3.4.11 If the Assessor is aware of a risk of the SU not complying with the assistance with medication, this should be noted on the assessment, Care Plan and service procurement document together with guidance for the care provider about what to do in such circumstances.

3.4.12 The Assessor will also record on the service procurement document if there are any Advanced Decisions in place.

3.4.13 In order to initiate support with medication the Assessor should indicate the level of support with medication that is required. (See paragraph 6.5 and the summary on the revised form F15a, attached as Appendix 10)

3.4.14 If there is more than one Provider, or a Provider and a family carer, involved in assisting the SU with their medication their respective roles and responsibilities should be clear from the Care Plan, service procurement document and Care/Service Plan which is kept in the SU’s home. Everyone should follow these procedures and complete the MAR chart and/or the SU’s Daily Log/Communication Sheet.

3.4.15 The leaflet “Taking Medication” should be given to the SU, and, where appropriate with the SU’s permission, to any family members or informal carers for their information, especially if they are involved in assisting with the administration of medication as part of the Care/Service Plan. At the point of review a leaflet should be given to the SU if they do not have one.

3.4.16 When the Assessor has completed the form F15a they should also request the SU to sign the Medication Administration Authorisation Form (Appendix 5). The Assessor should ask the SU to nominate a Community Pharmacy that will be responsible for dispensing prescriptions, and this should be recorded on the Authorisation Form.

3.4.17 Most SUs receiving regular medication will use a single pharmacy for all their prescription medication. Where this has not been the case the Assessor should agree with the SU a pharmacy that will be approached to take responsibility for dispensing prescriptions.

3.4.18 The Assessor should contact the new pharmacy faxing the Medication Authorisation Form and request the Pharmacist supply MAR charts when the next prescription is issued. Where the MAR chart is issues this will be supplied by the pharmacist and accompany the medications.

3.4.19 The Assessor should fax a copy of the Medication Administration Authorisation form to the nominated Pharmacist and to the GP.

3.4.20 The Assessor should provide the Pharmacist with the name and address of the SU, details of the SU’s GP, the Neighbourhoods and Community Care reference number to identify the SU in correspondence, and details of how prescriptions will be supplied to the pharmacy for dispensing. This information is given by faxing a copy of the Authorisation Form to the Pharmacist.

3.4.21 The Assessor should inform the GP, or other prescriber, that the SU is receiving assistance with medication and inform the GP of the telephone and fax numbers of the contact person of the Care Provider so that the GP can inform the Care Provider of any urgent changes to the SU’s medication. This can be done by faxing a copy of the Medication Authorisation form to the GP. The GP should then keep a record of the contact person for any communications regarding the SU’s medication.

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3.4.22 Where the SU is on a complex medication regime or there are concerns about the medication, the Assessor should request a review by the GP or seek advice from the Community Pharmacist. See 2.13 about advice regarding medication.

3.5 USE OF A COMPLIANCE AID 3.5.1. If the Assessor considers that the issue of a compliance aid may help a SU to maintain independence they should discuss this with the Pharmacist. Such aids should be used in preference to providing Home Support assistance wherever practicable, as the promotion of independence is an underlying principle of this Policy.

3.5.2 A multi-compartment compliance aid( MCA) should not be necessary for a SU who needs administration of medication. Careful consideration of the SUs needs must be made by an Assessor before requesting any exception to the Medication Policy is made.

3.6 ORDERING AND COLLECTION3.6.1 The arrangements for the ordering and collection and dispensing of prescriptions should be recorded on the Care/Service Plan by the Assessor. Some Pharmacists will offer a prescription collection (from the GP practice) service and a delivery service for dispensed prescription to the SU’s home for ‘house bound’ SUs – the Assessor should discuss options with the nominated pharmacy.

3.7 SERVICE USERS DISCHARGED FROM HOSPITAL 3.7.1 When a SU is discharged from hospital there will be an attempt to resume the original package of care. The Hospital Pharmacy will provide a MAR chart with the discharge medication, provided that there is sufficient notice of the discharge and that nursing staff clearly indicate that Home Support is to be provided. If there is not sufficient time before discharge to prepare a MAR chart it may be possible to forward this on to the SU separately following discharge.

3.7.2 If the SU did not receive assistance with their medication before admission but it is assessed that they will need this on discharge, this task will need to be part of the Care Plan and the person should be discharged with a MAR chart, providing, as above, that there is time to arrange this.

3.7.3 Some SUs who usually have a multi-compartment compliance aid (MCA) may need short-term assistance with their medication from a SW until their condition improves; in these short term situations it may be necessary for the SW to assist with medication dispensed in the MCA, for the purposes of rehabilitation, and to enable the SU to regain their independence.

3.7.4 All SUs discharged with a package of Home Support, which includes administration of medication, are to be reviewed in their own home as soon as possible following discharge. Where a MAR chart is not available the medication administered should be recorded on the SU’s Log/Communication Sheet.

4. THE ROLE OF THE SW IN ASSISTING WITH MEDICATION

SWs may only administer medication when appropriate training has been received and where the SU has given authorisation. Care Providers have a duty to assess the competence of their SWs to assist with medication.

Where the SU lacks capacity to give authorisation the Assessor will have made a ‘best interests’ decision that the SU should receive medication by administration. This will be noted on the Care/Service plan.

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SWs will find it helpful to introduce themselves to local Pharmacists. Pharmacists offer advice on many aspects of the use of medicines, however some services offered by Pharmacists e.g. collection of prescriptions from GP surgeries and delivery of dispensed medicines are not funded under the NHS and are thus undertaken on a goodwill basis.

4.1 PRESCRIBED MEDICATION

4.1.1 SWs may assist a SU to take medication which has been prescribed by the SU's Doctor or other authorised prescriber responsible for aspects of the SU’s care.

4.1.2 All SWs, who have undertaken the appropriate basic training on the management of medicines may provide assistance with the following:

4.1.3 Medication taken by mouth (oral preparations) e.g. tablets, capsules and oral liquidsMedication applied externally to the skin e.g. ointments, creams and lotions, subject to 4.1.6 and 4.1.8 below

4.1.4 Assistance with the administration of drops or other preparations (e.g. ointment) for instillation into the eye, ear or nose, and medication in patches to be applied to the skin (transdermal patches) may only be given after specific written instructions from the SW’s line manager. Where necessary and appropriate the SW will receive training in the administration of unusual medications or preparations e.g. from District Nurses.

