Adults, Health and Community Wellbeing
Medication and Related Tasks Standards,
Guidance and Workbook
Adult Services
Fourth Edition: June 2011
Lead Director:
Approved by:
Original guidance approved:
Last review completed in:
Next review due:
Liz Chidgey
Adults, Health and Community Wellbeing
Management Team
April 2010
June 2012
Document Control Sheet
To provide those involved in medication and related tasks
the
 Standards that Essex County Council expects to be met;
 Guidance on how to meet the Standards
Purpose of Document:
To provide worksheets and practical assessments as a
means of assessing the competence of:
 Staff involved in commissioning medication and related
tasks;
 Staff directly involved in prompting, assisting or
administering medication and related tasks
Target Audience:
All Adult Social Care Operational Staff, Providers and Care
Workers, Service Users and Personal Assistants
Action required:
Medication and Related Tasks Guidance, Third edition April
2010
This supersedes:
Medication and Related Tasks Workbook - Adult Services.
Third edition April 2010
This should be read
alongside:
Medication Prompting -A Home Safety Service Guide
Guidance Lead / Author: Tracey Field
Project Team:
Standards and Service Improvement Team
Contents
1
Introduction.............................................................................................................. 5
2
Glossary .................................................................................................................. 9
3
STANDARDS ........................................................................................................ 13
PART ONE ................................................................................................................... 15
Level 1 Training ............................................................................................................ 15
Induction and Commissioning....................................................................................... 15
4
Commissioning...................................................................................................... 17
5
Capacity, Consent, Covert Administration and Choice.......................................... 21
6
Levels of Support – Prompt, Assist or Administer ................................................. 25
7
Levels of Training .................................................................................................. 27
8
Risk Assessment................................................................................................... 28
9
The Support Plan and Support Plan Summary...................................................... 30
10 Roles and Responsibilities .................................................................................... 31
11 Core and Specialist Competencies and Tasks a Care Worker/ Personal Assistant
must not do ................................................................................................................... 36
12 A Brief explanation of Medication .......................................................................... 39
PART TWO................................................................................................................... 43
Level 2 Training ............................................................................................................ 43
Core Competencies ...................................................................................................... 43
13 Recording Procedures........................................................................................... 45
14 The Medication Toolkit .......................................................................................... 52
15 Possible Side Effects............................................................................................. 57
16 Errors with Medication and Related Tasks ............................................................ 59
17 Storage of Medication ........................................................................................... 61
18 Transfer of Medication........................................................................................... 64
19 Disposal of Medication .......................................................................................... 66
20 Homely Remedies ................................................................................................. 68
21 Drug Formulation and ways of taking it ................................................................. 71
22 Strengths of Preparation ....................................................................................... 82
23 Label Interpretation ............................................................................................... 83
24 Related tasks - Catheter Care ............................................................................... 96
25 Meeting needs not covered in the guidelines ...................................................... 100
26 Legislation and Guidance .................................................................................... 100
27 Useful Contacts ................................................................................................... 102
Page 3 of 142
28 Appendices.......................................................................................................... 103
29 Acknowledgements ............................................................................................. 104
PART THREE ............................................................................................................. 105
Competency Assessment Worksheets ....................................................................... 105
Level 1 - Worksheet 1: Commissioning Services and Commissioned Providers ........ 107
Level 1 - Worksheet 2: Capacity, Consent, Covert Administration and Choice........... 110
Level 1 - Worksheet 3: Prompting and Assisting ........................................................ 112
Level 1 - Worksheet 4: Administration ........................................................................ 113
Level 1 - Worksheet 5: Levels of Training................................................................... 114
Level 1 - Worksheet 6: Risk Assessment.................................................................... 115
Level 1 - Worksheet 7: The Support Plan and Support Plan Summary ...................... 116
Level 1 - Worksheet 8: Roles and Responsibilities ..................................................... 117
Level 1 - Worksheet 9: Core and Specialist Competencies and Tasks a Care
Worker/Personal Assistant must not do ...................................................................... 118
Level 1 - Worksheet 10: A Brief Explanation of Medication ........................................ 119
Level 2 - Worksheet 11: Recording Procedures ......................................................... 120
Level 2 - Worksheet 12: The Medication Toolkit ......................................................... 121
Level 2 - Worksheet 13: Possible Side Effects ........................................................... 122
Level 2 - Worksheet 14: Errors with Medication.......................................................... 123
Level 2 - Worksheet 15: Storage of Medication .......................................................... 124
Level 2 - Worksheet 16: Refrigeration of Medication .................................................. 126
Level 2 Worksheet 17: Refrigeration of Medication-Practical Assessment ................. 127
Level 2 - Worksheet 18: Transfer of Medication ......................................................... 128
Level 2 - Worksheet 19: Disposal of Medication and Expiry Dates............................. 129
Level 2 - Worksheet 20: Expiry Dates – Practical Assessment................................... 130
Level 2 - Worksheet 21: Homely Remedies................................................................ 131
Level 2 - Worksheet 22: Oral and Rectal Preparations and Injections........................ 132
Level 2 - Worksheet 23: Topical Applications ............................................................. 133
Level 2 - Worksheet 24: Eye preparations – Practical Assessment............................ 134
Level 2 - Worksheet 25: Inhalers ................................................................................ 135
Level 2 - Worksheet 26: Strengths of Preparation ...................................................... 136
Level 2 - Worksheet 27: Requirements of Labels ....................................................... 137
Level 2 - Worksheet 28: Requirements of Labels - Label Interpretation ..................... 138
Level 2 - Worksheet 29: Catheter Care....................................................................... 139
Level 2 - Worksheet 30: Care of Catheters – Practical Assessment........................... 140
Administration of medication: Competence Assessment..................................... 141
Page 4 of 142
1
Introduction
Essex County Council’s delivery vehicle is Self Directed Support via a Personal Budget
which can be managed by the Service User or managed on their behalf by Essex County
Council. The Service User will need to demonstrate how the estimated personal budget
will be used to achieve their eligible desired outcomes, this includes management of
medication.
For many Service Users taking medication and being assisted with related tasks is an
everyday but essential aspect of their life. Regardless of how the support is arranged, or
who is providing it, the Service User can reasonably expect that the people who support
them understand good practice, follow guidance and have demonstrated an ability to meet
required standards to ensure their support is compliant, safe, appropriate and that they will
have their medication and related tasks at the times they need them. This includes
support commissioned by Essex County Council or a Service User (The Commissioners)
and provided by an Agency Care Worker or a Personal Assistant.
Each Service User must be enabled to take their own medication as fully as their
understanding and physical abilities allow, therefore the Service User has the right to
administer their own medication without assistance from a Care Worker/Personal
Assistant. The assessment should include the Service User’s ability to manage
medication and related tasks, and this should be clarified and detailed in the Support Plan
and/or Support Plan Summary and form part of the ongoing risk assessment.
Employers have a responsibility to ensure Care Workers/Personal Assistants have an
appropriate level of knowledge and ability to undertake the work safely and competently.
Care Workers will only be able to prompt, assist or administer medication and carry out
related tasks once they have completed training and are assessed as competent. A record
must be kept of training and competence.
Essex County Council has developed this Medication and Related Tasks Standards,
Guidance and Workbook, an Assessors Answers book, and an online training package to
achieve these outcomes. The documents and online training are also available to Provider
Agencies via the Essex County Council Website for the documents and the Essex County
Council Learning Pool http://www.learningpool.com/essex/ website for the online training,
(use the link on the home page).
This Medication and Related Tasks Standards, Guidance and Workbook provides
everyone involved in commissioning and providing support with information on;

protecting Service Users against the risks associated with the unsafe management
use and of medication, by ensuring appropriate arrangements are in place for
obtaining, recording, storing, safe keeping, handling, using, safe administration and
disposal of medication

how the decisions, processes and actions will be carried out

safeguarding the interests of Service Users and all staff by setting out good practice
and the responsibilities of all concerned

meeting legal requirements and standards prescribed by the Care Quality
Commission or any successor body.
Page 5 of 142
1.1 Who should use this document?
This document must be followed by all staff directly employed by Essex County Council
and may also be used by Provider Agencies, Care Workers (including volunteers), Service
Users and Personal Assistants.
The document has a set of Worksheets to test an individual’s understanding of the
information and to form a basis for assessment of competency. There are also practical
assessments for Managers/Employers to observe Care Workers/Personal Assistants
prompting, assisting and administering medication or related tasks. These assessments
and observations should be recorded for service monitoring and audit purposes.
Commissioning staff must complete Level 1 Induction and Commissioning Training and
the Standards must be met and evidenced by completing the Worksheets.
Care Workers are advised to complete Level 1 Induction and Commissioning Training and
Level 2 Core Competencies Training. The Standards must be met and evidenced by
completing the Worksheets and practical assessments. Where a Care Worker is required
to carry out Specialist Competencies, Level 3 Specialist Competencies training should also
be completed and the Standards must be met and evidenced by completing the
Worksheets and practical assessments.
Staff employed by independent providers contracted with Essex County Council, including
volunteers, must meet the requirements of their own regulatory body i.e. Care Quality
Commission and the Standards set out in this Guidance. Providers can also access the
Essex County Council Medication and Related Tasks Standards and Guidance Workbook
and online training to meet these requirements.
It is recommended that Service Users and the Personal Assistants employed directly by
them also use this Medication and Related Tasks Standards and Guidance Workbook and
online training to ensure good practice is maintained and the staff they employ meet the
Standards set out in the document.
Page 6 of 142
1.2 Agreement to undertake Competency Assessment
Name
Job title
Workplace
Employer
Start date
Levels to be
undertaken
I agree to undertake the work required to achieve competency in Medication and Related
Tasks at the levels indicated above.
Signature of candidate .........................................................................................................
I agree to act as the assessor for the above candidate.
Signature of assessor ..........................................................................................................
Page 7 of 142
Page 8 of 142
2
Glossary
Term
Meaning
Administer
To select, measure and give medication to a Service User as
specified in the Support Plan and/or Support Plan Summary. Care
Workers/Personal Assistants will only administer in specially agreed
circumstances where assessment of the Service User under the
Mental Capacity Act has determined that the Service User does not
have the capacity to make decisions regarding medication for
themselves and cannot self-medicate, instruct others or manage
their medication, and cannot be supported by assisting or prompting
Approved
person
As required
medicine
The person with responsibility for assessing competency in relation
to medication and related tasks
Medicine to be given when required for a defined problem e.g. pain
or constipation. Care Workers/Personal Assistants cannot
administer this medication but are able to assist a Service User who
has capacity to decide to take the medication
Assist
To physically help a Service User who has mental capacity and
ability to instruct a Care Worker/Personal Assistant on what they
require, for example, opening a medication container or removing
tablets from a blister pack
Carer
An individual who provides care for someone on an informal basis
and is not paid to do so, usually a relative, friend or neighbour
Professional responsible for the Support Plan Summary and Risk
Assessment
The national body that regulates social care provision for adults,
including residential care homes and domiciliary support services.
CQC has a legal duty to inspect provisions and services to ensure
that standards are upheld
Care Manager
Care Quality
Commission
(CQC)
Care setting
The place where a Service User receives support
Care Worker
A person paid to provide support to a Service User as detailed in
the Support Plan Summary provided by the Commissioner
The person who arranges for support to be put in place, for Essex
County this is the Practitioner or Facilitator completing the
assessment or review. For personal assistants being employed by
the Service User using their personal budget, the Service User is
the Commissioner
Commissioner
Commissioning
The process of making arrangements for the support to be put in
place, including instructing, informing, purchasing or contracting
providers and Care Workers/Personal Assistants to deliver the
support. The Commissioner is responsible for assessing, coordinating and reviewing the Support Plan and/or Support Plan
Summary and completing Risk Assessments
Commissioning
Assessor
The Practitioner or Facilitator completing the assessment or review
and commissioning the support for the Service User
Page 9 of 142
Commissioning
Document
Competent
For support services managed by Essex County Council this is the
Information to Service Provider contract document
Assessed as able to do a particular task
Consent
Agreement from the Service User for medication to be administered
or assisted with or for a task to be carried out before it takes place.
It is the responsibility of the Practitioner/Facilitator to obtain
agreement from the Service User at the assessment stage unless
the Service User lacks capacity, in which case the Mental Capacity
Assessment should be considered
Continuing
Personal
Development
Daily
Communication
Record Sheet
Facilitator
A lifelong learning approach to support career planning, through
managing and getting the most from experiences and achievements
General Sales
List (GSL)
Medication sold over the counter in supermarkets, corner shops
and garages without the supervision of a Pharmacist. For example
small quantities of Paracetamol, vitamins and cough medicine
General
Practitioner (GP)
Healthcare
professional
Health team
A doctor based in the community
Homely
remedies
Information to
Service Provider
(ISP)
Inspection
Medication
Medication
Review
A form used to record the details of Prompting and Assisting with
medication and related tasks, and any other information regarding
the medication or related tasks
An unqualified social worker, occupational therapist or nurse who
carries out the social care assessment, the risk assessment and
together with the Service User develops the Support Plan and/or
Support Plan Summary, including detailing the medication and
related task requirements
Qualified medical and health related professionals, includes GP,
nurse, Pharmacist and NHS Direct
Health professionals who are responsible for the Service User’s
health care. This may include the primary care team, the Primary
Care Trust (PCT) and Strategic Health Authority
Treatments for minor ailments that do not need a prescription from
a doctor and can be bought over the counter such as paracetamol
for a headache, also includes herbal remedies. Often referred to as
‘over the counter’ medication
This is the commissioning contract made on behalf of the Service
User between the Commissioner and the Service Provider. It
provides confirmation of the requested services, outcome measures
and what will be looked at in the review. It authorises the Service
Provider to commence the service
An assessment of the standards being met, Adult Services
inspections are carried out by CQC
All medicinal products – tablets, capsules, ointments, oral syrups
and mixtures, drops, inhalers, creams and injections
A structured, critical examination of a patient’s medication, carried
out by a GP or Pharmacist at least once in every 15 months with
the objective of reaching agreement about treatment, optimising the
impact of medication, minimising the number of medication-related
problems and reducing waste
Page 10 of 142
Medicine
Administration
Record (MAR)
A form used to record the administration of medication and any
other information regarding the medication or related tasks. Usually
designed to show what was given, the dose given, the time given
and the identity of the person who gave it
Medicine
Management
Mental Capacity
Act
All aspects of managing medication including responsibility for
ordering, collection, storage, giving and disposal
The Mental Capacity Act 2005, covering England and Wales,
provides a statutory framework for people who lack capacity to
make decisions for themselves, or who have capacity and want to
make preparations for a time when they may lack capacity in the
future. It sets out who can take decisions, in which situations, and
how they should go about this
Monitored
Dosage Systems
(MDS)
My performance
A convenient form of packing medication by putting them in
separate blisters or compartments for each time of day. Safe
practice is not guaranteed by use of a MDS
An ongoing process between the supervisor and employee aimed
at improving overall performance
Includes district nurses, community nurses, paediatric nurses,
community mental health nurses (CMHN), other specialist nurses,
health visitors and school nurses
An injection devise for use with insulin cartridges or a disposable
injection device prefilled with medication
“Chemist” who advises on and dispenses medication
Nurses working
in the
community
Pen (medical)
Pharmacist
Policy
Practitioner
A high level document which sets out the principles or proposed
course of action designed to influence and determine decisions,
processes and actions
A qualified social worker, occupational therapist or nurse who
carries out social care assessments and risk assessments and
together with a Service User develops the Support Plan and/or
Support Plan Summary, including detailing the medication and
related tasks requirements
Prescription
Only Medicine
(POM)
Medication that can only be obtained from a Pharmacy in the
presence of a Pharmacist with a prescription written and signed by
a registered medical practitioner or dispensing doctor or hospital
doctor, or for some drugs, a dentist or nurse prescriber (not general
nurses)
Primary Care
Trust (PCT)
Provider
Primary Care Trust, there are currently 5 PCTs within Essex,
covering, Mid, North, South East, South West and West
The agency, residential care home or personal assistant that will be
providing support to a Service User
To remind the Service User who has mental capacity to make their
own decisions abut taking their medication, to take their medication
at a particular time or with food etc
Systematically check the risks and hazards for Service Users and
Staff. Agree and implement a plan to safely administer, assist or
prompt medication or to assist with related tasks
Prompt
Risk assessment
Page 11 of 142
Self Directed
Support
Service
Placement Team
Service User
Self Directed Support (SDS) allows Service Users to make
decisions about the support they require, this can either be
managed by themselves or by a 3rd party, or alternatively a
'Managed’ service is when Essex County Council manages the
support on behalf of the Service User
An Essex County Council Team that completes all sourcing,
purchasing and placing of Social Care Support packages through
pre-contracted and spot suppliers
A person who receives a service through Adult Social Care
Support Plan
Summary
People directly employed by Essex County Council or people
employed by independent providers contracted with Essex County
Council or people directly employed by a Service User
The Support Plan is completed by the Service User and their family
or friends in any manner they wish to use, it brings together the
Service Users aspirations, goals and desired outcomes and shows
how the Service User would like their needs to be met
A tool to record all essential data in a consistent manner regarding
the support required, how the eligible social care needs are going to
be supported, solutions agreed to manage identified risks, the costs
involved, who will be managing the money, the contingency plans
and the review requirements to assess its effectiveness. The
Support Plan Summary forms our legal 'care plan’ with the Service
User and must be completed if the Service User is having a
Personal Budget, but is optional if the Service User is having their
support managed by Essex County Council
Workbook
(Medication)
Yellow Book
A training aid to assist the understanding and competence of those
involved in medication and related tasks
Used to record details of taking Warfarin
Yellow Card
Used to record medication side effects and adverse reactions
Staff
Support Plan
Page 12 of 142
3
STANDARDS
The following Standards must be met by staff directly employed by Essex County
Council and staff employed by independent providers contracted with Essex County
Council, including volunteers. It is recommended that Service Users who employ
Personal Assistants (staff) directly stipulate that their staff also meet the Standards.
Standard 1. The Commissioner must complete a Commissioning Document to inform the
Provider of all essential aspects of the medication support required, and to
give the widest range of information possible including the level of support
and details of the medication management.
Standard 2. Providers commissioned by Essex County Council to provide support must
achieve ‘Care Quality Commission Outcome 9 - Medicines Management’
and adhere to the Standards laid down in this document. It is recommended
that Service User’s using their personal budget to commission individuals to
provide support also require these Standards to be met.
Standard 3. Assessment of the Service User’s capacity to give their consent is vital. If
the Service User’s capacity is being challenged, an assessment must take
place under the Mental Capacity Act. People with capacity must give
consent each time medication is given. The Support Plan/Support Plan
Summary should clearly state action to be taken if circumstances change,
and any specific preferences that have been identified relating to equality
and diversity.
Standard 4. In order to carry out their duties Care Workers/Personal Assistants must
only Prompt, Assist or Administer in accordance with the details specified by
the Commissioner in the Commissioning Document.
Standard 5. Essex County Council employed care staff can only provide support to a
Service User after completion of the Medication Standards, Guidance and
Workbook or online training and being assessed as competent. Agency
staff must meet the requirements of the ‘Care Quality Commission Outcome
9 – Medicines Management’.
Standard 6. A structured risk assessment must be conducted as part of the assessment
or review completed by the Practitioner/Facilitator for the Service User, their
environment and staff involved. The risk assessment will examine the
actions and resources required to safely and competently manage
medication and related tasks, and will highlight the risks and hazards and
how they may be managed.
Standard 7. A detailed plan will be developed for each Service User which will specify
the approach for supporting the individual, this will include support around
medication and related tasks.
Standard 8. The roles and responsibilities of key people involved in the Service User’s
medication support should be documented in the Support Plan/Support Plan
Summary and the Information to Service Provider.
Page 13 of 142
Standard 9. Prior to completing any Core or Specialist Competencies, all Care
Workers/Personal Assistants must be assessed as competent and this
should be evidenced in their personal development record.
Standard 10. All changes to medication must be clearly documented in the Medicines
Administration Record or Daily Communication Sheet.
Standard 11. A clear policy should be in place detailing action to be taken in the event of
errors occurring.
Standard 12. All medication must be stored in a manner consistent with the care setting,
requirements of individual medications and taking account of all relevant
legislation.
Standard 13. Providers must have a clear policy in place detailing the action to be taken
with respect to medication if a Service User is transferred between care
settings or is to be away from their usual place of residence.
Standard 14. A clear policy should be in place detailing the action to be taken if
medication needs to be disposed of.
Standard 15. A clear policy should be in place detailing arrangements around “Homely
Remedies”.
Page 14 of 142
PART ONE
Level 1 Training
Induction and Commissioning
Page 15 of 142
Page 16 of 142
4
Commissioning
Objectives
At the end of this section you will be able to:

Understand the meaning of ‘Commissioning’ with regards to medication

Know who is responsible for commissioning support

Know how support is commissioned

Understand the responsibilities of the Commissioner with regard to medication
Assessment method
1.
Completion of Worksheet 1
Standards and Guidance
4.1
Commissioning Services
STANDARD 1: The Commissioner must complete a Commissioning Document to
inform the Provider of all essential aspects of the medication support required, and
to give the widest range of information possible including the level of support and
details of the medication management.
Commissioning is the process of making arrangements for the support to be put in place,
including instructing, informing, purchasing or contracting providers and Care Workers/
Personal Assistants to deliver the support.
The Commissioner is the person who arranges for support to be put in place, for Essex
County this is the Practitioner or Facilitator completing the assessment or review. For
personal assistants being employed by the Service User using their personal budget, the
Service User is the Commissioner.
For Service Users who have elected to have their support arrangements managed by
Adult Social Care, services can be commissioned within Essex County Council or from an
agency by the Facilitator or Practitioner. This can be done by using an ‘Information to
Service Provider form’ (‘Commissioning Document’) which provides confirmation of the
required support/services, outcome measures, contingency arrangements and what will be
looked at in the review. The document authorises the service provider to commence the
service and is the commissioning contract made on behalf of the Service User between
the Commissioner and the Service Provider.
If the Service User arranges their support by directly employing a personal assistant using
their personal budget, the Service User is the Commissioner. It is recommended that
details of the services required are recorded in a similar way to the ‘Information to Service
Provider’ form.
An example of the “Information to Service Provider” form is included in Section 28
Appendices.
Page 17 of 142
Providers can only provide the medication and related tasks support identified in the
Support Plan/Support Plan Summary, therefore it is essential that all requirements are
identified and clearly documented. Details should reflect all discussions with the Service
User regarding the management of their medication and the level of support required i.e.
Prompt, Assist or Administer – see Section 6.
The following must be comprehensively and clearly recorded in the ‘Information to Service
Provider’ form (Commissioning Document):
 consent from the Service User for assistance with their medication or related task
 identification of the level of support required i.e. Prompt, Assist or Administer.
Subsequent reviews should address any adjustments that may be necessary
 instructions for Care Workers/Personal Assistants on all aspects of the medication
support they are required to undertake including the practice they are to follow for;

who will order the repeat prescription

who will take the prescription to the pharmacy

whether the newly dispensed medication can be delivered by a pharmacy; this is
the preferred method and should be used whenever possible in order to reduce
the risk to Care Workers/Personal Assistants involved from collecting medication

who will collect the dispensed medication from the pharmacy if delivery is not
possible

where the medication will be stored

the time of day the Service User needs to take their current medication as
specified by the GP. However, details of the actual prescribed medication should
not be included as these are likely to change and the commissioning document will
be incorrect.

how the disposal of medication will be dealt with

the contingency plans for unplanned events such as the need for an emergency
prescription which may need to be dispensed by an ‘out of hours’ pharmacy and
who will authorise the Provider or Care Worker/Personal Assistant to undertake
this additional task.
 the role and responsibilities of all staff involved in prompting, assisting or administering
medication and related tasks and clear definition of the responsibilities
 detailed instructions for the Care Worker/Personal Assistant on how to manage
medication that is dependent on the results of a blood test, such as Warfarin or Lithium,
particularly with reference to changes in dosage
 detailed information to Service Placement Team to confirm the support required
 the outcome measures and an outline of how the measures will be assessed in the
review.
Page 18 of 142
4.2
Commissioned Providers
STANDARD 2: Providers commissioned by Essex County Council to provide
support must achieve ‘Care Quality Commission Outcome 9 - Medicines
Management’ and adhere to the Standards laid down in this document. It is
recommended that Service User’s using their personal budget to commission
individuals to provide support also require these Standards to be met.
1. An agency or residential care home should have a pharmaceutical adviser to ensure
there are robust governance processes in place for medication management within the
care home/agency. This advice should be separately obtained and not come from the
supplier of medication to the home/patients to ensure independent appraisal and
monitoring of the pharmacy supply service. In respect of individuals procuring their
own medication management support, advice on medication management can be
obtained from their Community Pharmacist.
2. The Provider commissioned to provide medication support shall have in place as a
minimum, policies and procedures to cover the following:
a) The ordering, use, storage and disposal of the Service Users own medications to
maximise benefit and minimise wastage
b) Medication Reconciliation
c) Self administration of medication by Service Users
d) Administration of medication where commissioned to do so
e) Arrangements to be followed when medication is changed
f) Arrangements for transfer of medication with a Service User on admission to
hospital or other care settings (including use of ‘Green Bags’ used by the
Ambulance Service when transferring a patient)
g) Arrangements for discharge medication and on-going pharmaceutical care when
changing care settings
h) Arrangements for reporting medication incidents
i) Record keeping.
3. All prescriptions must be requested in writing allowing 48 hours notice (or longer if it is
a bank holiday or weekend).
4. Providers must have robust ordering systems in place to avoid requesting urgent
repeat prescriptions due to the Service User running out of medication.
5. Where it is not possible for the GP to indicate the exact dose on the prescription, for
example insulin, and the medication is to be administered, the Provider must ensure
that they are provided with written instructions by the GP. Maximum doses must be
stated for PRN (pro re nata - "as needed") prescriptions.
6. The Provider must ensure that staff are appropriately trained and knowledgeable
regarding Service Users medication and receive annual updates on medication and
medicines management - see later section on training.
7. For Service Users living in a residential care home, the Provider must ensure that
each resident has a documented medication review at least once a year.
Page 19 of 142
8. Where administration of medication is commissioned, the Provider must ensure that
safe systems are in place. Providers should note that where the Disability
Discrimination Act 2005 does not apply, provision of medication in monitored dosage
systems falls outside the current community pharmacy contract and the supplying
pharmacy may charge for this service. Therefore if Provider policy is to use Monitored
Dosage Systems, the Provider will be required to have formal arrangements in place
with the supplying Pharmacist for provision when the Disability Discrimination Act 2005
does not apply.
9. Where a Service User directly employs a Personal Assistant, it is recommended that
the Service User and Personal Assistant agree the policies and procedures to be used
in the medication support.
Page 20 of 142
5
Capacity, Consent, Covert Administration and Choice
Objectives
At the end of this section you will:

Understand what is meant by ‘Capacity’, how a Service User’s capacity is assessed,
and when the Mental Capacity Act (MCA) needs to be used in relation to medication

Understand what is meant by ‘Consent’ and when the Service User’s consent needs
to be obtained

Understand what is meant by ‘Covert Administration’

Understand what is meant by ‘Choice’ and why the Service Users choices should be
respected
Assessment method
1.
Completion of Worksheet 2
Standard and Guidance
STANDARD 3: Assessment of the Service User’s capacity to give their consent is
vital. If the Service User’s capacity is being challenged, an assessment must take
place under the Mental Capacity Act. People with capacity must give consent each
time medication is given. The Support Plan Summary should clearly state action to
be taken if circumstances change, and any specific preferences that have been
identified relating to equality and diversity.
5.1
Capacity
The Mental Capacity Act (2005) provides a statutory framework to empower and protect
vulnerable people who may not be able to make their own decisions.
The key principles of the Act are:

A presumption of capacity, unless proved otherwise;- every adult has the right to
make their own decisions

Individuals have a right to be supported to make decisions e.g. given the right
information in the most accessible way

Individuals have the right to make unwise or eccentric decisions

Best interests – anything done for or on behalf of someone who lacks capacity must
be in their best interests AND

Be the least restrictive intervention.
Mental Capacity Assessment
When a practitioner or facilitator is deciding whether someone has the capacity to make a
decision, it must be recognised this is ‘time and decision specific’. A Service User may be
able to make some decisions but not others, or a Service User may be able to make a
decision on one day and not on the next.
Page 21 of 142
The Practitioner/Facilitator must try all practical methods possible in order to help the
Service User understand the decision that needs to be made. A Service User will have the
capacity to make a decision if they are able to;
1.
2.
3.
4.
understand the information relevant to the decision
retain the information long enough to make a decision
use or assess the information while considering their decision
communicate that decision, when verbal communication is not possible, alternative
forms of communication such as blinking an eye or squeezing a hand are
appropriate.
If the Service User is unable to do any one of the above, they are unable to make the
decision for themselves.
If the medication support a Service User requires is ‘Administration’, and the Service User
lacks capacity to consent to this, they must be formally assessed following the guidelines
and principles of the Mental Capacity Act 2005.
An MCA1 is used to assess capacity to make day to day decisions and is sufficient for
homely remedies and benign medications and should be completed by the Practitioner /
Facilitator. As part of this assessment, relevant people such as family members and
unpaid Carers should be consulted to inform the decision. The details of those consulted,
how the decision was reached and what attempts were made to assist the Service User to
make his or her own decision must be documented in the Service Users Support Plan
Summary.
If there are fluctuations in the Service User’s capacity, the consequences of this should be
considered and a strategy put in place. Similarly, if there is a decision to administer the
medication in the best interests of a Service User who lacks capacity, it should be noted
whether the Service User is likely to be compliant with taking the medication and, if not, a
strategy should be put in place as guided by the clinical team.
For significant decisions, for example if the administration of medication or a related task is
intrusive or may have serious side affects, a MCA2 should be completed by the person
responsible for prescribing the medication.
If a Service User has appointed a ‘personal welfare attorney’ under Lasting Power of
Attorney, the attorney may be able to make decisions relating to administration of
medication if specified in the Order. The attorney can only make these decisions if the
Service User lacks the capacity to do so, and the Order says they can, and must always
act in the Service User’s best interests.
Medication cannot be compulsorily administered to individuals by Care Workers/Personal
Assistants. Please see the

Mental Health Act 1983

Mental Health Act 1983 as amended by the 2007 Act
The legal position pertaining to medication and related tasks is continuously under review
and is subject to change. Managers and Care Workers must ensure they keep up to date
on the law, local and national guidance. Further advice may be gained from legal
professionals.
Page 22 of 142
Guidelines for changes in circumstances
The Care Worker/Personal Assistant administering the medication can assume that any
actions in the Support Plan Summary are agreed to be in the Service User’s best interest.
However, they have a key role in assessing capacity and best interests at the time of
administering the medication. Variations in circumstances should be covered by the
Support Plan Summary e.g. what to do if a Service User;


who previously had capacity now appears to lack the capacity to agree to
administration, or
who lacks capacity but has previously complied with taking medication now refuses to
take that medication.
For any circumstances not covered by the Support Plan Summary, the Care
Worker/Personal Assistant should not proceed with administering medication but should
refer to their line manager for further advice.
For more guidance on capacity to consent see

Essex County Council Internet Safeguarding Pages or

Department of Health – Consent Key Documents
5.2
Consent
Care Workers/Personal Assistants require consent from the Service User before assisting
with or administering medication or related tasks. It is the responsibility of the Practitioner/
Facilitator to obtain consent from the Service User at the assessment and during
subsequent reviews and make a record in the Support Plan Summary. Written consent
should be maintained on the Service User’s file.
However, where consent is given it must not be assumed to be permanent, the individual
may withdraw their consent at any time. The Practitioner/Facilitator and the Care Workers/
Personal Assistants must ensure a Service User’s consent is continuously assessed.
Consent may ordinarily be assumed if the Service User commences the treatment. If the
individual refuses, or conducts themselves in a way to suggest refusal then consent may
not be assumed. The Service User can be approached again a little later but if refusal
continues advice must be sought from the GP and a record entered onto the Daily
Communication Record Sheet or the Medicine Administration Record as appropriate. If the
refusal continues for 24 hours then the manager of the service, the prescriber and/or the
Pharmacist should be contacted for further advice.
5.3
Covert Administration of Medication
‘Covert’ is the term used when medication is disguised and given without the knowledge or
consent of the person receiving them, for example, in food or in a drink.
Administering medication by deception is potentially an assault. Responsibility for covert
administration lies with the prescribing Practitioner and not the Practitioner/Facilitator,
Provider or Care Worker/Personal Assistant.
With the Service User's consent, making the medication more palatable by taking the
medication with food or drink is acceptable and is not the same as disguising medication
without the Service User’s consent (covert medication). Advice must be sought from the
Pharmacist or GP regarding altering or crushing the medication or mixing it with food or
Page 23 of 142
liquid to ensure it does not interfere with the properties of the medication and can also
advise on more palatable forms of medication.
5.4
Choice
A Service User may have certain preferences relating to equality and diversity. These
should be recognised at the assessment stage, arrangements made to accommodate
them and relevant details recorded in the Support Plan and/or Support Plan Summary and
Information to Service Provider form. There is very little published information about
cultural requirements in medication management, however the Royal Pharmaceutical
Society document “The handling of medicines in Social Care” states that the following
have been established and should be carefully considered by care services:
 Vegetarians and people from some religious groups do not want gelatine capsules
(made from animal products)
 Some people may prefer to have medication given to them by people of the same
gender
 Some religious festivals include fasting and some people prefer not to have medication
given at certain times
 Some religions may have specific requirements for medication preparation or content.
Information specific to Muslims is on www.islamset.com/bioethics/8thfiqh.html#2
Generally, Care Workers should promote the independence of the Service User and
sensitively work with their views and wishes in accordance with the Support Plan and/or
Support Plan Summary.
Page 24 of 142
6
Levels of Support – Prompt, Assist or Administer
Objectives
At the end of this section you will:

Understand the meaning of prompting, assisting and administering

Understand your responsibilities and those of other people involved

Demonstrate the correct way to prompt, assist or administer medication and related
tasks
Assessment method
1.
Completion of Worksheets 3 and 4
Standard and Guidance
STANDARD 4: In order to carry out their duties Care Workers/Personal Assistants
must only Prompt, Assist or Administer in accordance with the details specified by
the Commissioner in the Commissioning Document.
The Service User’s medication needs will be identified by the Assessor, the Support Plan
and/or Support Plan Summary will specify the approach for supporting the Service User
and detail the ‘level of support’ the Service User requires with their medication and related
tasks. It will also set out how, when and what Care Workers/Personal Assistants may do.
Care Workers/Personal Assistants must work to the Support Plan and/or Support Plan
Summary, Information to Service Provider and the Standards and Guidelines.
Prompt
To prompt means to remind a Service User who has mental capacity to make their own
decisions to take their medication or carry out a task, for example, to remind them to take
their medication at a particular time or with food. The Service User will be responsible, in
whole or in part, as detailed in the Support Plan Summary for the safe management of
their medication.
A prompt could be the Care Worker/Personal Assistant saying to the Service User ‘have
you taken your medication yet?’ or ‘is it time to take your medication?’ or similar and help
the Service User as requested.
As part of the prompt, medication can be passed to the Service User in a container. Family
filled monitored dosage systems can be used as the Service User decides whether to take
the medication or not.
Every instance of Prompting should be recorded on the Daily Communication Record.
Assist
To assist means to physically help a Service User who has mental capacity and ability to
instruct the Care Worker/Personal Assistant on what it is they require, for example,
preparing items for continence maintenance, opening a medication container or removing
tablets from a blister pack, for someone unable to use their arms/hands this can include
Page 25 of 142
‘giving’ the tablets to the Service User using a container. Family filled monitored dosage
systems can be used as the Service User decides whether to take the medication or not.
The Service User will be responsible, in whole or in part, as detailed in the Support Plan
Summary for the safe management of their medication.
Every instance of Assisting should be made on the Daily Communication Record sheet.
Administer
To administer means to select, measure and give medication to a Service User or carry
out a related task as specified in the Support Plan and/or Support Plan Summary, which
will specify the practice the Care Worker/Personal Assistant is are to follow and their
responsibility for ordering, recording, storing and disposing of the medication, in whole or
in part. Essentially, Administration is where a Care Worker/Personal Assistant makes a
judgement regarding a Service User’s medication in the best interest of the individual.
Administration of medication will only be agreed in special circumstances where
assessment under the Mental Capacity Act has determined the Service User does not
have capacity to make decisions for themselves regarding medication (see Section 5),
cannot self-medicate, instruct others or manage their medication, does not have an
appropriate family Carer and cannot be supported by assisting or prompting. This may for
example apply to a Service User with advanced dementia.
Care Workers/Personal Assistants must only administer medication from the original
container, dispensed and labelled by a Pharmacist. This includes pharmacy filled
monitored dosage systems and compliance aids.
Care Workers/Personal Assistants cannot administer from family filled monitored dosage
systems or compliance aids as they need to follow the pharmacy instructions and the
Patient Information Leaflet, thereby reducing the risk of errors occurring.
If the policy of the Provider organisation is to use a Monitored Dosage System when
administration support is commissioned and the Disability Discrimination Act does not
apply, the Provider must pay for them as the provision of monitored dosage systems and
compliance aids does not fall within the community pharmacy contract.
Every instance of Administering must be recorded on a Medicines Administration Record
(MAR). Any refusal by a Service User should be recorded and advice sought from the GP.
For further information, see the following Care Quality Commission (CQC) publication.
Medicine administration records (MAR) in care homes and domiciliary care
Prompting, Assisting and Administration
Care Workers/Personal Assistants should always seek to promote the independence and
dignity of the Service User. The Service User’s autonomy, human rights, privacy, cultural
and spiritual beliefs must be respected and where appropriate, the wishes of their family
and Carers must be taken into account.
Medication prescribed for a Service User becomes their property as soon as it is
dispensed. Medication must not be shared with another person.
Page 26 of 142
7
Levels of Training
Objectives
At the end of this section you will:

Understand the different levels of training available

Know which level of training is appropriate for a Care Worker/Personal Assistant to
provide the support required
Assessment method
1.
Completion of Worksheet 5
Standard and Guidance
STANDARD 5: Essex County Council employed care staff can only provide support
to a Service User after completion of the Medication Standards, Guidance and
Workbook or online training and being assessed as competent. Agency staff must
meet the requirements of the ‘Care Quality Commission Outcome 9 – Medicines
Management’
Medication and Related Tasks Training is arranged in three levels:
 Level 1 – Induction and Commissioning.
 Level 2 – Core Competencies.
 Level 3 – Specialist Competencies.
Level 1 - Induction and Commissioning
The Medication and Related Tasks induction training should be carried out as part of a
new member of staffs’ induction and will provide an understanding of Medication and
Related Tasks, the Standards Essex County Council expect staff and Providers to meet,
and the Commissioning process. Care Workers/Personal Assistants should complete the
induction and commissioning training prior to Core Competency Training.
Level 2 – Core Competencies
Core competencies are relatively straightforward, non invasive tasks such as oral
medication and homely remedies in the form of tablets, capsules or mixtures, eye, ear or
nose drops that approved Care Workers/Personal Assistants may prompt, assist or
administer following successful completion of appropriate Level 2 training in the handling
and use of medication and being assessed as competent.
Level 3 - Specialist Competencies
Specialist Competencies are to meet the more complex, specialist healthcare needs of a
particular identified Service User in agreement with the Service User, their Carer where
appropriate, the commissioning assessor, Healthcare Professional and the Provider. This
is a task in addition to core competencies and identified as specific to the individual
Service User such as oxygen management. The Care Worker/Personal Assistant will be
trained by a Healthcare Professional to assist the particular individual Service User. This
is NOT a generic competence and CANNOT be applied to other Service Users.
Page 27 of 142
8
Risk Assessment
Objectives
At the end of this section you will:

Know what aspects of medication management the Practitioner/Facilitator will need to
examine as part of their risk assessment.
Assessment method
1.
Completion of Worksheet 6
Standard and Guidance
STANDARD 6 – A structured risk assessment must be conducted as part of the
assessment or review completed by the Practitioner/Facilitator for the Service User,
their environment and staff involved. The risk assessment will examine the actions
and resources required to safely and competently manage medication and related
tasks, and will highlight the risks and hazards and how they may be managed.
The Pharmacy Risk Indicator and the Managing Medication sections of the
Assessment/Review notes should be completed. Although they are both in one domain,
they cover different aspects of medication management.
The Pharmacy Risk Indicator looks at whether the Service User;

needs help getting a regular supply of their medication

takes their medication in the way the doctor advises

can take the medication out of the packaging/container.
The Managing Medication section looks at;

Methods or equipment the Service User currently uses to help them take their
medication and whether these methods work or whether there could be a more
appropriate alternative such as Assistive Technology/Telecare equipment

Whether the Service User is helped to take their medication by someone else and
whether this help is appropriate and consistent and also if there is any risk of the help
not being available without prior warning, therefore would a more formal arrangement
such as Assistive Technology/Telecare equipment be a more appropriate

Whether the Service User has had their medication reviewed by their GP or
Pharmacist, and are they clear about how and when they should take it

Whether the Service User has any known allergies or whether they have experienced
possible side effects from any of the medication they take.
If the Pharmacy Risk Indicator is not considered to be appropriate for a particular Service
User, then the Managing Medication details should still be completed. The
Practitioner/Facilitator completing the assessment/review would know the situation, and
the Service User may have capacity, but if the worker changed and the information was
not recorded then this could present a risk to the Practitioner/Facilitator picking up the
case as well as to the Service User.
Page 28 of 142
These sections should ideally be completed, even if someone has capacity, especially
around the information regarding allergies. In the Managing Medication section, if the
Service User does not have capacity, indicate if a Mental Capacity Assessment has been
completed.
Advice should be sought from the Service User’s GP, Pharmacist or Community Nurse as
part of the assessment/review and care management process. Wherever possible,
information should be made available to the Service User about the medication they are
taking, or is advisable for them to take, including the risks. When assessing or reviewing,
establish what medication is being taken, what they are for, any side effects to look for and
also whether any of the medication requires close monitoring, such as warfarin, lithium,
anti-psychotics and identify who is involved with this.
If the Service User is responsible for their medication and related tasks, this should be
noted in the risk assessment and the Support Plan and/or Support Plan Summary.
Information in the Support Plan and/or Support Plan Summary and in the Commissioning
Document should be updated in consultation with the Service User as required.
When Care Workers/Personal Assistants carry medication on their person or in a vehicle
they should ensure a risk assessment is carried out by their line manager and that their
insurance cover is appropriate.
The contingency plan should address issues such as who will provide support with
medication in an emergency, for example;

if the Carer goes into hospital

what responsibilities a Practitioner/Facilitator with have i.e. advise relatives, collect
medication etc.
Page 29 of 142
9
The Support Plan and Support Plan Summary
Objectives
At the end of this section you will:

Understand the basic difference between a Support Plan and Support Plan Summary

Understand what information is needed in the Support Plan and Support Plan
Summary
Assessment method
1.
Completion of Worksheet 7
Standard and Guidance
STANDARD 7 – A detailed Plan will be developed for each individual which will
specify the approach for supporting the Service User, this will include support
around medication and related tasks.
The Support Plan is completed by the Service User, their family or friends, an advocate, a
service broker or with support from Essex County Council. It can be completed in a variety
of formats depending on their ability, for example a written document, video or pictures.
The Support Plan brings together the Service Users’ aspirations, goals and desired
outcomes and shows how the Service User would like their needs to be met.
The Support Plan Summary is a tool to record all essential data in a consistent manner
regarding the support, solutions agreed to manage identified risks, how the eligible social
care needs are going to be supported, the costs involved, who will be managing the
money, the contingency plans and the review requirements to assess its effectiveness.
The Support Plan Summary forms Essex County Council’s legal document with the
Service User and must be completed if the Service User is having a Personal Budget, but
is optional if the Service User is having their support managed by Essex County Council.
It is completed by the Practitioner/Facilitator.
Medication and related tasks must be carried out in accordance with the Support Plan
Summary which specifies the approach for supporting the Service User. It will set out
how, when and what Care Workers/Personal Assistants may do and detail the level of
support the Service User requires.
The Support Plan Summary should be reviewed to ensure the Service User’s changing
needs and views are met. All staff should always take into account the views of the
Service User they are working with and promote independence and dignity. The Service
User’s views should be obtained even in situations where it is difficult to gain those views.
The Support Plan Summary may involve partnership working and agreement with other
authorities such as Primary Care Trusts or be managed through integrated services, such
as mental health services.
Page 30 of 142
10 Roles and Responsibilities
Objectives
At the end of this section you will:

Be aware of the roles of all the people involved in a Service User’s medication and
related tasks support.

Understand the responsibilities of the different people involved.
Assessment method
1.
Completion of Worksheet 8
Standard and Guidance
STANDARD 8 – The roles and responsibilities of key people involved in the Service
User’s medication support should be documented in the Support Plan Summary
and the Information to Service Provider
There are a number of key people involved in the management of medication and related
tasks. It is important that everyone is clear on their respective role, their responsibilities
and those of other people.
To ensure safe and effective practice, any concerns or doubts regarding medication or
related tasks must be reported to line managers at the earliest opportunity, external
providers should report any concerns to the commissioner of the service.
Good communication is essential between all involved. These are the:
Service User

Commissioner

Managers at ECC, Residential Care Homes and Domiciliary Providers

Care Workers/Personal Assistants

Health Care Team i.e. GP, community nurse, community paediatric nurse

Pharmacists.
The need for confidentiality should always be considered i.e. when and to whom
information about an individual may be disclosed or discussed, e.g. doctor, Pharmacist,
other care professionals, relatives/solicitor with Lasting Powers of Attorney etc. The
people that the Service User is happy for their information to be shared with should be
recorded in the ‘Service User agreement to share information’ form by the Practitioner/
Facilitator.
The various support options include;

Care Homes (residential or nursing care)

Day services

An individual’s own home

Sheltered accommodation
Page 31 of 142


Supported Housing
Other networks and services i.e. voluntary agencies, activities and entertainment,
education and religious establishments).
Service User
The Service User will have responsibility for their medication if they have capacity and this
should be recorded in the Support Plan Summary. This information will be supplied to
those providing the support services.
Guidance should be offered to the Service User as part of the home risk assessment
completed by the Practitioner/Facilitator. Records should show any advice given, however
compliance is at the discretion of the Service User.
Commissioner
Where Essex County Council is commissioning the support, the Practitioner/facilitator is
the Commissioner and must;
 obtain consent from the Service User
 identify the level of support required i.e. Prompt, Assist or Administer. Subsequent
reviews should address any adjustments that may be necessary
 give clear instructions for Care Workers on all aspects of medication support they are
required to undertake and the practice they are to follow
 ensure all staff involved are clearly informed of their role and responsibilities in
prompting, assisting or administering medication and related tasks and that the
responsibilities are clearly defined and communicated in the Support Plan Summary to
all those involved
 provide detailed information to Service Placement Team to confirm the support being
requested and inform the Provider of all essential aspects of the medication support
required, giving the widest range of information possible including the level of support
and details of medication management.
Where the Service User is commissioning the support, it is advisable that the above
information is documented in the Support Plan and/or Commissioning Document and
discussed between the Service User and their Personal Assistant.
For more information on the Commissioner see Section 4.
Managers at Essex County Council, Care Homes and Domiciliary Providers
A manager is;
 responsible for ensuring that staff are trained and possess the skills and knowledge to
undertake the support
 accountable for ensuring that the person they are delegating to support a Service User
is properly trained in relation to the support required
 responsible for ensuring a Care Worker knows who they are accountable to, the
contract of employment should define this
For more information on the Provider see Section 4.
Page 32 of 142
Care Worker/Personal Assistant
A Care Worker/Personal Assistant providing support for medication and related tasks;
 has the responsibility of working to the Support Plan and/or Support Plan Summary,
Information for Service Provider/Commissioning Document, Medication Standards and
Guidance Workbook or online training, and their regulatory body’s equivalent
 should ensure they are aware of their competencies, responsibilities and what the
Commissioner and their Manager expects of them
 carry out the support in a safe manner and to the best of their ability and take
responsibility for their actions
 must obtain the Service User’s consent to assisting with or administering medication
and related tasks each time the medication is given or a task carried out
 must ensure the medication is prompted or assisted with, or administered according to
the Pharmacist’s label. These instructions reflect the prescriber’s (e.g. GP) written
instructions as detailed on the FP10 prescription form. Where the GP updates these
instructions after the medication has been dispensed, the GP must provide the Service
User or Provider with written instructions
 must ensure the Pharmacists written instructions are transferred from the medication
container onto the Medication Administration Record (MAR) or Daily Communication
Record Sheet
 must complete the Medicines Administration Record or Daily Communication Record
Sheet accurately
 must immediately report any medication and related task errors or incidents to their line
manager or person in charge of the care setting and the Service User’s GP
 must notify their Manager or the Commissioner if the level of support required appears
to have changed including when a Service User self administers their own prescribed
medication, and there is concern about the Service User’s ability to manage their own
medication
 work in close collaboration with the Service User’s GP and other health professionals
and keep them informed or any concerns
 must not make clinical decisions or judgments regarding medication e.g. increase or
change of dosage. The prescriber’s instructions should always be followed.
Health Care Team
Members of the health care team, which may include GPs, Pharmacists, pharmacy
technicians and nurses working in the community, are crucial for ensuring the safe
management of medication. Social care and community nursing are not interchangeable
services; they are complementary services, each with their own set of skills and expertise.
The primary responsibility for prescribing and management of medication or other
treatment and in monitoring the Service User’s health rests with the Service User’s GP in
consultation with other members of the primary care team and his/her patient. This
includes reviewing the need for continued prescribing of medication.
For those on repeat medication, as part of the national Quality and Outcomes Framework
(QOF) GPs are expected to carry out a medication review at least once in every 15
months. Generally however GPs undertake these reviews at least annually. A medication
Page 33 of 142
review is defined as ‘a structured, critical examination of a patient’s medication with the
objective of reaching an agreement with the patient about treatment, optimising the impact
of medication, minimising the number of medication-related problems and reducing
waste’. The QOF states that this review must be undertaken by a GP, Practice/Specialist
Nurse or Pharmacist and that any changes to medication have to be agreed with the
patient. It is therefore preferable that this review is undertaken on a face to face basis,
and that their unpaid Carer is also present where appropriate. A record of when this
review takes place should be kept by the Provider. For further information see;
http://www.npci.org.uk/medicines_management/review/medireview/resources/agtmr_web1.pdf
In addition to the QOF, the National Service Framework for Older People calls for GPs and
staff to review each patient over the age of 75 annually and every six months for those on
more than 4 medications.
Nurses working in the community are also involved in monitoring the health of the Service
User and the effects of medication. They can be a source of advice, guidance and support
to staff in the management of medication.
Pharmacists
Pharmacists have an important role in providing advice to Service Users and staff on the
safe storage, recording, handling, management and disposal of medication, and also
advice on possible side effects and following specific instructions. Pharmacists may be
involved in the initial assessment of pharmaceutical needs and will be able to help and
advise Service Users regarding specialist containers and the safe use and transportation
of medication. In many areas, Pharmacists can also provide a ‘medicines use review’
(MUR) which is a formal ‘Medication Review’ and ‘Medicines Handling Assessment’ and
may be necessary to fully assess the pharmaceutical needs of the Service User. This may
include a domiciliary visit by the Pharmacist. All patients/Service Users can be assessed
under the Disability Discrimination Act 2005, if, as a result of the assessment, it is deemed
that the Act does not apply, services would have to be formally commissioned as they fall
outside the current community pharmacy contract.
Another important role is inspection, for example they may be part of an inspection team
that monitors residential care homes and giving advice to Providers around the safe
management of medication.
Commissioners and Care Workers/Personal Assistants need to be aware of the range of
Pharmacist support provided within their area, the role of the Pharmacist may vary from
area to area, further details can be obtained from the Medicines Management Team at the
Primary Care Trust (PCT). Please refer to the links below:
Page 34 of 142
North East Essex PCT
Colchester Primary Care Centre, Turner Road, Colchester,
Essex CO4 5JR
Tel: 01206 286510, Fax: 01206 286710
Email: communications@northeastessex.nhs.uk
South East Essex PCT
Harcourt House, Harcourt Avenue,
Essex, SS2 6HE
Tel: 01702 224600, Fax: 01702 224601
Email: info@see-pct.nhs.uk
Southend-on-Sea,
Mid Essex PCT
Swift House, Hedgerows Business Park, Colchester Road,
Chelmsford, Essex CM2 5PF
Tel: 01245 398770, Fax: 01245 398710
Email: patientexperience@midessexpct.nhs.uk
West Essex PCT
Building 4, Spencer Close, St. Margaret’s Hospital, The
Plain, Epping, Essex, CM16 6TN
Tel: 01992 566140, Fax: 01992 566148
Email: mail@westessexpct.nhs.uk
South West Essex PCT
Head Office, Phoenix Court, Christopher Martin Road,
Basildon, Essex, SS14 3HG
Tel: 01268 705000, Fax: 01268 705100
Email: info@swessex.nhs.uk
Page 35 of 142
11 Core and Specialist Competencies and Tasks a Care Worker/
Personal Assistant must not do
Objectives
At the end of this section you will:

Understand what a ‘Core Competency’ is

Understand what a ‘Specialist Competency’ is

Know what training is needed to carry out either a Core or Specialist Competency

Know which tasks a Care Worker/Personal Assistant cannot do
Assessment method
1.
Completion of Worksheet 9
Standard and Guidance
STANDARD 9 – All Care Workers/Personal Assistants must be assessed as
competent and this should be evidenced in their personal development record prior
to completing any Core or Specialist Competencies
11.1 Core competencies
Core competencies are relatively straightforward non invasive tasks that Care Workers/
Personal Assistants assessed as competent may undertake to prompt, assist or administer
after Level 2 training or the regulatory body’s equivalent. A training plan must be
implemented as part of staff development and must provide appropriate support, training,
assessment of competence and specify when reviews and further training are required.
The purpose of the competency assessment is to ensure the Care Worker/Personal
Assistant can confidently and correctly prompt, assist or administer medication or carry out
related tasks for the Service User. This can be achieved by completion of the Worksheets
within this document or the online training and demonstrating competence through
evidencing their knowledge and practice. Organisations governed by other regulatory
authorities should follow their own guidance on recording training and competence
assessment. The Essex County Council guidance and training materials can be used by
these organisations to meet their regulatory authority’s requirements. All training,
observations and assessments should be recorded for service monitoring and audit
purposes.
A Support Plan Summary and Risk Assessment specifying the approach to prompting,
assisting or administering medication and related tasks must be agreed and followed.
Care Workers/Personal Assistants must record their actions on the appropriate forms.
Service Users who employ their own Personal Assistant may prefer to provide informal
training on their individual support requirements. In these circumstances it is
recommended that the Service User and their Personal Assistant also have a training plan
and record training undertaken and competency achieved.
Page 36 of 142
Tasks requiring Core Competency training
Once assessed as competent the Care Worker/Personal Assistant will be able to Prompt,
Assist or Administer with the medication and related tasks listed below;