4.1.5 Assistance with nebulisers and inhaler devices must only be given by SWs who have received instructions on the use of the particular device and have written authorisation from their line manager.

4.1.6 The following medications must NOT be administered by SWs: injections suppositories pessaries enemas internal rectal creams internal vaginal creams the application of dressings involving wound care the application of medication to broken skin (where there is an obvious

breach in otherwise intact skin)

4.1.7 The administration of these medications is the responsibility of a health care professional (e.g. a District Nurse). In some circumstances SWs will have undertaken advanced training to enable them to undertake some of the above tasks under the guidance of nursing staff. The health care professional remains responsible for the monitoring of such assistance with health care tasks and in some circumstances the Health Authority would need to fund such assistance.

4.1.8 Creams, ointments, and lotions should only be applied by SWs where the skin area to be treated is unbroken. SWs must contact their line manager if they have concerns regarding the application of external preparations.

4.1.9 Disposable gloves should be worn when applying external preparations e.g. ointments, creams, lotions.

4.1.10 SWs should make themselves aware of the exact arrangements for assisting the SU with their medication, including whether another worker or family carer is also involved in assisting with this task, and if there are any arrangements for what

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medications might need to be taken ‘as required’ or in an emergency. This information will be provided by the Assessor and will be contained in the Care / Service Plan.

4.1.11 SWs should follow carefully any special instructions on the label of the medication, such as ensuring the medication is taken as directed before or after a meal. This information should be on the MAR chart

4.1.12 The SW must contact their line manager for advice in the event of a SU, who has previously given authorisation, refusing to take prescribed medication.

4.1.13 The SW should immediately inform their line manager if they observe any possible adverse reaction to medication and in case of emergency should contact the G.P., Pharmacist, or the 111 service if the prescriber is not available. This applies whether assistance with the administration of medication is given or not. SWs are in a good position to advocate on behalf of the SU and feedback queries and concerns to the GP or Pharmacist.

4.1.14 Even where SWs do not give assistance with medication they should be aware whether a SU is taking medication. SWs should inform their line manager if they have any concerns about the SU’s health.

4.1.15 SWs should preserve the dignity and respect the wishes of the SU, including cultural practices, when assisting with medication. Guidance on these wishes or cultural issues should be recorded in the Care and Service Plans.

4.2 NON PRESCRIBED MEDICINES AND REMEDIES

4.2.1 SWs must not offer advice on non-prescribed medicines and remedies. It may be DANGEROUS TO DO SO. The SU may be allergic to the treatment or be taking other medicine that may result in harm to the SU.

4.2.2 The Good Practice Guide permits SWs to assist SUs with the administration of non-prescribed medication in addition to most prescribed medicines, providing that advice has been sought from the SU’s Doctor or Pharmacist to check if the non-prescribed medication is not contraindicated and may be safely administered to the SU, and providing that the completed Non-prescribed Medications form is attached to the duly signed Authorisation form. During the Assessment interview the Assessor should enquire about the SU’s use of non-prescribed medication using the form provided (Appendix 7). The outcome should be recorded on the form, which should be filed with the SU’s Care/Service Plan.

4.2.3 When SWs are asked by the SU to administer non-prescribed medication or to purchase a non-prescribed medicine, and the medicine has not been listed on the Non-prescribed Medications Form, they must either:

refer the SU to seek advice from their GP seek advice from their line manager, who will take further advice from the SU’s GP

or PharmacistThe line manager should record any advice received on the Reviews/Amendments of Non-prescribed Medications form and copy to the Assessor

4.2.4 Before contacting the line manager, the SW MUST ask the SU what other medicines they are taking. The Pharmacist and/or the GP require this information in order to determine if it is safe for the SU to take the non-prescribed medication. This course of action must be followed in circumstances where a SW is responsible for assisting the SU or where a SU manages their own medication.

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4.2.5 Non-prescription medicines may only be purchased or administered on behalf of a SU, where the Assessor or the SW’s Line Manager has contacted the SU’s GP or Pharmacist to check if the medication requested is appropriate and the medicine has been listed on the Non Prescribed Medication form (see Appendix 7).

4.2.6 Details of any non-prescribed medication (including the time and the dose) that is administered to the SU must be recorded on the SU's Log/Communication Sheet.

4.2.7 If there is more than one Provider, or a Provider and a family carer, involved in assisting the SU with their non-prescribed medication, their respective roles and responsibilities should be clear from the Care Plan, service procurement documents and Care/Service Plan, which is kept in the SU’s home. Everyone should follow these procedures and complete the SU’s Log/Communication Sheet when non-prescribed medication is administered.

4.2.8 Before assisting with non-prescribed medications the SW, or anyone else involved in assisting, should check on the SU’s Log/Communication Sheet to see if anyone else has administered non-prescribed medications and that the recommended dose will not be exceeded. They should then record on that sheet any medicine that they administer. If in any doubt contact your line manager for advice.

4.2.9 The use of non-prescribed medication should be checked at the Review of the Care Package, or whenever there is a change of prescribed medication, and any change should be noted on the Non-Prescribed Medications Form continuation Sheet.

4.2.10 Where the SU lacks capacity the Assessor would need to establish whether the lack of capacity applies also to the taking of non-prescribed medications and, if so, to determine what would be in the best interests of the SU in relation to the taking of such medications.

5. DISPENSING AND STORAGE

5.1 SWs must only administer medication from medicine containers supplied by a Pharmacist, hospital pharmacy or dispensing doctor practice.

5.2 SWs should ensure that all medication is stored in the agreed designated area.

5.3 Some medication requires refrigerated storage. It is acceptable to store medicines requiring refrigerated storage in a domestic refrigerator. However do NOT store medicines in, or immediately adjacent to, the icebox of a refrigerator or in the freezer compartment of a combined fridge freezer. Do not store medicines adjacent to uncooked meats or other food. Store medicines if possible in a door compartment that can be reserved for medicines.

5.4 The label on the medicine should indicate any special storage conditions. Storage arrangements should be noted on the SU's Care/Service Plan.

5.5 Unused, out of date medication, or medication no longer required, must be returned to any community pharmacy, with the SU's authorisation. Where there is no informal carer (e.g. a family member) who can be responsible for the return of medicines no longer required, the SW must obtain approval of their line manager to return the medicines to the pharmacy. Where the medication to be returned is listed on the (MAR) the MAR chart should reflect medicines for disposal furthermore good practice to receive a receipt of returned medication from the pharmacy. (See Appendix 3). Details should also be entered in the SU’s Log/Communication Sheet.

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5.6 The Assessor will note on the service procurement document if there is a need to make alternative arrangements to store medications in a locked container where this need has been identified by a risk assessment. This information will be transferred by the Care Coordinator/line manager on to the Care/Service Plan which is kept in the SU’s home.

5.7 The SW should be informed who is responsible for the ordering of repeat prescriptions. If the SW is responsible they should ask for repeat prescriptions in good time in order to avoid the SU running out of medication. A list of what medication has been requested should be kept by the person responsible for requesting the repeat prescription and this should be checked against what has been dispensed. Any difference should be reported to the Pharmacist before assisting with the administration of any medication.

5.8 The Pharmacist should be asked for a new MAR chart when the repeat prescription is submitted for dispensing. The Pharmacist should be informed of ‘as required’ medication which may not be on the repeat prescription, but needs to be on the new MAR chart for continuity.

5.9 Any changes in the dose of previously supplied medication should be communicated to the care provider by the prescriber. If this is initially verbally, the verbal instruction should be confirmed by another person and a written confirmation should be faxed at the earliest possible time.

6. ADMINISTRATION OF MEDICATION

6.1 A MAR chart must be maintained by the SW for each SU who is receiving administration of their medication from a SW.

6.2 The MAR chart and the SU’s Log/Communication Sheet must be kept in the SU's home in an agreed location, and both must be examined on each occasion the SW attends the SU’s home, in order to note any changes in medication.

6.3 Having received an authorisation form the pharmacist should agree to supply a MAR chart in line with the medication policy Guidance is given on the completion of MAR charts in the training.

6.4 SWs must always check the SU’s Log/Communication Sheet and the MAR chart prior to administering any medication to ensure that the medication has not already been administered.

6.5 Depending on the SU’s ability, the Assessor may identify that the only support necessary is to remind (prompt) the SU to take their medication. The SU must still be observed taking their medicine and this is documented in the patients notes. “mediciation prompt and observed”.

6.6 Administration of oral medication for the purposes of these guidelines means: removing medication from container and directly administering (see 6.7 and 6.8).

6.7 Doses of liquid oral medication must be measured using a 5ml medicine spoon, an oral syringe or a graduated medicine measure all of which are supplied by the Pharmacist. Where the SU experiences difficulty in taking liquid medicine from a medicine spoon or measure, an oral syringe may be required. SWs should contact their line manager if the SU is experiencing difficulties with liquid oral medicines.

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6.8 Medication should not be handled, and solid dose forms e.g. tablets and capsules should be passed to the SU in an appropriate container e.g. a medicine pot. . Where the SW has to place the dose in the SU’s mouth, the SW should wear disposable gloves.Sometimes the Pharmacist may advise that tablets need to be cut in half; this should be done with a proper tablet cutter. Staff involved in this task should have their practice checked to ensure they are using the cutter correctly and getting an accurate half tablet. Training should be offered where necessary.

6.9 Tablets should never be crushed, nor capsules opened, without the explicit instruction of the prescriber and/or the supplying pharmacist.

6.10 Some medication must be dissolved or dispersed in water before administration. This will be indicated on the label.

6.11 Tablets and capsules are best taken with a sufficient quantity of water to aid swallowing. This is especially important with capsules.

6.12 SWs must wear disposable gloves when applying external medication (e.g. ointments, creams, lotions or patches).

6.13 Always follow the dosage directions and other instructions on the medicine label.

6.14 Medication must only be administered if the container is clearly labelled with the SU’s name, the name of the medication and dosage.

6.15 A SU must never be forced to take medication as this is illegal and could be an assault on the SU.

6.16 If a SU refuses their medication this must be reported to the SW’s line manager immediately and should also be noted on the MAR chart and in the SU’s Log/Communication Sheet. The SW should check if guidance has been given on the Service Plan about what to do in this situation.

6.17 SWs must only administer medication from containers that have been assembled by the Pharmacist, supplied by a hospital or dispensing doctor practice.

6.18 SWs must not administer medication from multi-compartment compliance aids or other compliance aids made up by family members or friends of the SU.

6.19 If the label becomes detached from the container, is illegible, or has been altered, medication must not be administered. Advice should be sought through the line manager who should seek further advice where necessary. Out of normal working hours advice can be sought from the G.P. Collaborative (by ringing the patient’s own GP) and also via the 111 service. Details should be recorded on the chart.

6.20 Medicines have an expiry (use-by) date. The expiry date must be checked to ensure that the medicine may still be used.

6.21 The SW must inform their line manager about any medication that has expired. The line manager must contact the SU's doctor to ascertain if the medication is still required, in which case the doctor will be requested to issue a new prescription. The SW must enter the details on the SU's chart, and in the SU’s Log/Communication Sheet and the expired medication should be returned to any pharmacy. (See paragraph 5.8 above and Appendix 3)

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6.22 If medication is labelled with imprecise or ambiguous directions, e.g. ‘take as directed’, ‘take as before’, ‘apply to the affected part’, the SW must seek clarification through their line manager.

6.23 Most medication will be prescribed for administration on a regular basis. Some treatments may be prescribed on a PRN or an ‘as required’ basis. It is essential that the SW has sufficient information in order to determine if a dose being requested by the SU is appropriate. If in doubt the SW must contact their line manager who must contact the GP practice for clarification. Any such ‘as required’ dose should have information about the purpose of the medication, the recommended dose, the recommended frequency and the maximum dose. The reason for assisting with a dose of ‘as required’ medication should be recorded on the SU’s Log/Communication Sheet.

6.24 Some medication is prescribed on a reducing or variable dosage regime and the SW must always refer to any accompanying information or charts. (See Appendix 4).

6.25 It is important to note that alcohol will interfere with the action of some medication and therefore SWs should remind SUs of the potential for adverse effects of alcohol consumption whilst taking some medication. Where a known interaction exists between a medicine and alcohol a warning should appear on the label of the medicine container. SWs should notify their Line Manager of any concerns about the use of alcohol by the SU.