Inhaled medication (e.g. for asthma)
Oral medication and homely remedies in the form of tablets, capsules or mixtures
Medicated cream or ointment
Eye, ear or nose drops
File finger or toe nails
Prompt or Assist with pre-assembled injection devices e.g. Epi-pen or for Anaphylactic
reactions or insulin in a pen-device
 Catheter bag and continence maintenance, this does not include changing catheters or
bladder washouts or clearing blockages
11.2 Specialist Competencies
Specialist competencies are undertaken to meet more complex needs of a particular
identified Service User in agreement with the Service User, their Carer where appropriate,
the Commissioner, Healthcare Professional and the Provider. These are tasks in addition
to core competencies and identified as specific to that Service User. Aspects of specialist
competencies must be agreed with the relevant authorities, such as health professionals.
The Care Worker/Personal Assistant will be trained by a Healthcare Professional to carry
out the specific identified specialist healthcare task for the identified Service User, and
signed off as competent for this task by the healthcare professional. This is NOT a generic
competence and CANNOT be applied to other Service Users. Care Workers/Personal
Assistants must agree to provide the assistance and have the specialist training with the
individual Service User they are to assist. Monitoring and reviews must be carried out
throughout implementation. The dates for monitoring and reviewing must be recorded.
The Healthcare Professional will continue to monitor and guide the Service User’s health,
Support Plan Summary, tasks and relevant activities relating to the Service User.
Tasks requiring Specialist Competency training
The Care Worker/Personal Assistant must receive advice and training from a Healthcare
Professional and be assessed as competent prior to the carrying out the tasks below. The
list below is not exhaustive but gives examples of current recognised specialist tasks.
Requests for other tasks must be discussed with the organisation’s Manager

Assistance with oxygen management and Transport of oxygen cylinders.
Home oxygen is commissioned by the PCT. The supplier of the oxygen will provide
full information to Service Users about the care and use of their oxygen equipment and
provide a contact number for further advice.
Before working with oxygen, a risk assessment must be completed by the Practitioner
/ Facilitator as part of the Support Plan Summary and agreed with the Service User,
Provider, Care Worker, relevant health professional, health and safety, environment
and fire safety professionals.
When a Service User goes on holiday, arrangements for the continued supply of
oxygen must be made well in advance, ensure the GP is contacted in good time.
Fire precautions and procedures, and moving and handling guidance must be adhered
to. For information and advice use the following links or contact the oxygen supplier
Essex County Council Putting People First Risk Enablement Policy
Page 37 of 142
Essex County Council Strategic Health, Safety and Welfare Policy










Rectal administration, liquid or suppositories e.g. Diazepam, Paraldehyde for seizures
Administration of Buccal Midazolam
Administration through a Percutaneous Endoscopic Gastrostomy (PEG) a naso-gastric
tube or jejeunostomy (stomach)
Administer nebuliser medication - only in those circumstances where the Service User
is stabilised and the dosage is pre-measured
Administer any pre-assembled injection devices e.g. Adrenaline for Anaphylactic
reactions or insulin in a pen-device
Oral suctioning only
Specialist exercises as instructed by a therapist e.g physiotherapist
Specialist eye/ear, drops, e.g. short course of antibiotics
Colostomy care – routine management of colostomy care
Any medication, healthcare intervention, alternative or complimentary treatment or
therapy not listed above must be agreed as suitable by a Registered Medical
Practitioner and must be agreed in writing
11.3 Tasks a Care Worker/Personal Assistant must not do:
The following is a list of the tasks a Care Worker/Personal Assistant must not do;
 Apply or renew sterile dressings to open wounds, except as a First Aid treatment. (First
Aid includes, for example, if a someone falls and grazes their knee, this can be
cleaned and a plaster applied)
 Commence treatment for pressure sores and open wounds unless under the direct
supervision of a health professional
 Dispose of sharps and clinical waste from the Service User’s home, this is the
responsibility of the community nurse. Care Workers may, with appropriate guidance
place sharps in a special container provided by a health professional
Residential care homes are required to safely dispose of clinical waste, refer to
Department of Health publication: Safe Management of Healthcare Waste Consult
Environmental Health and Health professionals for further advice
 Maintain oxygen cylinders. The home oxygen supplier will be able to advise and
oxygen users will have a help-line number to phone for assistance.
 Insert catheters or re-insert catheters - obtain medical support
 Insert or re-insert feeding tubes - obtain medical support
 Provide tracheal suction
 Manually evacuate bowels
 Vary medication dosage according to food intake unless under direct medical
supervision e.g. for diabetes and cystic fibrosis
 Administer injections using medical syringe other than pre-filled syringes e.g. insulin
pen as part of specialist task following training
 Carry out specialist tasks without specific training and consent and confirmed
competency by a Healthcare Professional to undertake that task for a specified
individual
 Cut finger or toe nails – they are to be filed only
Seek advice from your line manager if in doubt about any task
Page 38 of 142
12 A Brief explanation of Medication
Objectives
At the end of this section you will:

Understand what medication is

Be aware of the side effects that medication may have

Know what medicine classifications are

Know about controlled drugs
Assessment method
1.
Completion of Worksheet 10
Guidance
A drug is something which when taken into the body may change or affect one or more of
the body’s functions.
Medication is a preparation that contains a drug that is used to;

treat a condition - e.g. an antibiotic to treat certain infections

control a condition - e.g. a medication to lower your blood pressure

treat the symptoms of a condition - e.g. a painkiller for toothache

prevent someone from becoming unwell - e.g. a vaccination against disease.
All medication is potentially harmful if not used correctly, and care must be taken with
storage, use and disposal. Safe use of medication means it is given in such a way as to
maximise benefit and avoid causing harm. GPs and Pharmacists are able to advise on
ways of managing medication to meet needs, e.g. to prescribe liquid medication for a
Service User who has difficulty swallowing, or avoiding rectal medication for wheelchair
users.
Today’s medications are powerful compounds that can control disease and illnesses, ease
discomfort and prolong life for millions of people and are generally beneficial.
Unfortunately no medication is without potential side effects and some are worse than
others and vary from person to person. They are prescribed where the benefit of the
treatment outweighs the risks of the side effects. Some of the most common side effects
are rashes, stiffness, breathing difficulties, shaking, swelling, headaches, nausea,
drowsiness, vomiting, constipation and diarrhoea. Please note this is not an exhaustive
list.
Side effects are not the only potential problem with medication; sometimes people take
medication when they do not need it or use it in the wrong way or even take someone
else’s medication.
Usually these things happen by accident or because of misunderstandings. Often the
consequences are mild but sometimes they can be severe or even life-threatening.
Medication can be dangerous if not treated or handled carefully.
Page 39 of 142
Medication dispensed by a Pharmacist becomes the property of the Service User to whom
it has been prescribed, it should not be used by anyone else. It should be acknowledged
that a Service User has the right to administer their own medication without help from a
Care Worker/Personal Assistant. Their ability to do so would be part of ongoing risk
assessments. Suspected changes in a Service User’s capacity and/or ability to selfadminister should be reported to an appropriate manager for review and recorded in the
Service User’s records. There are a number of compliance aids available to assist in selfmedication, a Pharmacist or Essex County Council’s Equipment and Assistive Technology
Team can advice on these.
12.1 Medicine Classifications
The Medicines Act 1968 defines three main groups of medication, these are:GSL General Sales List medication that can be bought or supplied over the counter in
supermarkets, corner shops and garages without the supervision of a Pharmacist
as they are thought safe enough e.g. small quantities of Paracetamol, vitamins,
some cough medicines. GSL medicines may also be dispensed on a prescription.
P
Pharmacy medicines that may only be sold or supplied from pharmacies under the
supervision of a Pharmacist. P medicines include all those that are not GSL or
POM. e.g. Night Nurse, Paracodol, Veganin. P medicines may also be dispensed
on a prescription.
POM Prescription Only Medicines can only be obtained from a Pharmacy in the
presence of a Pharmacist using a NHS prescription or a private prescription which
can only be written by a registered medical practitioner, dispensing doctor or
hospital doctor, or for some drugs, a dentist or nurse prescriber (not general nurse).
CD
Controlled Drugs certain POMs have more stringent controls and these are
classed as Controlled Drugs (CDs). They have special storage requirements under
the Misuse of Drugs Act 1971 which apply in a nursing or residential care home but
do not apply in a Service User’s own home.
A list of all available medication and the category they belong to i.e. GSL, P or POM is
available from Pharmacists. The British National Formulary (BNF) specifies which
medications are POM or CD but does not distinguish between P and GSL medication.
Important sources of information about medication are;
 the British National Formulary,
 the Monthly Index of Medical Specialities (MIMS) which can be obtained from MIMS
PO Box 270, Southall, Middlesex UB1 2WF,
 the Electronic Medicines Compendium (EMC)*(free to use),
 the Service User
 GP, community nurse, Pharmacist, and NHS Direct
12.2 Controlled drugs
Controlled drugs are prescribed and dispensed for individually named people, in the same
way as other medication. They are usually used to treat severe pain, induce anaesthesia
Page 40 of 142
or treat drug dependence; some are used to treat conditions such as attention deficit
hyperactivity disorder (ADHD). Controlled drugs can be abused, for instance when they
are taken without any clinical reason to do so, therefore they have additional safety
precautions legal requirements for the storage, administration, recording and disposal of
controlled drugs. These are set out in the Misuse of Drugs Act 1971 and the subsequent
2007 amendment which specify who is allowed to supply and possess CDs.
Extra time should always be allowed for controlled drug prescriptions to be written due to
the special legal requirements. If the prescription does not comply with the requirements,
it may be sent back to the prescriber for altering before it can be dispensed. If Care
Workers/Personal Assistants collect controlled drugs from a pharmacy on behalf of a
Service User, they may be asked to provide identification. Anyone who wilfully misuses a
Service User’s medication will be subject to investigation and appropriate actions. Any
queries regarding the management of medication should be directed to the line manager.
Controlled drugs are divided into five categories.
Schedule 1: Includes drugs which are primarily not used medicinally such as cannabis
and LSD. A special Home Office Licence is needed in order to possess
these.
Schedule 2: Includes drugs such as diamorphine, morphine, pethidine, cocaine which
are subject to full CD requirements relating to prescriptions, storage and
records. In residential or nursing homes they must be stored in a special
cupboard and a register of the use of these drugs must be kept in addition
to the administration records on the Medication Administration Record
(MAR) sheet. Special storage is not necessary in a domiciliary setting.
Schedule 3: Includes most barbiturates and buprenorphine. These drugs are subject to
the special requirements for prescriptions but records do not need to be
kept in a register and they do not need to be stored in a CD cupboard.
Buprenorphine and temazepam are an exception as they must be stored in
a CD cupboard.
Schedule 4: Benzodiazepines and anabolic steroids. There are no special requirements
for writing prescriptions, records do not need be kept and they do not need
to be stored in a CD cupboard. Schedule 4 exists mainly to exert control on
the destruction of these drugs by importers, exporters and manufacturers.
A Home Office licence is also required to import/export anabolic steroids.
Schedule 5: Includes those preparations which are exempt from virtually all CD
requirements because they are dilute and therefore not as liable to abuse
e.g. Oramorph® 10mg/5ml solution. There are no special requirements for
writing prescriptions, additional records do not need to be kept and they do
not need to be stored in a CD cupboard. However note that Oramorph
Concentrate 100mg/5ml is a schedule 2 and must legally be kept in a CD
cupboard.
Sometimes, local ‘Good Practice’ policy will increase the requirements for particular drugs,
for example temazepam may be recorded in CD registers in residential homes where there
has been a problem with tablets going missing or Oramorph® may be treated as a CD
although its low concentration means that it is not legally a schedule 2 controlled drug. In
residential care homes the administration of controlled drugs is witnessed by a second
designated appropriately trained member of staff.
Page 41 of 142
Use the links below for further information on the safer management of controlled drugs,
Care Quality Commission guidance on The safe management of controlled drugs in care
homes
The Department of Health - Interim guidance - safer management of controlled drugs:
guidance on the destruction and disposal of controlled drugs
12.3 Needle exchange services and methadone programmes
Only staff trained to specialist competency level may participate in needle exchange
schemes and methadone programmes where this is specifically agreed by the appropriate
manager. Such schemes will usually only apply in the Drugs and Alcohol service. Staff
must ensure they keep up to date with local protocols, including the proper handling of
prescriptions, to ensure safe practice and to satisfy health and safety and legal
requirements.
Page 42 of 142
PART TWO
Level 2 Training
Core Competencies
Page 43 of 142
Page 44 of 142
13 Recording Procedures
Objectives
At the end of this section you will;

Understand the need to maintain accurate records

Understand what needs to be recorded

Demonstrate the ability to maintain accurate records in relation to medication and
related tasks.

Understand the circumstances in which the GP or Pharmacist should be contacted
about a Service User’s medication records.
Assessment method
1.
Complete Worksheet 11
2.
Care Workers/Personal Assistants will complete appropriate recording on 3 occasions
after prompting, assisting or administering medication
Guidance
Medication is at all times the property of the person for whom they are prescribed and
should be treated in the same way as any other valuable possession. Care Workers/
Personal Assistants have a duty of “care” and must account for medication taken: When
administering they must also account for medication received and destroyed
It is important to clearly and accurately record medication being taken or used, what is
done and when as it happens on either a Daily Communication Record Sheet for
prompting and assisting or a Medicines Administration Record Chart (MAR chart) for
administering, there are many different versions available. Do not rely on memory to write
information accurately at a later time. Anyone should be able to understand from the
record exactly what has happened and be able to account for all of a Service Users
medication. Whatever format is used, the records must;











be written in ink as soon after the event as possible
be legible
be understandable, coherent and in a language that shows respect for the individual
be accurate
be complete
be up to date
be dated
detail the time that the medication was given or the task carried out
detail what was given or carried out by the Care Worker/Personal Assistant
have the name of Care Worker/Personal Assistant printed alongside the record.
be signed by the Care Worker/Personal Assistant.
The record should also include;
 when medication is not taken
 if the Service User vomited shortly after taking it.
Page 45 of 142
Dispensed medication must include full instructions for its use, the term “as directed” is not
acceptable and should be returned to the Pharmacist or GP for additional advice.
When variable doses are prescribed, e.g. one or two tablets, the indicators for different
doses must be clear and the maximum daily dose must be specified, particularly important
when a Care Worker/Personal Assistant is administering. The actual dose taken must be
recorded on the MAR chart or Daily Communication Record sheet when it is taken.
Some medication is meant to be taken occasionally when there is a specific need for e.g.
tablets for pain, constipation, indigestion or anxiety and can be either prescribed or bought
“over the counter”, these are often referred to as “as and when medicines”. Prescribed “as
and when medicines” should have details of when it is to be taken and a description of the
physical or psychological symptoms that will be exhibited when the medication is needed.
Care Workers/Personal Assistants cannot administer this type of medication but are able
to assist a Service User that has capacity to decide to take the medication, a record must
be made on the Daily Communication Record sheet when it is taken.
The dose of some medication depends on results of a blood test i.e. Warfarin or Lithium.
The result of the blood test and the prescribed dose must be recorded in the Service
User’s Record Book, i.e. for Warfarin this is the ‘Yellow Book’. Care Workers/Personal
Assistants who are prompting or assisting Service User’s with this type of medication must
ensure the Service User knows what dose to take, but cannot be involved in interpreting
the information in the ‘Record book' as this lies outside their responsibility. Where Service
Users do not seem able to continue this responsibility, the Care Worker/Personal Assistant
must notify their line manager who should ask for a review of the commissioned support.
Where Care Workers/Personal Assistants are administering, they must ensure they know
the frequency of the blood tests, and that the result and prescribed dose are entered into
the 'Record book’ and signed and dated by a Healthcare Professional or recognised family
member at the appropriate frequency. The dose administered must be entered onto the
MAR chart along with the details of the Care Worker/Personal Assistant administering the
dose. The 'Record Book' should be kept with the MAR chart for reference. The Care
Worker/Personal Assistant must not continue to administer unless the Service User is
having regular blood tests at the agreed frequency and results and doses are being
entered into the 'Record Book'. If the Service User is not having regular blood tests, the
Care Worker/Personal Assistant must inform their line manager. If the Provider is not able
to secure rapid clarification from the doctor and/or Pharmacist then contact a Pharmacist
at the PCT for help. Another example of a varying dose medication is methotrexate, this
medication is always given as a single dose once a week.
Care homes and home care providers that store people’s records on a computer should
take advice concerning the Data Protection Act 1998. Any records made either on paper
or electronically must identify the person who made the record and be tamper-evident.
13.1 Prompting and Assisting - Daily Communication Record Sheet
Care Workers/Personal Assistants who prompt or assist Service Users to take medication
must record all actions on a Daily Communication Record Sheet, clearly stating whether
the Service User was ‘prompted’ or ‘assisted’ with their medication. An example is shown
below and a Word Document is attached in the Appendices (Section 29).
Page 46 of 142
Communication Record Sheet
Service User Name:
Swift Number:
Please use as many lines as is needed to record full details.
Date
Time in
Report
Sheet No: …………….
Time Out
Page 47 of 142
Print Name
Signature
13.2 Administration - Medication Administration Record (MAR)
Care Workers/Personal Assistants who administer medication must have a MAR chart
to refer to and record all administration or omission of medication. There may be
circumstances in which alternative methods of recording medication are agreed with
Service User as part of their Support Plan and/or Support Plan Summary to meet their
particular needs, this must also be recorded. The MAR lists a Service User’s medication
and doses along with spaces to record exactly when and how much is given. The
following information must be recorded:







Which medication is currently prescribed for the person
Details of the Service Users dispensed medication
When it must be given
The strength and form of the medication
What the dose is
Any special information, such as giving the medication with food.
In the event of refusal to take medication, this must also be recorded.
The Provider of the service is responsible for providing MAR charts, they should have
their own MAR chart as they are required to do so by the Care Quality Commission
(CQC). Pharmacists and GP’s are not responsible for providing MAR charts but may be
prepared to do so upon request, although this may involve a cost. Anyone populating a
MAR chart would be potentially liable if it were wrong so there may be reluctance to
provide it other than from where the Service User gets their regular prescribing service.
The MAR chart details must match the details on the labels of the dispensed
medication, unless the GP has updated these and provided written instructions. Any
changes to the dosage should be recorded, giving details of the doctor who authorised
the changes and when, if possible the GP should alter the record and initial it.
Medication ordered or received by a Care Worker/Personal Assistant must be recorded
and administration should be in accordance with the label on the container or the
updated GP’s instruction.
If anyone else administers medication, including homely remedies, such as family
members or the Service User themselves they should be encouraged to complete the
MAR. This will ensure continuity of care and reduce the possibility of medication being
omitted or administered too frequently. Every entry on the MAR must be initialled
legibly by the administering person.
It is an individual’s right to refuse medication. The general consent given by a Service
User does not give a Care Worker/Personal Assistant the right to administer medication
against a Service User’s wishes. If medication is not taken a record should be made on
the MAR with the reason why using the appropriate code which will be listed on the
chart with an explanation of what the code means, this may vary according to the
pharmacy. Examples of some codes are:
R = Refusal
A = Absent e.g. in hospital
D = Discrepancy
S = Sleeping
V = Vomiting
U = Medication Unavailable
If the refusal continues for 24 hours then the manager of the service, the prescriber
Page 48 of 142
and/or the Pharmacist should be contacted for further advice. If the medication was
already assembled it must be disposed of appropriately and this must also be recorded.
This is safer than the possibility of returning it to the wrong container.
Medication must be audited at regular intervals to ensure that the records tally with the
actual amounts held. Any discrepancies must be reported to the line manager. Care
Workers, and where appropriate, Service Users and their Carers should agree how they
will ensure the safe management of medication.
Ensure that the records are available to the GP, Pharmacist and community nurse. Any
changes in medication must be clearly indicated on the record at the time of the change.
The Care Quality Commission (CQC) guidance ‘Medicine administration records in care
homes and domiciliary care’ provides further detailed information.
An example of a Medication Administration Record is shown below and a Word
Document is attached in the Appendices in Section 28.
Page 49 of 142
Page 50 of 142
Page 51 of 142
14 The Medication Toolkit
Objectives
At the end of this section you will

Know the procedure for prompting, assisting and administering

Know the ‘five rights’ and how to check these

Understand what a Monitored Dosage System is and how this is used.