6.26 Some medication causes side effects and the SW should be alert to this possibility and report any concerns to their Line Manager.

6.27 When necessary the line manager of the SW or the Assessor/Care Manager should discuss any concerns relating to a SU’s medication with the supplying Pharmacist or the GP.

6.28 If there is more than one Provider, or a Provider and a family carer, involved in assisting the SU with their medication their respective roles and responsibilities should be clear from the Care Plan, /Service Plan, which is kept in the SU’s home. Everyone should follow these procedures and complete the MAR chart.

6.29 The assistance with the administration of controlled drugs follows the steps for the administration of any other medication.

6.30 Where patches are prescribed, these should be accompanied with a Body Chart which will be kept with the MAR chart. See appendix 12 for Body chart.

7. Covert Administration (Support Workers giving medicines to Service Users without their knowledge)

Covert Administration may be permitted provided that the organisation has a specific policy and, furthermore, that any decision taken:-

is in the best interest of the SU meets the requirements of the Mental Capacity Act

The Mental Capacity Act 2005 has produced an assessment tool called the two stage functional test.

The two-stage functional test

In order to decide whether an individual has the capacity to make a particular decision you must answer two questions:

15

Stage 1. Is there an impairment of, or disturbance in the functioning of a person's mind or brain? If so,

Stage 2. Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

The Mental Capacity Act says that a person is unable to make their own decision if they cannot do one or more of the following four things:

Understand information given to them Retain that information long enough to be able to make the decision Weigh up the information available to make the decision Communicate their decision – this could be by talking, using sign language or

even simple muscle movements such as blinking an eye or squeezing a hand.

8. RECORDING

7.1 The SW must confirm that a dose has been administered by entering their initials or signature in the appropriate administration record box on the chart. Medication administered to a SU must be recorded at the time of the administration.

7.2 For non-prescribed medication refer to Appendix 7.

7.3 Where a single dose of medication has been removed from the container but is not used, it may be disposed of by flushing down the toilet although, preferably, it should be disposed of by placing in a suitable container, envelope or disposable glove and taking to the community pharmacy. Details of medication destroyed must be recorded in the SU’s Log/Communication Sheet.

7.4 If the SU requests that a spoilt dose is not destroyed (e.g. after having been dropped on the floor) and that the dose be administered the details must be recorded on the SU’s MAR chart and the SW should report the administration of the spoilt dose to their line manager immediately. This situation may occur if the spoilt dose is the only dose remaining.

7.5 Where the SU lacks capacity to decide the safety of taking a spoilt dose the SW should follow the guidance, dispose of the dose appropriately and report any problems to their line manager.

7.6 Where medication is not recorded on a MAR chart, or where a MAR chart is not available, the medication administered should be recorded on the SU’s Log/Communication Sheet. The SW should inform their line manager where this is happening so that arrangements can be made to provide a MAR chart.

7.7 Errors can occur and Service Providers should have clear incident reporting systems for their staff to follow so that the workers and the organisation learn from mistakes and prevent errors in the future.

9. MEDICATION RECORDS

8.1 The current (MAR chart) should be kept in a safe place in the SU’s home. Where there are concerns about the safekeeping of the MAR charts or Care/Service Plans this should be reported to the Assessor, who will assess the risks and plan to minimise those risks. The arrangements for the safekeeping of papers and charts would be noted in the Care/Service Plan. The Care Coordinator/Senior Care Worker must send Completed

16

MAR charts to the Service Provider’s branch or team office for storage on the SU’s file. In exceptional circumstances where there are two Service Providers the main Provider shall with the consent of the SU take the chart for their own files and send a copy to the other Provider. If the SU is assessed not to have capacity to consent a best interests decision as to the sharing of information should be taken by the Assessor

8.2 Where SWs assist SUs with their medication this should be recorded on the SU’s Service Plan.

9. DAY CARE

9.1 The Medication Policy does not cover day care opportunities. The responsibility for taking medication when having day care opportunities lays with the SU themselves.

10.RESPITE CARE/SHORT TERM CARE

10.1 Where a SU, who receives assistance with medication, has a period of short term care, the Assessor should identify whether the family carer or SW is to arrange for the medication to go with the SU. The medication should be contained in their clearly labelled original containers. The MAR chart should accompany the SU to enable the medication recording system to continue. Medication and MAR charts should accompany the SU on their return home.

10.2 Where the Assessor is coordinating an emergency placement they should ensure that the medication and the MAR chart go with the SU to the home.

11.CHANGES AND EMERGENCIES

11.1 Where a SU, who does not usually have assistance with medication, needs such help, the SW will inform their Care Coordinator that there has been a change in the SU’s needs. The Care Coordinator will then request the allocated Assessor / Duty Worker at the relevant Assessment and Care Management office to carry out an unplanned review of the SU’s needs. If this is an urgent request and the circumstances warrant it the Duty Worker could authorise a temporary increase in service to provide help with medication, if Assessor feels the SU cannot self-administer with start and end dates. The Assessor will also ensure the completion of the Medication Administration Authorisation form, if this has not been completed previously, and supply a copy to the Service Provider. If the SU is unable to sign because of the lack of time in the emergency situation then the Assessor should authorise the assistance, explain that on the form and arrange for the SU to sign the Authorisation at the earliest opportunity.

11.2 Where a SU is admitted to hospital as a planned admission the SU, Assessor, family, carer or SW should arrange for the medication and MAR chart to go with the SU to enable the hospital to administer medication as prescribed. They should also ensure that this happens in the event of an emergency admission. Best practice is that the medication and MAR chart accompany the SU on any admission to hospital.

11.3 It is good practice that any changes in medication should be communicated to the Care Provider by the prescriber.

11.4 A new MAR chart should be provided where practicable whenever there is an alteration to the medication prescribed. When this is not possible, the changes should be documented on the existing MAR chart. These alterations should be signed and dated by the clinician or alternatively written authorisation should be provided. Any alterations to

17

the MAR chart that cannot be shown as coming from an authorised source will not be administered without clarification as above.