Be aware of Telecare, the aim of Telecare and where to find further information.

What to do if there are any changes in a Service User’s medication
Assessment methods
1.
Complete worksheet 12
Guidance
14.1 The ‘five rights’
The process for prompting, assisting or administering firstly requires ensuring the
following ‘five rights’ are met;
RIGHT SERVICE USER: It is essential that Care Workers/Personal Assistants correctly
identify the Service User. The usual checks are name, address and date of birth. If the
Service User is not known to the Care Worker, an open question such as "What is your
name?" should be asked. Do not use a closed question e.g. "Are you xxxxx?".
Medication prescribed and dispensed for one person should not, under any
circumstances, be given to another person or used for a purpose different from the one it
was prescribed for.
RIGHT MEDICATION: Select all of the correct medication for the Service User for the
time of day. Even when medication is supplied in a Monitored Dosage System, there
may be other medication in the fridge. In order to identify the medication correctly, the
medication pack must have a label attached by the Pharmacist or Dispensing GP. If the
label becomes illegible or detached, immediate advice should be sought from the
pharmacy that supplied the medication. Care Workers/Personal Assistants must not alter
labels on dispensed medication pack.
When prompting or assisting, the Service User has responsibility for their own medication
and should therefore know what they have to take and when, the Care Worker/Personal
Assistant should follow the Service User’s instructions.
When administering, it is the responsibility of the Care Worker/Personal Assistant to
"check in" the medication. If any discrepancies are found between the instructions given
on the label and those on the medication form, the medication must not be given and
immediate advice sought from the supplying Pharmacist. If medication is not given,
details must be entered onto the MAR Chart. To administer refer to the MAR chart and
check the label on the medication to ensure it is being given to the right person. Do not
rely on memory. Check;
Page 52 of 142








the name of the Service User
the name of the medication
the form of the medication e.g. tablets, syrup
strength
dose, i.e. number of tablets to be given
frequency i.e. number of times per day
that the medication has not already been given to the person by somebody else
all medication is within the expiry date which indicates when the medication is no
longer to be used. Treatment with medication that is outside the expiry date is
dangerous as medication deteriorates.
RIGHT DOSE: Check the amount and frequency that the medication is to be taken. The
directions from the prescriber are transferred to the Pharmacist's label and the MAR.
These should match and be followed exactly.
RIGHT ROUTE: Care should be taken NOT to make assumptions. Check the medication
label and information leaflet which will explain HOW the medication should be taken.
Some tablets, for example, are dissolved under the tongue or between the lip and top
gum, not swallowed.
RIGHT TIME: The Pharmacist label will detail the prescriber's instructions and should be
supported by the medication information leaflet. As before, check this and if there is any
doubt about the directions, contact the supplying pharmacy.
14.2 Procedure for Prompting, Assisting and Administering Medication
Once the ‘five rights’ have been established, the process is:
Self-administration checklist






Is the Service User able to read the information on the container?
Can the Service User open the container?
Does the Service User understand what the medicine is for?
Does the Service User understand any special instructions to be followed?
Does the Service User understand the dose to be taken?
Is the Service User aware of the need to check for possible side effects?
To prevent cross-infection
Wash hands with soap and water and dry carefully before and after handling medication.
Check for Special Precautions
Check the label to see when it should be given and for any other special precautions or
instructions on the MAR or ‘Patient Information’ leaflet which should be supplied with
each medication, including those supplied in monitored dosage systems, and must be
followed by the Service User and Care Workers/Personal Assistants. For example:
 To minimise their effect on the stomach lining, irritant medication should be taken
with meals or snacks
 To prevent interference with the absorption of the medication, medication that
Page 53 of 142
interacts with food or which is destroyed by digestive enzymes should be taken
between meals or on an empty stomach.
To prevent errors
Take the medication and the MAR chart or the Daily Communication Record sheet to the
Service User. Check the Service User's identity and the dose, give the medication as
instructed on the MAR, label and Patient Information leaflet.
To prevent the need for disposal
Ask the Service User if they want their medication before taking them out of the
packaging, people can refuse medication for different reasons and it may be better to
wait a little while and ask again later. If the Service User continues to refuse, they must
never be forced and the Care Worker/Personal Assistant should seek advice from their
line manager or a medical professional.
If the Service User needs to swallow the medication, to ensure that it reaches the
stomach without undue delay encourage them to sit upright or to stand and swallow the
medication with a good drink of water. Observe to ensure that the Service User has
swallowed it completely.
Comply with the Recording Procedure by always making a record of exactly what has
been done at the time it is done, including when the Service User refuses the medication.
14.3 Helping Service Users who cannot swallow
If a Service User cannot swallow tablets or capsules, this should be discussed with a
Healthcare Professional who will be able to advise whether a suitable liquid product is
available. This could be a liquid version of the original medication or a different
medication that has the same effect. In either case, this will have to be discussed with
the Service User, prescriber and/or Pharmacist.
With the Service User's consent, making the medication more palatable by mixing it with
food or drink is acceptable and is not the same as disguising medication without the
Service User’s consent. Advice must be sought from the dispensing Pharmacist or GP
regarding altering or crushing the medication or mixing it with food or drink to ensure that
this will not interfere with the properties of the medication. The Pharmacist or GP can
also advise on more palatable forms of medication.
If a Service User is having difficulty swallowing the Care Worker/Personal Assistant
should;



record this on the Daily Communication Record or MAR chart
report it to their line manager and to the prescriber
seek advice from the Pharmacist/prescriber to consider alternatives.
14.4 Monitored Dosage Systems (MDS)
MDS is merely a convenient form of packaging for a limited group of medications. Safe
practice is not guaranteed by use of a MDS and if one is used it must be a recognised
product.
Page 54 of 142
MDS can either be filled and fully labelled by a Pharmacist or dispensing doctor, or
independently by the Service User or their family. If the MDS does not have a pharmacy
label attached it will be a Service User or family-filled MDS.
Service User or family-filled MDS CANNOT be used when administering as it is unlikely
that the Care Worker/Personal Assistant will be able to identify each individual
medication or the instructions for each one. It can be used when prompting or assisting.
A pharmacist or dispensing doctor filled MDS which has been labelled can be used when
administering provided that each medicine can be identified at the time of administration.
This can be achieved by using a separate MDS card for each medicine or by providing
information on the card/label about each medicine e.g. colour, size, shape, markings
where the MDS contains several medicines.
MDS works well when a Service User’s medication is regular and does not change
frequently. Providers and Care Workers/Personal Assistants must consider carefully
how any changes in medication can be quickly dealt with by the supplying pharmacy.
This may involve:
 Introducing new medication into the pack
 Removing medications from the pack.
MDS can only be used for tablets and capsules, but some are not suitable and the
following should not be put into MDS:




Medication that is sensitive to moisture, e.g. effervescent tablets
Light-sensitive medication e.g. chlorpromazine
Medication that should only be dispensed in glass bottles, e.g. glyceryl trinitrate (GTN)
Medication that may be harmful when handled, e.g. cytotoxic products like
methotrexate
 Medication that should only be taken when required, e.g. painkillers
 Medication whose dose may vary depending on test results, e.g. warfarin.
 ‘as required’ medication.
The NHS may not fund MDS and suppliers of medication (Pharmacists, dispensing GPs)
do not have to provide a MDS except when the Service User is assessed as requiring it
to self-medicate under the Disability Discrimination Act 2005. If agency policy includes
the use of a MDS, then the agency must pay for this service. In other circumstances the
Service User may be asked to pay for the equipment.
Appropriate paperwork must be completed by the Service User and the Pharmacist for
the medication to be dispensed in a MDS.
13.1 Assistive Technology and Telecare Solutions
Telecare products are designed to help people live at home independently in their own
home and provide support and reassurance to Carers. There is a range of technology
available which can support a Service User with prompting and/or assisting medication. It
will not administer medication.
Please see the Medication Prompting – A Home Safety Service Guide (in the Practice
Guidance Library section of EASI on the Essex County Council Intranet) or click on the
Page 55 of 142
document below to open a word version.
Medication Support
Methods.doc
For general information on Telecare Solutions please see the Essex County Council
Website page for Staying Independent
14.5 Changes in Medication
STANDARD 10 – All changes to medication must be clearly documented in the
Medicines Administration Record or Daily Communication Sheet
Those responsible for administering medication may only do so in accordance with
written instructions or confirmation from the appropriate health care professional. Care
Workers/Personal Assistants must not accept verbal orders to change medication or vary
dosage. All changes must be recorded on the MAR as soon as written confirmation is
received.
If the change in medication significantly affects the support or care provided, the
Manager or Practitioner/Facilitator should be consulted as it may be necessary to review
the Support Plan Summary.
Page 56 of 142
15 Possible Side Effects
Objectives
At the end of this section you will;

Recognise signs which could be a side effect of medication

Know what to do if you suspect the Service User is suffering from any side effects

Know what to do if any mistakes are made in relation to medication or related tasks
Assessment method
1.
Complete worksheet 13
Guidance
Side effects normally appear at the start of taking a course of medication and not further
on in the treatment. Suspected side effects and adverse reactions must be recorded and
the GP must be contacted. The GP may decide the benefits of treatment outweigh the
problems, or they may decide to stop or change the treatment.
Side effects and adverse events can also be reported to the Medicines and Healthcare
products Regulatory Agency (MHRA) using a Yellow Card, it is normally the GP that
does this, however anyone can. The card is in the back of the BNF (British National
Formulary) book or can be done online at www.yellowcard.gov.uk
Signs to be aware of are:
















Falls
Drowsiness and confusion
Incontinence
Diarrhoea
Constipation
Cold hands and feet
Tremor
Abdominal pain
Skin rashes
Breathing difficulties
Swellings
Nausea
Vomiting
Stiffness
Headaches
Weight gain
The above list is not exclusive, if it is suspected that something may be wrong, the line
manager should be advised as soon as possible.
Further information about medication prescribed for the Service User will be found in the
‘Patient Information’ leaflet which should come with each container of medication. Care
Page 57 of 142
Workers/Personal Assistants are encouraged to read the ‘Patient Information’ leaflet for
each medication prescribed for the Service User to be aware of the possible side-effects.
Where medication is supplied in Monitored Dosage Systems, the Pharmacist should
provide a copy of the ‘Patient Information’ leaflet for each medication within the pack.
Ask the Pharmacist for these if they are not available to you or the Service User. These
Patient Information leaflets must be current, new leaflets should be provided at each
dispensing.
Page 58 of 142
16 Errors with Medication and Related Tasks
Objectives
At the end of this section you will;

Understand what is classed as an error with medication

Know what to do if any errors are made, or suspected, in relation to a Service User’s
medication or with any related tasks
Assessment method
1.
Complete worksheet 14
Standard and Guidance
STANDARD 11 – A clear policy should be in place detailing action to be taken in
the event of errors occurring.
Errors can occur in prescribing, dispensing, prompting, assisting or administering
medication. Most medication errors do not harm the individual although some can have
serious consequences. Care Workers/Personal Assistants must report errors in the
prompting, assisting or administering of medication and related tasks to their line
manager, this may result in appropriate further training and competence testing. It is
important that errors are recorded and the cause investigated to learn from the incident
and prevent a similar error happening in future. Failure to follow these guidelines could
result in a safeguards alert being raised. Examples of administration errors are:





Wrong dose is given, too much or too little
Medication is given at the wrong time
Medication is not given
Medication is given more than once
Medication is given to the wrong person (a criminal act if deliberately done)
If a Care Worker/Personal Assistant is aware of having made an error in prompting,
assisting or administering medication or notices that an error has been made, the
following action must be taken:
 Seek advice from the GP, appropriate Healthcare Professional or A&E. Some errors
may appear trivial, e.g. omitting a dose of paracetamol or antibiotics, however, since it
is not appropriate for a Care Worker/Personal Assistant to gauge the seriousness,
advice from a professional must be sought. Medication errors must not be treated as
trivial and must all be reported.
 Notify the line manager.
 Enter details of the error on the MAR or Daily Communication Record Sheet including
a note of any changes or deterioration in the Service User’s health or behaviour.
Page 59 of 142
The line manager must:
 Notify the Care Quality Commission of the error in writing, this comes under Care
Quality Commission Regulation 37 and applies to Essex County Council and external
agencies. Please see the document - Guidance for providers: How to tell us about
notifiable events for further information. Regulation CH 37 (1)(e), AP 33 (3) (e), covers
any event which adversely affects the well-being or safety of any person using the
service and includes ‘an error in administration of prescribed medication that leads
to a medical consultation’. The timescale for reporting is ‘Without delay’ for Care
Homes and ‘Within 24 hours of becoming aware’ for others.
 Consider raising a Safeguards alert following the procedures of the organisation.
 Inform the Service User’s Practitioner/Facilitator.
 Investigate the cause of the incident.
If serious negligence or an attempt to cover up an error is discovered, this should be
treated as a disciplinary offence and the safeguards alert process should be followed,
including informing the Police. This may result in legal action against the Care Worker,
their employer or both.
Errors should not be ignored. A culture that allows staff to report incidents without the
fear of an unjustifiable level of recrimination must be encouraged by:
 Having a clear incident reporting system
 Investigating reports to learn from the incident and decide whether there is a need to
offer training to an individual or review existing procedures in order to prevent a similar
error happening in the future
 Recording any action taken
 Reporting serious incidents to the regulatory body.
Page 60 of 142
17 Storage of Medication
Objectives
At the end of this section you will;

Understand the principles involved in the storage of medication

Understand factors which can affect the stability of medication

Know how to ensure that all medication in the working environment is stored safely
and appropriately

Be able to interpret manufacturer’s instructions regarding expiry dates
Assessment method
1.
Complete Worksheets 15, 16 and 17
2.
Examine medication either in the Care Worker’s/Personal Assistants own home or
those belonging to a Service User. Discuss the storage of this medication.
Standard and Guidance
STANDARD 12 – All medication must be stored in a manner consistent with the
care setting, requirements of individual medications and taking account of all
relevant legislation
In a person’s own home
The Service User (or designated person when the Service User lacks capacity) will be
responsible for the safe keeping of the medication and will decide where and how to
store it. Guidance should be offered by the Practitioner/Facilitator as part of the risk
assessment carried out during the assessment and subsequent reviews. The Service
User should be advised to keep medication away from children in their own homes, and
to keep external preparations separate from internal medication to avoid them being
ingested accidentally.
Permanent storage sites should not be located near to a heat source or within a humid
environment. Precautions should be in place to maintain appropriate stocks of
medication dependent upon need.
In residential care homes and day centres
All medication which can be stored at room temperature must be stored in a lockable
cupboard or tethered lockable trolley which must be attached to a secure position when
not in use. It should be large enough for the medication belonging to each Service User
to be kept separately and must only be used for medication and items for related tasks.
Ideally, internal and external medications should be stored in separate cupboards/
trolleys, but a compromise would be to store them on separate shelves, with the external
medication below the internal medication. The cupboard/trolley keys must not be part of
the master key system and only authorised staff may access the medication key system.
The positioning of medication cupboards/trolleys should be determined by ease of
access when dealing with medication whilst being mindful of the need for security. The
storage site should be below 25 degrees centigrade and the temperature should be
Page 61 of 142
monitored using a minimum/maximum thermometer to ensure this and recorded.
Controlled drugs should be stored in a separate, lockable cupboard that complies with
the Misuse of Drugs (Safe Custody) (amendment) Regulations 2007. Only staff with
authorised access to the drug cupboard should hold the keys, which should never be
given to a member of staff who is not permitted to access controlled drugs. The keys
must be kept on the person of a designated member of staff at all times and signed for at
each changeover of staff in a book kept especially for this purpose.
Service Users who self-medicate should be provided with a personal lockable drawer or
cupboard to store their medication, a risk assessment should be in place to cover this.
17.1 Refrigerated Storage
Some medication must be stored in a refrigerator e.g. antibiotic syrup, because at room
temperature they break down or ‘go off’. The temperature of the fridge should be 2-8ºC.
The ‘Patient Information Leaflet’ supplied with the medication will state whether it needs
to be kept in a fridge. Care Workers/Personal Assistants who administer medication in
the Service User’s home should, after asking permission, check that the fridge is working
correctly if it is used to store medication. If there appears to be a problem, the Care
Worker/Personal Assistant should advise the Service User and consult with the GP,
Pharmacist or their line manager.
Manufacturers specify that some creams and ointments are to be stored in a “cool place”
(below 15 degrees centigrade), this does not necessarily mean a refrigerator. For advice
regarding storage contact the dispensing Pharmacist.
In residential care homes and day centres
Medication that requires refrigeration should be stored in a lockable refrigerator reserved
solely for medication or in small homes and day centres, in a locked container in the
fridge. The temperature must be monitored and recorded on a daily basis, if it falls
outside this range, Managers must be notified.
17.2 Causes of deterioration in Medication
During storage medication may be subject to chemical reactions which can lead to their
deterioration. This is because a medication is almost always a mixture of active
ingredients, which may in time interact with each other. This may cause a loss of
effectiveness or an increase in its side effects. Bacterial growth may occur due to the
breakdown of the preservative or physical changes may occur causing it to appear
cloudy or a change of colour or odour, however, chemical changes can occur in a
medication without any alteration in its appearance.
Changes in medication and the speed with which changes may occur are affected by its
storage conditions which include temperature, humidity, light and atmospheric gases. It
is essential to follow the manufacturer’s instructions regarding storage conditions.
17.3 Factors affecting stability of Medication
(a) Temperature
The rate of most chemical reactions is increased with temperature. In general,
medication should be stored in cool places, but be sure to follow the storage instructions
which can be found on the packaging, containers or accompanying leaflets. The
Page 62 of 142
instructions may include any of the following:
Store at room temperature
15°C - 25°C
Store in a cool place
less than 15°C but not necessarily in a fridge
Store in a refrigerator
2°C - 8°C
Therefore, always avoid leaving or storing drugs above radiators or hot water pipes, near
ovens or near windows in direct sunlight.
(b) Humidity
Medication is usually most stable in a dry form. Therefore tablets are more stable than
liquids and often have longer expiry dates. Tablets and powders will deteriorate more
quickly if in contact with water or damp or steamy conditions, therefore, always avoid
storing medication in kitchens or bathrooms. It is very important to always replace lids of
tablet bottles securely after use. Sometimes manufacturers provide desiccants (moisture
absorbing crystals) in containers to keep the capsules or tablets dry, ensure that these
are not thrown away and that the Service User is aware and does not confuse it with the
medication.
(c) Light/Oxygen
Discoloration of medication is often caused by the effects of air on the medication. This
effect is speeded up in the presence of light. Medication should therefore be stored in
dark conditions whenever possible i.e. not in glass fronted cupboards.
Page 63 of 142
18 Transfer of Medication
Objectives
On completion of this section you will:

Understand how to maintain continuity of care when a Service User transfers to
another care setting

Know which records need to be transferred with the Service User
Assessment method
1.
Complete Worksheet 18
Standard and Guidance
STANDARD 13 – Providers must have a clear policy in place detailing the action to
be taken with respect to medication if a Service User is transferred between care
settings or is to be away from their usual place of residence.
18.1 Transferring medication when people move
People who receive social care support may need to transfer to another care setting.
Transfers include:



Hospital admission
Respite care in a social care setting
Permanent move to a residential care home or nursing home.
When a Service User transfers to another care setting, to ensure continuity of care it is
essential that a copy of the Service User’s Support Plan and/or Support Plan Summary
and their medication goes with them. A record of medication that was sent with the
Service User should be provided and include the following information:




Date of transfer
Name and strength of medication
Quantity
Signature of the member of staff who arranged the transfer of the medication.
Where Care Workers/Personal Assistants are responsible for administering medication, a
copy of the MAR is also essential and must go with the Service User to inform the new
Provider which medication is taken and whether the Service User refuses to take any.
18.2 Returning from hospital stays
All people discharged from hospital should have complete documentation listing all their
medication at the time of discharge as this may have changed considerably from the
medication that was taken into hospital. The hospital staff will inform the Service User’s
GP. If the Care Worker/Personal Assistant is responsible for administering the Service
User’s medication they should:
Page 64 of 142




Let the supplying pharmacy know the changes as soon as possible
Prepare a new MAR chart or Daily Communication Record Sheet if this has not
already been supplied by the Pharmacist
Dispose of any unwanted or discontinued medication by returning it to a pharmacy
Request a new prescription as soon as possible.
If a MDS is normally used, or the hospital Pharmacist assesses it as being necessary,
the hospital Pharmacist should dispense a new supply in the appropriate system at the
time of discharge and liaise with the Community Pharmacist.
18.3 Whilst away from home
When a Service User leaves their home, such as to go on holiday, to attend day care or
education, it is essential that the medication required during the time they will be away is
taken with them. It may be necessary to arrange alternative packaging of the medication
in which case a separate prescription to cover this period will be needed. Risk must be
assessed by the Practitioner / Facilitator as part of the Support Plan Summary.
If a Service User regularly leaves their home then discussion with their Healthcare
Professional should take place to see whether the time the medication is taken could be
adjusted to suit the Service User’s way of life. Transporting medication should be kept to
a minimum and safe alternatives discussed with the appropriate professionals.
The Care Worker/Personal Assistant should continue to record the prompting, assisting
or administration of the Service User’s medication using the appropriate recording
practice. The quantity of medication taken outside the home should also be recorded.
When Care Workers/Personal Assistants carry medication on their person or in a vehicle
they should ensure a risk assessment is carried out by their line manager and that their
insurance cover is appropriate.
Page 65 of 142
19 Disposal of Medication
Objectives
On completion of this section the Care Worker/Personal Assistant will be able to:

Understand when medication should be disposed of

Understand how to interpret the expiry date

Know what information to record on the MAR chart or Daily Communication Record
Assessment method
1.
Complete Worksheets 19 and 20
Standard and Guidance
STANDARD 14 – A clear policy should be in place detailing the action to be taken if
medication needs to be disposed of.
Situations when medication might need to be disposed of include:
 A Service User’s treatment is changed or discontinued - with the Service User’s
consent the remaining supplies should be returned to the Pharmacist
 A Service User transfers to another Provider - they should take all of their medication
with them, unless they agree to dispose of any that are no longer needed
 A Service User passes away - The Service User’s medication records should be kept.
In residential care homes the medication should also be kept for seven days in case
the Coroner’s Office or courts ask for them
 The medication reaches its expiry date - some expiry dates are shortened when the
product has been opened, for example eye drops. When applicable, this is stated in
the Patient Information Leaflet (PIL).
It is essential that the manufacturer’s instructions regarding expiry dates are strictly
adhered to.
‘Use by March 2012’ means do not use after 31 March 2012.
’Expiry date March 2012’ means do not use after 31 March 2012.
‘Use before March 2012’ means do not use after the last day of February 2012.
Expiry dates should be checked regularly. Many antibiotic syrups and some other
liquids have quite short expiry dates. Eye drops, once opened, must be discarded
after 28 days as sterility cannot be maintained and infection could be introduced into
the eye. Some tablets that are prescribed to treat angina have an 8-week life once the
bottle has been opened. Once opened clearly write the date of opening on the label.
Where a Service User in their own home is managing their medication, they are
responsible for safe disposal but the Practitioner/Facilitator or Care Worker/Personal
Assistant may advise.
Where the Care Worker/Personal Assistant is responsible for managing the medication,
Page 66 of 142
they must record the disposal of surplus, unwanted, refused, expired, dropped or spilt
medication.
An individual dose of medication removed from the container and subsequently not
administered must be disposed of safely. It must not be returned to the container.
Best practice denotes;


where only one or two tablets need to be disposed of, the Care Worker/ Personal
Assistant can do this by flushing them down the toilet. Wherever possible ask
someone to witness the disposal and sign the medication form, MAR chart or Daily
Communication Record.
larger quantities of medication are disposed of by placing them in either a container
or a sealed envelope and returning them to the Pharmacist, who will ensure they are
disposed of in accordance with current waste regulations. Good practice would
dictate that the form is signed by the pharmacy receiving the drugs for destruction to
complete the audit trail.
Permission for the removal of any medication should be obtained from the Service User
and recorded on the appropriate medication form as agreed in the Support Plan
Summary.
The following details should be recorded on the MAR or Daily Communication Record:





Date of return to pharmacy
Name and strength of medication
Quantity removed
Name of the person for whom medication was prescribed or purchased
Name and signature of the Care Worker/Personal Assistant who arranged disposal
Nursing care homes must dispose of medication using a licensed waste management
company and not a Community Pharmacist. Additional advice is provided by:
Care Quality Commission - Safe disposal of waste medicines from care homes (nursing)
Department of Health - Health Technical Memorandum 07-01: Safe Management of
Healthcare Waste
19.1 Disposal of Controlled Drugs
Controlled Drugs dispensed individually for a patient must be returned to the supplying
Pharmacist or dispensing doctor for disposal. Full records must be kept. There are
additional legal requirements for disposal of controlled drugs, for more information
reference should be made to the Department of Health policy - Safer management of
controlled drugs: guidance on the destruction and disposal of controlled drugs
Page 67 of 142
20 Homely Remedies
Objectives
On completion of this section you will:

Understand what is meant by a ‘Minor Ailment’ and ‘Homely Remedies’

Know how minor ailments are treated

Know when a Service User can take a homely remedy
Assessment method
1.
Complete Worksheet 21
Standard and Guidance
STANDARD 15 – A policy should be in place detailing arrangements around
“Homely Remedies”.
Anyone can buy ‘homely remedies’ from a suitable shop, often referred to as ‘over the
counter’ medication, for example, paracetamol for a headache. They are treatments for
minor ailments and are not prescribed for an individual.
If a Service User has capacity and decides to take a homely remedy, a Care Worker/
Personal Assistant can assist them with their requirements, but cannot offer advice. An
appropriate record must be made on the Daily Communication Record Sheet.
Homely remedies cannot be administered to a Service User who lacks capacity to make
a decision about taking the medication, unless it is part of the Support Plan Summary. If
a homely remedy is given to a Service User in line with the Support Plan Summary a
record must be made on the MAR.
When a Service User takes any non-prescribed homely remedies the recorded details
should include;





name of the medication
dosage
time given
reason the Service User took the homely remedy
name and signature of the Care Worker/Personal Assistant.
Service Users who purchase their own medication should be encouraged to tell Care
Workers/Personal Assistants when and what they have taken, details of this should also
be recorded. The Service User should also be encouraged to confirm with a GP or
Pharmacist that the medication they have purchased is compatible with any prescribed
medication that they are taking.
Herbal remedies must be treated the same as homely remedies. They are often thought
to be completely safe in all circumstances, however many herbal remedies are very
potent and can react with prescribed medication.
Page 68 of 142
Symptoms appearing to be minor may be indicative of a more serious condition;
treatment should not extend beyond 48 hours unless agreed by the GP. Care Workers /
Personal Assistants must be alert to any possibility of overdose such as paracetamol
found in many headache or cold remedies.
If unsure, consult the Pharmacist.
In a residential care home or day care services, a range of products agreed with the GP
or Pharmacist may be held in store for the treatment of minor ailments for named
individual Service Users. Homely remedies should be stored in a locked medication
cupboard but in a separate section from the prescribed medication.
20.1 Situations where a Service User may be prompted or assisted to
use homely remedies
Symptom /
problem
Possible treatment Comments
Mild pain
Paracetamol, (not
aspirin which may
cause bleeding and
fluid retention)
Check that any prescribed medication being
taken does not contain paracetamol as this
could lead to an overdose.
Cough
Simple linctus
Proprietary brands
1. See GP if signs of infection – yellow or green
sputum.
2. Proprietary brands may contain stimulants.
3. If remedy contains codeine it may cause
constipation.
4. Service User may find it useful to use linctus
containing expectorant.
5. If Service User is diabetic, linctus must not
contain sugar.
Mild diarrhoea Fluid replacement
1. May have complex causes, if not easily
resolved check with GP.
24 hour fast
2. Kaolin and morphine is often popular with
Kaolin
Service Users but is not necessarily a good
Loperamide
choice.
Rehydration with oral
rehydration sachets 3. Initial treatment would normally be a 24 hour
fast and fluid replacement.
Constipation
Long term use of
1. Constipation may be a side effect of
stimulant laxatives is
prescribed medication.
not appropriate.
2. Best to seek advice and not use homely
Dietary consideration
remedy.
is important
3. Ensure adequate fluid intake.
Page 69 of 142
Indigestion,
heartburn
Magnesium
compounds
Aluminium
compounds
Proprietary
preparations
Haemorrhoids Soothing cream or
suppositories,
proprietary
preparations
1. Pain in chest area can be due to angina or
myocardial infarction (heart attack). Ensure
these are not the cause.
2. Many antacids have high sodium content –
may need to check with GP if this is a
problem.
3. Magnesium preparations tend to loosen
stools whereas aluminium preparations tend
to constipate.
1. May be combined with other symptoms
which need medical attention such as
constipation, diarrhoea, high blood pressure.
2. May cause bleeding which leads to other
problems – consult GP.
3. Be careful of proprietary preparations which
contain local anaesthetics as these can
cause sensitisation.
4. Some products contain steroids and the
maximum period of use is 7 days.
1. Check whether dentures fit properly or
whether there are signs of gum recession on
natural teeth, refer to dentist if necessary.
2. Is the tongue raw? This can be a sign of
vitamin deficiency.
3. Are there any signs of infection such as
thrush.
4. Ulcers which are difficult to heal should be
seen by a GP or dentist.
Sore mouth
Oral hygiene
preparations
Skin rashes
Emollients
Calamine
Cool bath
1. Do not use antihistamines or local
anaesthetics as these can cause sensitivity.
2. Consider whether the rash is drug- related.
Sunburn
Calamine lotion
Proprietary
preparations
1. Calamine may be messy but it is effective.
2. Use proprietary after-sun preparations if mild
sunburn.
3. Check whether light sensitivity may be due to
other medication being taken e.g.
amiodarone or chlorpromazine
4. Use a sunscreen to prevent the sunburn
happening.
Page 70 of 142
21 Drug Formulation and ways of taking it
Objectives
On completion of this section you will:

Understand the different types of medication available

Understand the different methods for using/taking medication
Assessment method
1.
Complete worksheets 22, 23, 24 and 25.
2.
Examine a range of medication and discuss the types of medication found and how
they are used/taken.
Guidance
Most medication is specially prepared in a form designed for convenience of taking and
to ensure that doses are accurate. Other forms of medication are designed to make
taking the medication as easy as possible, for example most children and some adults
cannot swallow tablets and therefore need a liquid preparation.
Some Service Users may need to have a drug administered by injection, suppository or
nasogastric/PEG tube, all of which fall under "Level 3 - Specialist Tasks"- additional
training and competency testing is required before these tasks can be undertaken.
21.1 Types of Medication
It is useful to understand the importance of some types of medication prescribed and
administered to individuals, for example:











Antibiotics - used to fight infection
Analgesics - used to relieve pain
Anti-histamines - used to relieve allergy symptoms, e.g. hay fever
Antacids - used to relieve indigestion
Anti-coagulants - used to prevent blood clotting e.g. for thrombosis, following heart
attack, during some surgical procedures
Psychotropic medication - used to treat depression
Diuretics - used to get rid of excess fluids in the body
Laxatives - used to alleviate constipation
Hormones e.g. insulin, steroids, hormone replacement therapy (HRT)
Cytotoxic medication - used to treat some forms of cancer
Anti-cholinesterase inhibitors - used to treat some forms of dementia.
21.2 Oral Preparations
The most convenient and frequent route of taking medication is orally i.e. by mouth, this
includes tablets, capsules and some liquids such as syrups and sprays. The drugs in the
medication are absorbed into the bloodstream through the walls of the intestine.
Page 71 of 142
21.2.1
Tablets
These are solid dose forms containing one or more drug compressed into various
shapes. In most instances they also contain other ingredients necessary for their
manufacture, disintegration or appearance. Some tablets are film-coated or sugar-coated
e.g. ibuprofen. This is usually to disguise the unpleasant taste of the tablet.
Do not break a tablet unless it is scored as this may cause incorrect dosage,
gastrointestinal irritation or destruction of a medication in the stomach.
Slow release tablets In some tablets the active ingredient is released slowly to produce
a prolonged effect after the tablet has been swallowed whole. These tablets may be
referred to as sustained-release (SR), long acting (LA) or modified release (m/r). The
difference between sustained release and modified release tablets is only a matter of
degree, the British National Formulary (BNF) now refers to all tablets which have some
mechanism to control the release of the active ingredient as modified release.
It is important not to break, crush, bite or chew this type of tablet because controlled
release, long acting, sustained or slow release preparations are designed to release the
medication more gradually than standard formulations. The intention is that they last
longer and may not need to be taken so often. If they are ‘broken’, more of the
medication is released and the absorption rate will be altered, this could:



Increase the chance of side effects
Lead to poor compliance as it may taste unpleasant
Lead to failure of the treatment as the effect is not lasting as long as it should.
The Care Worker/Personal Assistant should ask the Service User to swallow these whole
and not to chew them.
Examples include:Voltarol retard
Inderal LA
Adalat retard
diclofenac SR 100mg tablets or 75mg tablets
propranolol 160mg SR capsules
nifedipine m/r 20mg tablets or 10mg tablets
Enteric-coated tablets Some drugs can irritate the stomach and cause indigestion, e.g.
aspirin, diclofenac, prednisolone. In many cases these tablets are covered with an
enteric-coating. This coating only breaks down when the tablet reaches the small
intestine, this prevents the tablet disintegrating in the stomach and causing irritation.
Therefore it is important not to break, crush, bite or chew this type of tablet, ask the
Service User to swallow these whole and not to chew them.
21.2.2
Capsules
The drug is enclosed in a gelatin shell which breaks down after the capsule is swallowed,
releasing the drug. Capsules can be in a modified release form similar to tablets.
21.2.3
Liquids
Liquids can occur as syrups, solutions, mixtures or suspensions. In a suspension the
drug is dispersed within the liquid but not dissolved. All suspensions must be shaken
before taking to ensure that the drug is evenly distributed throughout the bottle, this
prevents overdosing or under dosing.
Page 72 of 142
21.2.4
Sub-lingual and Buccal tablets and sprays
Sub-lingual tablets e.g. Glyceryl Trinitrate (GTN) are designed to be dissolved under the
tongue and are absorbed into the blood stream very quickly. GTN is also available in a
spray, which is also used under the tongue. This route is used when a rapid effect is
required or when the drug is broken down significantly in the gastro-intestinal tract or
liver before reaching the blood stream.
Buccal tablets e.g. Suscard® are placed between the upper lip and gum and left to
dissolve. Good practice would be to use a different site each time to avoid dental caries.
They produce a prolonged effect unlike sub-lingual tablets.
21.3 Rectal Preparations
21.3.1
Suppositories
Suppositories are solid unit dose forms suitably shaped for insertion into the rectum. The
rectal route is used either for a local effect e.g. Anusol® for haemorrhoids or for a
general effect e.g. diclofenac for an anti-inflammatory action. In certain situations a drug
cannot be given orally and the rectal route may be an alternative e.g. Service User is
vomiting or unconscious.
21.3.2
Enemas
Enemas are solutions, suspensions or emulsions which are packed in a special container
designed to assist the insertion of the solution into the rectum e.g. Predenema® for
ulcerative colitis/Crohn's disease, Relaxit® for constipation. The majority of enemas
produce a local effect.
21.4 Injections
Administration of drugs by injection usually produces a rapid response and this method
can be life saving in emergencies. In all cases the solutions for injections are sterile
preparations of a drug dissolved or suspended in liquid. There are various types of
injection:
21.4.1
Intravenous
The drug is injected directly into the vein and therefore directly into the bloodstream.
21.4.2
Intramuscular
The drug is injected into a muscle.
21.4.3
Sub-cutaneous
The drug is injected under the surface of the skin e.g. most insulins.
21.5 Topical Applications
Conditions affecting the skin, ears, nose, eyes and vagina are best treated using drugs
applied directly to the area involved, this produces the maximum effect with the minimum
of side effects. However, in order to do this the instructions should be followed carefully
avoiding a higher dose than recommended or application for longer than necessary.
21.5.1
Skin preparations
Cream - non-greasy, water-based preparation used to apply drugs to an area of the body
or to cool or moisten skin. They usually have a preservative to reduce growth of bacteria.
Page 73 of 142
Ointment - greasy preparation used to apply drugs to an area of the body or to act as a
protective layer or relieve dry skin conditions. These also contain a preservative.
If applying medication to the skin, gloves must be used for protection and also to prevent
cross-infection. These medications are directly absorbed through the skin and if not
protected, Care Workers/Personal Assistants will also absorb the medication.
21.5.2
Ear drops
These are solutions or suspensions of drugs for instillation into the ear.
21.5.3
Nasal drops/sprays
These are usually simple solutions of drugs in water and are intended for instillation into
the nostrils for their local effect.
21.5.4
Eye drops
These are sterile drug solutions or suspensions for instillation into the eye. They are
used for antibacterial, antiviral, anaesthetic, anti-inflammatory, glaucoma or diagnostic
purposes. Contamination during application must be avoided.
Eye drops must be discarded within 4 weeks (28 days) after first opening or earlier if
directed to do so in the patient information leaflet.
21.5.5
Pessaries
Solid dose forms suitably shaped for inserting into the vagina where they dissolve or
melt. This route is used for a local effect e.g. Canesten® pessaries for vaginal thrush.
21.6 Patches
These are applied to skin where the drug is absorbed into the blood stream to produce a
systemic affect e.g. pain control, Hormone Replacement Therapy (HRT), Glyceryl
Trinitrate (GTN).
21.7 Inhalation
Drugs used to treat asthma e.g. Salbutamol, are inhaled for a direct effect on the
respiratory tract. There are many different types of inhaler, the correct technique for their
use is vital to ensure an adequate dose reaches the lungs. For this reason different
inhalers may suit different people. Examples of inhaler types include:
Metered dose aerosol inhaler (MDI)
i.e. Cyclohaler® Diskhaler® Turbohaler® Accuhaler®. The drug inside the inhaler
goes straight into the airways, therefore, a much smaller dose is needed than when the
drug is taken as a tablet or liquid by mouth. The airways are treated, but little of the drug
gets into the rest of the body therefore, side-effects are unlikely to occur, or are minor. In
the treatment of asthma, the drugs inside inhalers can be grouped into 'relievers',
'preventers' and 'long acting bronchodilators'.
Relievers - contain bronchodilator drugs
Reliever inhalers are taken 'as required' to ease breathless or wheezy symptoms. The
drug in a reliever inhaler relaxes the muscle in the airways which opens the airways
wider, and symptoms usually quickly ease. These drugs are called bronchodilators as
they dilate (widen) the bronchi (airways). There are several different reliever drugs, for
example, salbutamol and terbutaline, these come in various brands made by different
Page 74 of 142
companies. There are different inhaler devices that deliver the same reliever drug.
Generally, reliever (bronchodilator) drugs tend to be put in blue or grey inhaler devices.
If the symptoms only occur every 'now and then', then the occasional use of a reliever
inhaler may be all that is needed. However, if a reliever is needed to ease the symptoms
three times a week or more, a preventer inhaler is usually advised.
Preventers - usually contain a steroid drug
These are taken every day to prevent symptoms from developing. The drug commonly
used in preventer inhalers is a steroid of which there are various brands. Steroids work
by reducing the inflammation in the airways, when the inflammation has gone the
airways are much less likely to become narrow and cause symptoms. Inhalers that
contain cromoglycate or nedocromil drugs are sometimes used as preventers, however
they do not usually work as well as steroids. It takes 7-14 days for the steroid to build up
its effect, therefore it will not give any immediate relief of symptoms. However, after a
week or so the symptoms have often gone, or are much reduced. It can take up to six
weeks for maximum benefit, after which a reliever inhaler may not need to used very
often, if at all. Again, there are often different inhaler devices that deliver the same drug.
Generally, preventer drugs tend to come in brown, orange, or red inhaler devices.
Long acting bronchodilators
The drugs in these inhalers work in a similar way to 'relievers', but work for up to 12
hours after taking each dose, they include salmeterol and formoterol and may be
prescribed in addition to a steroid inhaler if symptoms are not fully controlled by the
steroid inhaler alone. Some brands of inhaler contain a steroid plus a long acting
bronchodilator for people who need both to control their symptoms.
Solutions/suspensions for nebulisation
This is a more concentrated solution of the drug, which can be given via a nebuliser in an
acute asthma attack, or occasionally they may be used on a more regular basis
particularly in COPD. During an acute attack it is often difficult to use ordinary inhalers
and the dose from an inhaler may be too small to have adequate beneficial effects.
21.8 Recognised dose abbreviations
At times, the following abbreviations/Latin may be seen:
Abbreviation
a.c.
b.d. or b.i.d.
o.d.
o.m.
o.n.
p.c.
q.d.s
q.q.h.
Stat
t.d.s.
t.i.d.
Latin full name
Ante cibum
Bid die or bis in die
Omni die
Omni mane
Omni nocte
Post cibum
Quarter die summendus
Quarta quaque hora
Statim
Ter die sumendus
Ter in die
Page 75 of 142
Instructions
To be taken before food
Twice a day
Every day
Every morning
Every night
After food
To be taken 4 times a day
Every 4 hours
At once
To be taken 3 times a day
3 times a day
21.9 Additional Procedures
21.9.1
Oral Preparations
To ensure that only the tablets/capsules required at this time are taken transfer the
required number into an appropriate container from the bottle or strip pack.
If the tablets/capsules are in a monitored dosage or compliance pack open the required
section and empty the tablets/capsules into an appropriate container.
The level of support will vary from handing the container to the Service User to placing
the tablets into the Service User’s mouth if a physical disability prevents them from
undertaking this task. The level of support will be detailed in the Support Plan Summary.
Where the Care Worker/Personal Assistant is taking responsibility for administration of
medication the identity, quantity and dosage must be confirmed before administering by
referring to the information on the label and the MAR.
If the medication is a syrup or mixture, prevent cross-infection by using the medicine
spoon or medicine syringe that the Pharmacist provided. Avoid touching the preparation.
When giving liquids in a dose of less than 5ml, or when an accurately measured dose in
multiples of 1ml is needed, an oral syringe should be used in preference to a medicine
spoon or measure as it is much more accurate and will make measuring the correct dose
much easier. Oral syringes are washable and re-usable.
Correct use of the oral syringe is very important. The tip should be gently pushed into
and towards the side of the mouth. The contents are then slowly discharged towards the
inside of the cheek, pausing to allow the liquid to be swallowed.
21.9.2
Ear drops
1. If the ear drops are a suspension, shake the bottle before using the drops.
2. Take the lid off the bottle.
3. Ask the Service User to tip their head to one side or lie on their side so that the
affected ear is facing upwards.
4. Gently pull the ear lobe away from the neck.
5. Hold the bottle or dropper over the ear opening and gently squeeze the correct
number of drops into the ear.
6. Ask the Service User to keep their head tipped or to stay lying on their side for a few
minutes to let the drops spread into the ear canal.
7. Wipe away any excess liquid with a clean tissue.
8. Repeat this procedure for the other ear if the doctor or Pharmacist has advised this.
9. Replace the lid on the bottle.
10. Take care not to touch the tip of the bottle or dropper. If the dropper is separate don't
put it down on any surface.
21.9.3
Nose drops
1. If the nose drops are a suspension, shake the bottle before using the drops.
2. Ask the Service User to gently blow their nose so their nostrils are clear.
Page 76 of 142
3. Take the lid off the bottle (for bottles with an integrated dropper, draw some liquid
into the dropper).
4. Ask the Service User to tip their head back.
5. Hold the bottle or dropper above the nostril and gently squeeze the correct number of
drops into the nostril, taking care not to touch the nose with the bottle or dropper.
6. Ask the Service User to keep their head tipped back for a few minutes to allow the
drops to drain into the back of the nose.
7. Repeat this procedure for the other nostril if the doctor or Pharmacist has advised
this.
8. Replace the lid on the bottle.
9. Take care not to touch the tip of the bottle or dropper. If the dropper is separate don't
put it down on any surface.
21.9.4
Nasal spray
1.
2.
3.
4.
5.
6.
Shake the bottle.
Ask the Service User to gently blow their nose so that your nostrils are clear.
Take the lid off the bottle.
Ask the Service User to tilt their head slightly forward.
Close one nostril by gently pressing against the side of the nose.
Insert the tip of the nasal spray into the other nostril and ask the Service User to start
to breathe in slowly through their nose. Whilst they are still breathing in squirt one
spray into the nostril keeping the bottle upright.
7. Remove the spray from the nostril and ask the Service User to breathe out through
their mouth.
8. Ask the Service User to tilt their head backwards to allow the spray to drain into the
back of the nose.
9. Repeat steps 7 and 8 if a second dose is required in the same nostril.
10. Repeat this procedure for the other nostril if the doctor or Pharmacist has advised
this.
11. Replace the lid on the bottle.
12. Take care not to touch the tip of the nasal spray.
21.9.5
Eye preparations
Management of eye preparations:
1. Ensure eye drops are being stored correctly, some require refrigeration once they are
opened.
2. Check that they are still within the date of use, some are preservative free and have
a much shorter expiry time. It is important that eye drops are dated with the date
opened to ensure the correct expiry date can be calculated.
3. If different eye drops are to be instilled to the same eye, allow a few minutes interval
between to avoid a dilution effect.
4. With combined prescriptions of drops and ointment put drops in first as the greasy
ointment can inhibit absorption of drops.
5. Ensure medication applicators touch no part of the eye to prevent contamination of
the preparation and prevent damage to the eye.
6. Eye preparations should never be shared between Service Users.
Page 77 of 142
Management of hygiene:
1. Strict hygiene precautions must be used, wash hands very carefully with soap and
dry thoroughly on a clean towel before commencing treatment.
2. Great care is necessary to prevent cross infection especially from eye to eye.
3. In cases of infection or inflammation the treatment must be referred to a healthcare
professional.
4. Be gentle and precise in all movements, the eyeball is very sensitive therefore avoid
touching it.
5. Check the preparation to be instilled, use the correct dropper for each eye.
General preparation:
1. Ensure that there is a good light source and that the Service User is not dazzled
2. Explain the procedure to the Service User to encourage co-operation. Make sure
you know which eye or whether both are to be treated.
3. Ensure the Service User is seated or lying comfortably with head supported and neck
slightly extended.
4. Work from behind the Service User as there is less distraction and you will be able to
rest your hand on their forehead.
5. Ask the Service User to look upwards, this effectively moves the eye into a position
which will minimise possible danger of accidental damage.
6. Provide a clean tissue to dab excess fluid.
7. If the eye is encrusted or there is any discharge, contact a Healthcare Professional
immediately. Do not proceed with the instilling any eye medication without further
advice.
Instilling eye drops and ointment
1. Rest two fingers on the skin below the eye and gently draw down the lower eyelid.
2. Ask the Service User to look upwards then squeeze the dropper gently to allow one
drop of solution into the eye near the outer corner, as this will reduce the loss of
solution down the tear duct which is near the inner corner.
3. Ensure the Service User keeps head tilted back while blinking gently without
squeezing the eyelids to retain as much fluid as possible.
4. Dab excess fluid away from cheeks with the clean tissue, but do not rub the eye.
5. Apply ointment using the same procedure, holding the tube clear of the eye while
applying a ribbon of ointment just inside the lid, starting at the inner corner and
moving along to the outer side, if applied correctly it should not cause Service User to
blink.
6. Encourage the Service User to open and close the eye twice in order to get the
ointment on both lids.
7. Observe and report: any redness of eye lids sticky or blood shot eyes any complaints
of pain, discharge or irritation of the eye.
Eye drop applicators
Some Service Users may be given an eye drop applicator of which there are many
varieties. These appliances are designed to help the Service User to instil their own eye
Page 78 of 142
drops. If a Service User has one of these appliances and is experiencing difficulties seek
advice from health professionals.
21.9.6
Patches
Patches are applied to the skin and they have a systemic, not a topical effect i.e. they are
absorbed. The medication they contain is absorbed directly through the skin into the
bloodstream. They look like a sticking plaster and are applied in much the same way. It
is most important that the oestrogen patches used in hormone replacement therapy are
always applied below the waistline.
Assemble the medication and any equipment needed for its application.
Make sure the skin is clean, dry and undamaged, and apply the patch firmly, just like a
plaster; avoid touching the active centre of the patch.
Vary the site of each new application so that the skin does not get sore from repeated
application in the same place.
The major advantage of using transdermal patches is that if the Service User
experiences any side effects, such as a headache with glyceryl trinitrate (GTN) or any
adverse reaction, simply removing the patch should very quickly also remove the
problem. But as with any other medication, always check before taking any action.
It is important to dispose of patches in the correct manner as even used patches contain
some active medication that may harm children or animals. Once the patch has been
removed fold it in half with the sticky side inwards so it sticks to itself, now return the
used patch to its original pouch. Once this has been done the patch can safely be
disposed of in the normal bin for household rubbish.
21.9.7
Inhalers
There are several different types of inhaler available. Make sure you are familiar with the
method for using each Service User’s particular inhaler. If you are concerned about the
use of the inhaler ask your line manager or the Pharmacist for help or advice.
The following instructions apply specifically to the type of inhaler illustrated adjacent to
the text. Make sure you are familiar with the instructions for the type of inhaler that your
Service User has. Ensure that the Service User understands the instructions and follows
them carefully. If necessary go through the instructions with them as they use it.
How to use a metered dose inhaler
1. Remove the cap and shake the inhaler.
2. The Service User should breathe out and
completely empty the lungs.
3. The Service User should put the mouthpiece in the
mouth and start inhaling. At the same time they
should press the canister down at the start of a
slow deep inspiration, continue to inhale deeply
until the lungs are completely full.
4. Hold the breath for about 10 seconds.
5. Wait about 30 seconds before taking another
inhalation.
Page 79 of 142
How to use a spacer device e.g. volumatic
1. Remove the cap, shake the inhaler and insert into
the device.
2. Place the mouthpiece in the mouth.
3. Press the canister once to release a dose of the
drug.
4. Take a deep, slow breath in.
5. Hold the breath for about 10 seconds, then breathe
out through the mouthpiece.
6. Breathe in again but do not press the canister.
7. Remove the device from the mouth.
8. Wait about 30 seconds before a second dose is taken.
How to use a spacer device e.g. Nebuhaler
Method particularly useful for young children.
1. Remove the cap, shake the inhaler and insert into the
device.
2. Place the mouthpiece in the Service Users mouth, be
careful that the lips are behind the ring.
3. Seal the lips round the mouthpiece by gently placing the
fingers of one hand round the lips.
4. Encourage breathing in and out slowly and gently. This
will make a ‘clicking’ sound as the valve opens and
closes. Once the breathing pattern is well established,
depress the canister with the free hand, leave the device
in the same position, allowing breathing to continue.
5. Remove the device from the mouth.
How to use the autohaler
1. Remove protective mouthpiece and shake the inhaler.
2. Hold the inhaler upright and push the grey lever right up.
3. Breathe out gently. Keep the inhaler upright and put the
mouthpiece in the mouth and close lips round it. The air
holes must not be blocked by the hand.
4. Breathe in steadily through the mouth. Don’t stop
breathing when the inhaler ‘clicks’ and continue taking a
really deep breath.
5. Hold the breath for about 10 seconds.
6. Wait at least 60 seconds before taking another inhalation.
N.B. The lever must be pushed up (‘on’) before each dose, and
pushed down again (‘off’) afterwards, otherwise it will not
operate.
Page 80 of 142
How to use the diskhaler
1. Remove mouthpiece cover then remove the white tray
by pulling it out gently and then squeezing the white
ridges either side until it slides out.
2. Put foil disk – numbers uppermost – on the wheel and
slide tray back.
3. Slide tray in and out by holding the corners of the tray
– this will rotate the disk. A number will appear in the
small window. Rotate until number 8 appears, as the
disk contains 8 doses this is a convenient way of
knowing how many doses remain.
4. Keeping the Diskhaler level, lift the rear of the lid and
pull it up as far as it will go. This will pierce the top
and bottom of the blister. Close the lid.
5. Hold the Diskhaler level, breathe out gently and put the mouthpiece in the mouth.
Do not cover the small air holes on either side of the mouthpiece. Breathe in
through the mouth as quickly and deeply as possible.
6. Remove the Diskhaler from the mouth and hold the breath for about 10 seconds.
How to use the Turbohaler
1. Unscrew and lift off white cover. Hold the Turbohaler
upright and twist blue grip forwards and backwards as
far as it will go.
2. Breathe out gently, put mouthpiece between the lips
and breathe in as deeply as possible.
3. Remove Turbohaler from the mouth and hold breath
for about 10 seconds.
How to use the Accuhaler
1. Hold the outer casing of the Accuhaler in one hand
whilst pushing the thumbgrip away until a click is
heard.
2. Hold the Accuhaler with the mouthpiece towards
you, slide the lever away until it clicks. This makes
the dose available for inhalation and moves the
dose counter on.
3. Holding the Accuhaler level, breathe out gently
away from the device, put mouthpiece in mouth and
take a breath in steadily and deeply.
4. Remove Accuhaler from mouth and hold breath for 10 seconds.
5. To close, slide the thumbgrip back towards you as far as it will go until it clicks shut.
6. For a second dose repeat steps 1 to 5.
7. The dose counter counts down from 60 to 0/ the last five numbers are in red.
Note: If the device being used by the Service User is not detailed above, consult with
your Pharmacist.
Page 81 of 142
22 Strengths of Preparation
Objectives
On completion of this section you will:

Understand that there are different ways of describing the same measurement of
medication

Know what the different ways of describing a measurement are
Assessment method
1.
Complete Worksheet 26
Guidance
Strengths of tablets may be written in different ways and it is important to be sure what
has been prescribed. Generally it is good practice to avoid using decimal points and
abbreviations to reduce the risk of errors. In the examples given below the second option
would be the preferred format.
Solids
1g
=
1 gram
1mg
=
1 milligram
=
0.001 grammes
1mcg
=
1 microgram
=
0.001 milligrams
1ng
=
1 nanogram
=
0.001 micrograms
Liquids
1L
=
1 Litre
1ml
=
1 millilitre
=
0.001L
Examples
1:
Digoxin 0.125 mg daily
=
Digoxin 125microgram daily
2:
Alfacalcidol 0.25 microgram od
=
Alfacalcidol 250nanogram od
3:
Levothyroxine 0.1mg od
=
Levothyroxine 100microgram od
If you are at all uncertain about the dose of a medication that is to be given, you must
seek help from your manager or a Pharmacist.
Page 82 of 142
23 Label Interpretation
Objectives
At the end of this section you will be able to:
Describe the legal requirements of a label on a container of medication.