12.DOSING INTERVALS

12.1 Where the SU needs assistance with the administration of medication at specific time intervals the Care Coordinator or the Assessor should check the essential requirements with the GP or Pharmacist to see if the dosing schedule of the medications can be realigned, e.g. by use of a controlled release formulation. If the dosing intervals are an essential component of treatment, e.g. as in a 6 hourly regimen for antibiotic treatment, and the service provided does not cover these requirements, the Assessor should increase the care package accordingly. Where assistance with the administration of medication is required during the night the Night Care Visiting Service might be appropriate to provide this assistance in some circumstances.

13.TRAINING

13.1 A training programme has been agreed and is arranged for all SWs by their employer.

13.2 Any training provided must give underpinning knowledge that will contribute towards the appropriate Health and Social Care Diploma Award Level 2 or other recognised training as this becomes available.

13.3 Care providers must identify a competent person to deliver the training programme.

13.4 All trainers must attend the Sheffield Home Support Medication Training for designated trainers; only individuals who have attended the training may deliver the programme and work within the Quality Assurance Framework for trainers.

13.5 All trainers must also attend a refresher, Sheffield Medication Training programme within a two year period. This is the responsibility of each provider.

13.6 SWs must attend an annual Medication Refresher programme arranged by the Care Provider.

13.7 Care Providers will be responsible for quality assuring their training and assessing the competence of their workers, both before working in the field and subsequently.

14.ADVICE TO SERVICE USERS ON MEDICAL ISSUES

14.1 It is the responsibility of the prescriber to explain the reason for the treatment and the likely effects (including side effects) of any medication prescribed to the SU.

14.2 The prescriber makes a judgement on whether to explain to a SU the nature of an illness and the implications of any treatment. This judgement must be respected by SWs.

14.3 SWs MUST NOT discuss or disclose a SU’s medical history or treatment to a relative or lay person. Any questions must be re-directed to the SU, the SU's Medical Practitioner, or the SW’s Line Manager.

15. FOOD SUPPLEMENTS

15.1 Food supplements are not addressed by the Medication Policy but they should be treated as any other special diet, that is, the instructions would be clearly noted in the

18

Care/Service Plan and would be followed by the SW. Compliance with the instructions would be recorded in the SU’s Log/Communication Sheet and/or MAR chart.

16.REVIEW OF THE MEDICATION POLICY

16.1 No policy or guide will cover every eventuality. In the event of uncertainty staff will need to use common sense and seek appropriate advice and guidance. Such advice and guidance can be sought from a line manager, the SU’s GP, the Pharmacist. Staff are requested to submit any comments on current procedures to their line managers, who will ensure that a record of these comments is made at the back of the Policy (Appendix 8) to aid the next review.

16.2 Please return these forms to the Strategic Commissioning and Partnerships Section, Communities Portfolio, Redvers House, Union Street, Sheffield, S1 2JQ or email to contractscommissioningenquiries@sheffield.gov.uk

There may be occasions where situations are not covered in this guidance. Please bring any concerns you have to the attention of your line manager.

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Appendix 1

GLOSSARY OF TERMS

Administer/Administration

Shall mean: The taking of an oral dose of medicine; The application of external medication (e.g. ointment,

cream, lotion or drops); The operation of an inhaler device in order for the dose of

medication to be inhaled.

Advocate Someone who provides support and representation for a person.

Assessor

return to Policy Statement

Shall mean the person authorised by the appropriate organisation* to undertake an assessment of the SU’s ability to manage their medication, and who is responsible for obtaining the authorisation of the SU for a SW to assist them with the administration of their medication. The Assessor is usually a Care Manager or a Social Worker.*Organisations include Sheffield City Council, Sheffield Teaching Hospital Foundation Trust, Continuing Health Care, Sheffield Health and Social Care.

Authorisation

return to Policy Statement

Delegating the power or asking someone to carry out a task on one’s behalf.

Best interests The term ‘best interests’ is not actually defined in the Mental Capacity Act. This is because so many different types of decisions and actions are covered by the Act, and so many different people and circumstances are affected by it.

Section 4 of the Act, and Chapter 5 of the Code of Practice, see http://www.sheffield.gov.uk/safe--sound/social-services/mental-capacity-act/code-of-practice , explains how to work out the best interests of a person who lacks capacity to make a decision at the time it needs to be made. This section sets out a checklist of common factors that must always be considered by anyone who needs to decide what is in the best interests of a person who lacks capacity in any particular situation. This checklist is only the starting point: in many cases, extra factors will need to be considered.

return to Policy Statement

When working out what is in the best interests of the person who lacks capacity to make a decision or act for themselves, decision-makers must take into account all relevant factors that it would be reasonable to consider, not just those that they think are important. They must not act or make a decision based on what they would want to do if they were the person who lacked capacity.

Capacity

return to Policy Statement

“A person’s capacity (or lack of capacity) refers specifically to their mental capacity to make a particular decision at the time it needs to be made. Anyone assessing someone’s capacity to make a decision for themselves should use the two-stage test of capacity. • Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn’t matter whether the impairment or disturbance is temporary or permanent.) • If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made? They are unable to make a decision for themselves if they cannot do any one of the following four things:

• Understand information given to them relevant to the decision.

• Retain that information long enough to be able to make the decision.

• Use or weigh up the information available to make the decision.

• Communicate their decision.”

from MCA Code of Practice

Care/Service Plan

return to Policy Statement

This phrase is used to refer to both the Care Plan completed by the Assessor based on the Summary of Assessed Needs and to the Care/Service Plan prepared by the Care Coordinator / Line Manager based on the F15a, Service Plan for Home Support, service procurement document, and other assessment paperwork supplied by the Assessor – this is the Plan which is kept in the SU’s home. Occasionally these plans are referred to separately as the Care Plan and the Service Plan.

Consent The free agreement to a course of action, verbally or in writing, formally or informally, having taken into account and understanding the risks, consequences, benefits and purpose of that action.

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Container Shall mean the packaging of the medication supplied by the Pharmacist. For example glass or plastic bottle, foil strip or blister packaging, tube containing ointment or cream for external application. Includes a multi-compartment compliance aid ( MCA) or other compliance aid.

Decision Maker

return to Policy Statement

Section 5.8 of the Mental Capacity Act explains the ‘decision maker’ as follows: - “Under the Act, many different people may be required to make decisions or act on behalf of someone who lacks capacity to make decisions for themselves. The person making the decision is referred to throughout the Code as the ‘decision-maker’, and it is the decision-maker’s responsibility to work out what would be in the best interests of the person who lacks capacity. For most day-to-day actions or decisions, the decision-

maker will be the carer most directly involved with the person at the time.

Where the decision involves the provision of medical treatment, the doctor or other member of healthcare staff responsible for carrying out the particular treatment or procedure is the decision-maker.

Where nursing or paid care is provided, the nurse or paid carer will be the decision-maker.

If a Lasting Power of Attorney (or Enduring Power of Attorney) has been made and registered, or a deputy has been appointed under a court order, the attorney or deputy will be the decision-maker, for decisions within the scope of their authority.

Deputy The court will appoint a deputy to manage a person’s property and affairs (including financial matters), in similar circumstances to those in which they would have appointed a receiver in the past.

Enduring Power of Attorney (EPA)

See Lasting Power of Attorney (LPA).

SW Shall mean the Service Provider’s employees engaged in delivering home support services to the SUs.

Lasting Power of Attorney (LPA)

“Before the Enduring Powers of Attorney Act 1985, every power of attorney automatically became invalid as soon as the donor lacked the capacity to make their own decision. But that Act introduced the Enduring Power of Attorney (EPA). An EPA allows an attorney to make decisions about property and financial affairs even if the donor lacks capacity to manage their own affairs.

The Mental Capacity Act replaces the EPA with the Lasting Power of Attorney (LPA). It also increases the range of different types of decisions that people can authorise others to make on their behalf. As well as property and affairs (including financial matters), LPAs can also cover personal welfare (including healthcare and consent to medical treatment) for people who lack capacity to make such decisions for

22

themselves.” MCA Code of Practice

Medication Administration Record (MAR) chart

The Medication Administration Record(MAR) chart is a schedule for administering medications to a patient for a defined period of time, including time to adminster the medications. It is issued by the Pharmacist to the service user. The SW records the administration of the medication on this chart.

Medication

return to Policy Statement

Shall mean a collective term for medicine(s) to be administered to the SU. The term drug may also be used. Medication could include tablets, capsules, oral liquids and medication applied externally to the skin e.g. ointments creams, lotions.

Compliance Aid A simple device designed to help patients to adhere to taking their medication and maintain independence in this responsibility. May take the form of a multi compartment compliance aid ( MCA) - a generic term for a device that allows medicines to bepackaged in individual compartments either by patients, carers or professionally by pharmacists. A Monitored dosage system (MDS) consists of blister packs prepackaging of all a patients medications. Compliance aids can also take other forms eg a medication reminder charts, “Haleraid”s etc.

Non-prescribed medication

Homely remedies for minor ailments that could be bought over the counter, such as paracetamol for headaches or indigestion remedies.

PRN Latin abbreviation meaning to be taken ‘as required.’

Prompt Shall mean to indicate to the SU that it is time for their medication - this will usually be done verbally but may be physical e.g. by signs - and observing that they have taken the dose.

Service Provider Shall mean the organisation which has been contracted or commissioned to provide home support services to the SU.

Service User

return to Policy Statement

Shall mean the individual assessed by the Assessor to receive home support services and assistance with their medication, referred to by others as the client or patient.

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Appendix 2

MEDICATION CHECKLIST FOR SWS

i) You must NEVER involve yourself with SU’s medication unless you have been asked to do so by your manager and the SU has given authorisation. If the SU is unable to give authorisation then the Assessor will arrange for a ‘best interests’ decision to be made and this will be noted in the Care/Service Plan

ii) You must not fill Monitored Dose System cassettes, or put out medicines in advance in egg cups, saucers etc.

iii) You must always administer medication in line with the correct procedure:a) The MAR Chart and the Service Plan will be set up and kept in the

SU's home and should be examined on each occasion for any changes in medication;

b) Check the MAR chart and the SU’s Log/Communication Sheet to ensure that the medication has not already been administered

c) Select the medication required

d) Check the name of the SU, name and dose of the drug on the label with the description on the

e) Administer the medication

f) Record the administration of medication by entering your initials in the correct date and time box on the MAR Chart (or record in the SU’s Log/Communication Sheet if appropriate.)

g) Record on the MAR chart if medication is not taken, indicating the reason using the appropriate code on the MAR Chart

iv)Under no circumstances should staff alter the labels on medication.

v)Medication should not be handled. Tablets and capsules should be shaken or tapped onto a spoon to prevent handling. Liquid medication should be measured using a 5ml medicine spoon or graduated medicine measure showing specific measurements to ensure the correct dosage is given.

vi)The use of an oral syringe to measure and administer a dose of liquid may be advisable if a SU has difficulty taking a liquid medicine from a spoon or medicine measure. Oral syringes are available from the Pharmacist on request (see paragraph 6.6).

vii) SWs are not authorised to assist with the administration of certain types of medication (see paragraph 4.4).

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Appendix 3

DISPOSAL OF MEDICATION NO LONGER REQUIRED

i) Occasionally it may be necessary to dispose of a SU’s medication, for example if the medication has expired or if the SU's doctor has said that it is no longer required. When this is the case, and there is no one else able to do this, the SW must seek authority from their line manager to return medicines to the Pharmacist. (Approval for the time allocation may also be required).

ii) Medication no longer required must be returned to the Pharmacist. The SW should INDICATE WHICH MEDICATION LISTED ON THE MAR CHART IS BEING RETURNED, sign it and get the Pharmacist to countersign the MAR chart.

iii) When it is necessary to dispose of a single dose of medication, for example if a single tablet is spoilt (e.g. dropped on the floor), or the SU has refused to take their medication after it has been removed from the container, it is acceptable for a single dose of medication to be flushed down the toilet. Details of medication destroyed in the SU’s home must be recorded on the SU’s Log/Communication Sheet (see paragraph7.4).

iv) The SW should refer any queries regarding the disposal of medication to their line manager, or the SU's Pharmacist.

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Appendix 4

SPECIAL DOSAGE INSTRUCTIONS

1. Variable Dose Medication

SWs should refer to their Line Managers if they have any queries or concerns about variable dose medication for any individual SU.

Medicines may be prescribed in a variable dose regimen, most commonly in the following categories:

i) Where the dosage schedule is described at the time the prescriber writes the prescription

For example:

Paracetamol 500mg tablets – one or two tablets to be taken up to three or four times a day if required for pain.

The SW has to decide if it is appropriate to administer the medication (i.e. is the SU complaining of pain, has the SU received treatment in the previous six to eight hours) and whether one tablet or two tablets should be taken. This should be the SU’s decision, but if the SU has been taking the maximum dose for several doses it might suggest that the prescriber needs to consider an alternative drug for pain management. Where the SU does not have the capacity to decide what number of tablets they should take the SW should follow the instructions of the prescriber, who should have stated the recommended and maximum dose of an ‘as required’ medication. If there is any doubt about the suitability of the medication the SW should not assist and should refer to their Line Manager who may contact the SU’s G.P. on the SU’s behalf.

The SW must record on the MAR chart dose of the medicine in addition to entering their initials in the recording panel, and enter the exact time.

For example:Time/date 12/01/02Breakfast 2 tabs BJ

08.00DinnerTea 1 tab IRJ

17.00Supper

ii) Where the prescriber does not have information to indicate the required dose when ordering the drug.

iii) Where the dosage is dependent on additional information being provided during treatment, for example as with Warfarin, see below.

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2. Sliding Scale Dosage Schedules

Sliding scale dosage schedules are employed to either

(i) Incrementally reduce the dose of a drug over a defined period of time in order to achieve a complete withdrawal of the medication or to reach a maintenance dose.

(ii) Incrementally increase the dose of a drug to achieve a satisfactory maintenance dose of the medication.

Information on the dosage scheduling may be shown on the label, or frequently on a separate chart supplied by the hospital, GP practice or community pharmacy. In some cases the separate chart may include provision for recording doses administered. Where separate details of the dose schedule are provided, the label may indicate this e.g. Medicine to be taken as directed in accompanying chart.

SWs must always refer to any accompanying information or charts.

Where an accompanying chart includes space to record doses administered then this should be completed by the SW in addition to completing the MAR chart. The dose of drug administered should be recorded in addition to the SWs initials.

3. Warfarin tablets

The SU’s required dose will be dependent upon results of regular routine lab tests. Individual dosages can vary from as little as 1 mg/day to more than 10mg/day.

The SU should have a separate record card (often a yellow book) onto which the dosage is entered by the laboratory service, anticoagulant service or GP following a routine blood test. Alternatively, details of the appropriate dosage will be posted to the SU's home or GP surgery.

The SU will usually have a supply of Warfarin in several strengths (usually 1mg, brown, and 3mg, blue, tablets), which will enable the correct dose to be selected.

The SW must ask the SU for information on the current dosage if this is known and which should be confirmed with the written information supplied by the Anticoagulation Clinic (Yellow book or printed letter).This dose should be administered and recorded on the MAR chart along with their initials. Where the SU is unable to supply that information reliable arrangements for the communication of that information should be established by the Care Coordinator /Line Manager and be clearly understood by the SW.

Warfarin increases an individual’s likelihood of bleeding. If a SU taking Warfarin develops any bruising or bleeding their GP should be notified or the 111 service contacted before administering a dose of Warfarin.

The National Patient Safety Agency (NPSA) website http://www.nrls.npsa.nhs.uk/resources/?entryid45=59814&q=0%c2%acwarfarin%c2%ac should be consulted for the latest guidance in this matter.

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Appendix 5

Medication Administration Authorisation

I give authorisation for Sheffield Neighbourhoods and Community Care Directorate to arrange for a support worker (SW) to assist with the administration of medication as prescribed by my doctor (dentist, nurse prescriber, or other authorised prescriber).

I also give authorisation for the support worker to administer non-prescribed medication in accordance with the agreed non-prescribed list. Any changes or additions will have to be checked and authorised in the same way.

I understand that: The support worker cannot administer anything which is not already

on the (MAR) Chart The support worker will not assist me with any medication that is

above prescribed or recommended dosageAnyone who assists me with my medication to record full details of any assistance and medication given - Prescribed medication must be recorded on the (MAR) Chart and non-prescribed medication on the Home Support Log or Communication Sheet

Medication may only be administered from a Multi-compartment Compliance Aid for a short period of time due to acute illness

Social Services may need to ask me and maybe other people about what other medication I am taking

I agree that: I will make available to the support worker the MAR chart and

communication records relating to my medication and care. I authorise my support worker and/or their managers to liaise with

my GP, Pharmacist or any other prescriber about my medication and any arising issues

I will give full information to my support worker about my medication including what I have and have not taken.

I will give full cooperation in the implementation of this agreement and issues concerning my medication including the storage and disposal of medication that is no longer prescribed, out of date or is spoilt and cannot be used safely.

Please sign on the next pagePage 1 of 2

28

Service User

Signature: Date:

Print name:

CareFirst No:

Address of Service User:

Telephone No:

Assessor

Signature:

Print:

Telephone Number: Fax Number:

GP

Name Surgery

Telephone Number: Fax Number

Service Provider contracted to provide service

Contact person:

Telephone Number: Fax Number:

Pharmacy nominated by Service User:

Telephone No: Fax No:

How prescription will be supplied to the Pharmacist :

Community Pharmacy has agreed* to supply MAR charts: Yes No

NB: Copies of this form must be: kept in Service User’s file sent to the Service User sent to the Service Provider

faxed to the Community Pharmacyfaxed to the GP

29

*The Pharmacist will supply MAR charts only on receipt of this Authorisation Formpage 2 of 2

Appendix 6 Example of (MAR) chart

30

Appendix 7

Non-Prescribed MedicationCopy and keep with all copies of the Service User’s Authorisation Form

To be completed by Assessor or SW’s Line Manager

The Good Practice Guide permits SWs to assist Service Users with the administration of non-prescribed medication providing that advice has been taken from the Service User’s Doctor or Pharmacist checking that it is suitable and does not affect any medication the Service User is already taking. Where the person lacks capacity, information should be sought from their family, carer, LPA, advocate or whoever has the required information.The Service User should be asked the following questions in relation to non-prescribed medication:

Do you take any medicines that are not prescribed for you by your doctor? (or dentist/nurse prescriber/pharmacist prescriber) Yes No

If Yes: Do you take non-prescribed medicines Regularly? Yes No

Occasionally? Yes No What non–prescribed medicines do you take regularly, (e.g. vitamins, herbal products)

Medicine Recommended dose

Dosage interval

Maximum dose in 24 hours

AuthorisedYes / No

Authorised by GP or Pharm

What non-prescribed medicines do you take occasionally (e.g. Paracetamol for pain relief, dioralyte for diarrhoea, E45 Cream / Aqueous Cream for dry / itchy skin)?

Medicine Recommended dose

Dosage interval

Maximum dose in 24 hours

AuthorisedYes / No

Authorised by GP or Pharm

N.B: Indicate against each medicine listed if the continued use of the non-prescribed medicine has been approved by the Service User’s GP or Pharmacist. The doctor should be requested to prescribe all medicines taken on a regular basis (if available on an NHS prescription)

Name of Assessor/Line Manager ………………………………………………………

Name of GP ...……………………………………………………………….……………

Name of Pharmacist ……………………………………………Date …………………….

If you have concerns about any aspect of the Service User’s medication you speak first to the Pharmacist.

Any changes should be noted on the continuation sheet by Assessor or Line Manager

Page 1 of 2

Appendix 7 – Continuation Sheet

Reviews / Amendments of Non Prescribed Medication

Details Entered By Signature Date

Page 2of 2

Appendix 8

Comments for the Review of the Medication Policy No Policy or guidance will cover every eventuality. Line Managers will record comments regarding this Policy on this sheet to

enable them to contribute to the next review. In the case of guidance being required urgently, this should be given

immediately and the issue noted. Where an Assessor, Care Coordinator or Line Manager requires clarification

of the Policy they should use this form to get feedback from the Medication Policy Group

Date Issue/problem Action taken, if any Name Base

NBPlease send this form to the Strategic Commissioning and Partnerships Section, Neighbourhoods and Community Care Directorate, Redvers House, Union Street, Sheffield, S1 2JQ or email it to contractscommissioningenquiries@sheffield.gov.uk

33

This leaflet is available in large print, Braille, audiotape and electronically. It’s also available in Arabic, Bengali, Chinese, Somali and Urdu. To ask for copies please telephone (0114) 273 4969.

Appendix 9 (Page 1 of 2)

Taking medication

Information for service users, relatives, friends and other carers where a

SW is helping with medication

Version 2 / R. McSweeney / Aug 06

Warqadan waxaa lagu heli karaa Soomaali, qoraal ama cajlad, haddii aad doonayso

soo wac taleefanka 273 4969.

Produced: April 2008 Next edition: April 2009 NCC1120

Neighbourhoods & Community Care. Quality & Communications. Tel: 273 4969. www.sheffield.gov.uk

Information for service users

Your SW can help you take your medicines when this is agreed as part of your care/service plan. Your care/service plan should also record any help with medicines you receive from any other person such as a relative, friend or other carer.

You’ll need to tell your Assessor the name and address of your Pharmacist (Chemist) so that we can make sure your Pharmacist provides you with a Medication Record Card (MAR)

It’s best if you get all your prescriptions and non-prescription medicines from the same Pharmacist. Non-prescription medicines include things like herbal remedies or medicines you can buy over the counter, like cough syrup.

If a relative, friend or other carer gives you any medicines they should record it on the Medication Record Card. If they give you a non-prescribed medicine, which isn’t on the card, they should record it on the Home Support Log or Communication Sheet. They may give non-prescribed medication providing it has been agreed by your G.P. and/or Pharmacist, and it is recorded on the Non-Prescribed Medication Form.

If you’ve any concerns about your medication, or any side effects, please contact your Doctor or Pharmacist.

If you want to find out more, talk to your SW or contact the Adult Services Access Team on (0114) 273 4908 and ask for the telephone number of your Assessor.

Version 2 / R. McSweeney / Aug 06

Appendix 9 (Page 2 of 2)

Information for relatives, friend or other carers

If you’re helping to give the service user any prescribed or non-prescribed medicines you must make sure that the Assessor and the SW know this. This is so that the medication can be added to the service user’s care plan, service plan and MAR chart. Non-prescription medicines include things like herbal remedies or medicines you can buy over the counter, like cough syrup.

If you want to give the service user any prescribed or non-prescribed medicines that aren’t in the care/service plan, you must check with the Doctor or Pharmacist first. Prescribed medication must be recorded on the (MAR) Chart and non-prescribed medication on the Home Support Log or Communication Sheet. The Pharmacist will not issue a MAR chart unless supplied with an Authorisation form by the Assessor. If a Service User needs assistance with their medication they

should not normally need a Nomad as this is only for people who can be responsible for their own medication.

You must make sure that you fill in the MAR chart every time you give the service user any medicine. This is to make sure you don’t give a double dose, or miss a dose. If you’ve any concerns about the medication, or any side effects the service user is having, please contact the service user’s Doctor or Pharmacist.

Where the Service User lacks the mental capacity to make decisions about their medication we may have to make decisions in their best interests and would consult relatives and friends where possible. If you want to find out more, talk to the SW or contact the Adult Services Access Team on (0114) 273 4908 and ask for the telephone number of the service user’s Assessor.

Service Plan for Home Support Appendix 10 page 1

First Name Address:

Post code:Tel Number:

Team

Family NameCareFirst Number

Date of Birth Gender

M F

GP

Tel.

Hospital Discharge?

Yes No

Ethnic Origin

Is the Service User able to sign contact sheet? Yes No Is there an informal carer who can sign contact sheet? Yes No

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F15a

Contact Person for service user

Tel. Number:

Assessor / Social Worker

Tel. Number:

Other people living with User

Medication: how the person manages medication (tick assessed need. Do not list drugs) No Assistance Required Assistance Required at level a) c) (See below & Medication Policy Good Practice Guide section 6)

Use this space for details about equipment/adaptations and how the person uses them:

Medication Assistance level a) prompt and observe Service User taking medication c) Removing medication from container and directly administering

Provider Task Notes M T W T F S SVisit start time State if Required

Number of SWs

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Service Plan For Home Support Appendix 10 page 2

First Name Family Name CareFirst Number

Provider Task Notes M T W T F S SVisit start

timeState if

required

Number of SWs

Desired Outcome: Continuation

Sheet N

umber

Provider Number 1: Start date: Finish date:Provider Number 2: Start date: Finish date:

F15a

Appendix 12

BODY CHART