Describe situations when they would seek advice from their line manager or a
Pharmacist.

Describe warning labels and when these may be present
Assessment method
1.
Completion of Worksheets 27 and 28
From the ‘Examples of Labels’ in section 22.4, the assessor will show you 20 labels
for different types of medication e.g. liquid, tablets, capsules, sublingual sprays.
You will be allowed a set period of time to study the labels and must indicate on the
assessment sheet in Worksheet 28 any problems associated with each label.
You will discuss any problems with the instructions on the label and any errors or
omissions which would need to be clarified before the medication could be given.
A score will be awarded for each label according to the following guidelines :1 = Good understanding of drug, dose, form and directions. All errors/
omissions found
0 = Unable to understand instructions and missed errors/omissions.
The pass score will be 100% for 2 consecutive occasions.
If 100% is not achieved, the Care Worker/Personal Assistant must repeat the
assessment after a period of retraining decided by the assessor and the Care
Worker/Personal Assistant until 100% is reached on 2 consecutive occasions.
Additional Assessment sheets can be opened using the icon in Worksheet 28.
Guidance
23.1 Understanding label instructions
It is essential that the instructions on medication labels are clearly understood by anyone
supporting a Service User with their medication. In the event of any uncertainty as to the
precise meaning of the instructions, the Care Worker/Personal Assistant should refer
immediately to their line manager, Pharmacist or the Service User’s GP.
The time medication is taken can be very important and is sometimes misunderstood
from the label instructions.
If the instruction is that the medication should be taken once a day, it is often most
convenient for the Service User to take that medication with their breakfast. However, it
should be ensured that the medication is not adversely affected by being taken with food.
Some medication can cause drowsiness therefore it would be better for it to be taken at
bed time. In general it is important to give the medication at the same time each day.
Page 83 of 142
If the instruction is that the medication should be taken each morning further clarification
may be necessary as to whether this should be taken with breakfast or immediately on
rising. Some medication will work much more quickly if given on an empty stomach.
Medication which is to be taken twice a day is commonly taken with breakfast and tea.
However, some medication needs a 12 hour period in between taking the two doses. A
12 hour period needs to be adhered to wherever possible as a longer or shorter gap may
cause side effects due to a too high or a too low concentration in the blood.
If medication needs to be taken three or four times a day this is normally during the
daytime rather than throughout the 24 hours and should be spaced evenly to ensure
effectiveness and to avoid a too high or a too low concentration in the blood.
If medication is required to be taken at night, care needs to be taken to ensure exactly
when that should be. If the level of support is ‘administration’, Care Workers/Personal
Assistants should avoid giving medication too early and it should not be left in a
container for the Service User to take later. Sleeping tablets are normally best given half
an hour before bedtime.
If the instruction on the label indicates that the dose is variable for example “one or two
tablets” then the indicators for the different doses must be clear for the person supporting
the Service User and the maximum daily dose must be specified. The actual dose given
to the Service User must be recorded on a MAR chart or Daily Communication Record
sheet in the usual way.
Very occasionally medication may be labelled to be taken “as directed”. This is not
acceptable for any medication that is being administered by a Care Worker/Personal
Assistant and must always be referred back to the Pharmacist or GP, it is essential that
Care Workers/Personal Assistants are aware of the exact requirements.
There are many possible variations on the instructions that may appear on medication
labels. When a Service User starts a new medication it is a good idea to check any
instruction with the Pharmacist and to mention other medication the Service User is
taking.
23.2 Legal requirements of labels
23.2.1
General requirements
a. All labels must be indelible.
b. All the details on a label must be in English although some details may be given in
another language as well.
c. Labels must be clear and legible.
d. All medication containers must be labelled with "Keep out of the reach and sight of
children".
23.2.2
Labelling of dispensed items
The label on a dispensed medication must include:
1. The name of the patient/Service User.
2. Name and address of the pharmacy or details of the dispensing GP or hospital doctor
supplying the medication.
3. Date of dispensing.
Page 84 of 142
4. Name of medication.
5. Form of medication i.e. tablet, liquid etc.
6. Number of tablets dispensed or quantity of liquid/cream.
7. Strength of medication where appropriate.
8. Directions for use. "As directed" is not an acceptable instruction where Care Workers/
Personal Assistants are responsible for administering medication
9.
“For external use only" if product is a cream/ointment/lotion etc.
10. An expiry date may be shown on the label where a medication deteriorates quickly
when started e.g. antibiotic liquids, sub-lingual Glyceryl Trinitrate tablets.
11. Additional ‘warning label’ information may also be included, see ‘Additional Labels’
section 23.3.
23.3 Additional labels
The following additional labels are taken from the medical and pharmaceutical reference
book - British National Formulary (BNF) Recommended label wordings.
Labels 1–19 and 29–33 are wordings which can be given as separate warnings. Labels
21–28 are wordings which can be included in an appropriate position in the directions for
dosage or how to take. Label numbers 20, 31 and 33 do not exist.
Each medication listed in the BNF has the code numbers of any relevant additional
labels next to it. Cautionary labels are not a legal requirement but it is considered good
professional practice to use them on all dispensed medication.
In general, no label recommendations are made for injections as it is assumed that they
will be administered by a Healthcare Professional or a well-instructed patient. There may
be occasions when Pharmacists will use their professional discretion and omit one or
more of the additional labels for a particular patient.
1. Warning. This medicine may make you sleepy
To be used on preparations for children containing antihistamines, or other
preparations given to children where the warnings of label 2 on driving or alcohol
would not be appropriate.
2. Warning. This medicine may make you sleepy. If this happens do not drive or
operate machinery. Do not drink alcohol
To be used on preparations for adults that can cause drowsiness, thereby affecting
the ability to drive and operate hazardous machinery; label 1 is more appropriate for
children. It is an offence to drive while under the influence of drink or drugs.
Some of these preparations only cause drowsiness in the first few days of treatment
and some only cause drowsiness in higher doses.
In such cases the patient should be told that the advice applies until the effects have
worn off. Many of these preparations can produce a slowing of reaction time and a
loss of mental concentration that can have the same effects as drowsiness.
Avoidance of alcoholic drink is recommended because the effects of CNS
depressants are enhanced by alcohol. Strict prohibition however could lead to some
patients not taking the medication. Pharmacists should therefore explain the risk and
encourage compliance, particularly in patients who may think they already tolerate
Page 85 of 142
the effects of alcohol (see also label 3). Queries from patients with epilepsy regarding
fitness to drive should be referred back to the patient’s doctor.
Side-effects unrelated to drowsiness that may affect a patient’s ability to drive or
operate machinery safely include blurred vision, dizziness, or nausea. In general, no
label has been recommended to cover these cases, but the patient should be
suitably counselled.
3. Warning. This medicine may make you sleepy. If this happens do not drive or
operate machinery
To be used on preparations containing monoamine-oxidase inhibitors; the warning to
avoid alcohol and de-alcoholised (low alcohol) drink is covered by the patient
information leaflet.
To be used as for label 2 but where alcohol is not an issue.
4. Warning. Do not drink alcohol while taking this medicine
To be used on preparations where a reaction such as flushing may occur if alcohol is
taken (e.g. metronidazole and chlorpropamide). Alcohol may also enhance the
hypoglycaemia produced by some oral antidiabetic drugs but routine application of a
warning label is not considered necessary.
5. Do not take indigestion remedies 2 hours before or after you take this medicine
To be used with label 25 on preparations coated to resist gastric acid (e.g. entericcoated tablets). This is to avoid the possibility of premature dissolution of the coating
in the presence of an alkaline pH.
Label 5 also applies to drugs such as ketoconazole where the absorption is
significantly affected by antacids; the usual period of avoidance recommended is 2 to
4 hours.
6. Do not take indigestion remedies or medicines containing iron or zinc 2 hours
before or after you take this medicine
To be used on preparations containing ofloxacin and some other quinolones,
doxycycline, lymecycline, minocycline, and penicillamine. These drugs chelate
calcium, iron and zinc and are less well absorbed when taken with calciumcontaining antacids or preparations containing iron or zinc. These incompatible
preparations should be taken 2-3 hours apart.
7. Do not take milk, indigestion remedies, or medicines containing iron or zinc 2
hours before or after you take as this medicine
To be used on preparations containing ciprofloxacin, norfloxacin or tetracyclines that
chelate calcium, iron, magnesium, and zinc and are thus less available for
absorption; these incompatible preparations should be taken 2-3 hours apart.
Doxycycline, lymecycline and minocycline are less liable to form chelates and
therefore only require label 6 (see above).
8. Do not stop taking this medicine unless your doctor tells you to stop
To be used on preparations that contain a drug which is required to be taken over
long periods without the patient necessarily perceiving any benefit e.g.
antituberculous drugs.
Also to be used on preparations that contain a drug whose withdrawal is likely to be a
particular hazard (e.g. clonidine for hypertension). Label 10 (see below) is more
appropriate for corticosteroids.
Page 86 of 142
9. Space the doses evenly throughout the day. Keep taking this medicine until
the course is completed unless you are told to stop
To be used on preparations where a course of treatment should be completed to
reduce the incidence of relapse or failure of treatment.
The preparations are antimicrobial drugs given by mouth. Very occasionally, some
may have severe side-effects (e.g. diarrhoea in patients receiving clindamycin) and in
such cases the patient may need to be advised of reasons for stopping treatment
quickly and returning to the doctor.
10. Warning. Read the additional information given with this medicine
To be used particularly on preparations containing anticoagulants, lithium and oral
corticosteroids. The appropriate treatment card should be given to the patient and
any necessary explanations given.
This label may also be used on other preparations to remind the patient of the
instructions that have been given.
11. Protect your skin from sunlight-even on a bright but cloudy day. Do not use
sunbeds
To be used on preparations that may cause phototoxic or photoallergic reactions if
the patient is exposed to ultraviolet radiation. Many drugs other than those listed in
Appendix 9 (e.g. phenothiazines and sulphonamides) may, on rare occasions, cause
reactions in susceptible patients. Exposure to high intensity ultraviolet radiation from
sunray lamps and sunbeds is particularly likely to cause reactions.
12. Do not take anything containing aspirin while taking this medicine
To be used on preparations containing probenecid and sulfinpyrazone whose activity
is reduced by aspirin.
Label 12 should not be used for anticoagulants since label 10 is more appropriate.
13. Dissolve or mix with water before taking
To be used on preparations that are intended to be dissolved in water (e.g. soluble
tablets) or mixed with water (e.g. powders, granules) before use. In a few cases other
liquids such as fruit juice or milk may be used.
14. This medicine may colour your urine. This is harmless
To be used on preparations that may cause the patient’s urine to turn an unusual
colour. These include phenolphthalein (alkaline urine pink), triamterene (blue under
some lights), levodopa (dark reddish), and rifampicin (red).
15. Caution flammable: Keep your body away from fire or flames after you have put
on this medicine
To be used on preparations containing sufficient flammable solvent to render them
flammable if exposed to a naked flame.
16. Dissolve the tablet under your tongue-do not swallow Do not transfer from this
container. Store the tablets in this bottle with the cap tightly closed. Get a new
supply 8 weeks after opening
To be used on glyceryl trinitrate tablets to remind the patient not to transfer the
tablets to plastic or less suitable containers.
Page 87 of 142
17. Do not take more than . . . in 24 hours
To be used on preparations for the treatment of acute migraine except those
containing ergotamine, for which label 18 is used. The dose form should be specified,
e.g. tablets or capsules.
It may also be used on preparations for which no dose has been specified by the
prescriber.
18. Do not take more than . . . in 24 hours Also do not take more than … in any one
week
To be used on preparations containing ergotamine. The dose form should be
specified, e.g. tablets or suppositories.
19. Warning. This medicine may make you sleepy. If you still feel sleepy the next
day, do not drive or use tools or machines. Do not drink alcohol
To be used on preparations containing hypnotics (or some other drugs with sedative
effects) prescribed to be taken at night. On the rare occasions (e.g. nitrazepam in
epilepsy) when hypnotics are prescribed for daytime administration this label would
clearly not be appropriate. Also to be used as an alternative to the label 2 wording
(the choice being at the discretion of the Pharmacist) for anxiolytics prescribed to be
taken at night.
It is hoped that this wording will convey adequately the problem of residual morning
sedation after taking ’sleeping tablets’.
20. Label number 20 does not exist
21. Take with or just after food, or a meal
To be used on preparations that are liable to cause gastric irritation, or those that are
better absorbed with food.
Patients should be advised that a small amount of food is sufficient.
22. Take 30 to 60 minutes before food
To be used on some preparations whose absorption is thereby improved.
Most oral antibacterials require label 23 instead (see below).
23. Take this medicine when your stomach is empty. This means an hour before
food or 2 hours after food
To be used on oral preparations whose absorption may be reduced by the presence
of food and acid in the stomach.
24. Suck or chew this medicine
To be used on preparations that should be sucked or chewed.
The Pharmacist should use discretion as to which of these words is appropriate.
25. Swallow this medicine whole. Do not chew or break
To be used on preparations that are enteric-coated or designed for modified-release.
Also to be used on preparations that taste very unpleasant or may damage the
mouth if not swallowed whole.
26. . . Dissolve this medicine under your tongue
To be used on preparations designed for sublingual use. Patients should be advised
Page 88 of 142
to hold under the tongue and avoid swallowing until dissolved. The buccal mucosa
between the gum and cheek is occasionally specified by the prescriber.
27. . . . Take with a full glass of water
To be used on preparations that should be well diluted (e.g. chloral hydrate), where a
high fluid intake is required (e.g. sulphonamides), or where water is required to aid
the action (e.g. methylcellulose). The patient should be advised that ‘plenty’ means at
least 150 mL (about a tumblerful). In most cases fruit juice, tea, or coffee may be
used.
28. Spread thinly on the affected skin only
To be used on external preparations that should be applied sparingly (e.g.
corticosteroids, dithranol).
29. Do not take more than 2 at any one time. Do not take more than 8 in 24 hours
To be used on containers of dispensed solid dose preparations containing
paracetamol for adults when the instruction on the label indicates that the dose can
be taken on an ‘as required’ basis. The dose form should be specified, e.g. tablets or
capsules.
This label has been introduced because of the serious consequences of overdosage
with paracetamol.
30. Contains paracetamol. Do not take anything else containing paracetamol while
taking this medicine
To be used on all containers of dispensed preparations containing paracetamol.
31. Label No. 31 does not exist
32. Contains aspirin. Do not take anything else containing aspirin while taking this
medicine
To be used on containers of dispensed preparations containing aspirin when the
name on the label does not include the word ’aspirin’.
Label No. 33 does not exist
Page 89 of 142
23.4 Examples of labels
23.4.1
Tablets and capsules
1
2
3
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
FOLIC ACID 5MG TABLETS
LANSOPRAZOLE 30 MG CAPSULES
MORPHINE SULPHATE 60 MG
TABLETS
Take ONE daily Miss A.N.OTHER
21NOV03 30 TABS
Take ONE capsule in the MORNING
swallowed whole, not chewed. Do not
take indigestion remedies at the same
time of day as this medicine.
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Miss A.N. OTHER 03OCT02 28
CAPSULES
ANYTOWN PHARMACY, ANYTOWN
03923 555321
6
4
5
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
ACICLOVIR 200 MG TABLETS
IMIPRAMINE 25 MG TABS
MST continues tables. Take ONE
tablet TWICE a day. DO NOT CHEW.
MAY CAUSE DROWSINESS. AVOID
ALCOHOL.
21 NOV03 60 TABS
Take ONE tablet FIVE times daily for
five days. Take at regular intervals.
A.N. OTHER
Take SIX tablets at NIGHT
03 OCT 03 25 TABLETS
A.N. OTHER
168 TABLETS
ANYTOWN PHARMACY, ANYTOWN
03923 555321
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
500mg
ONE tablet to be sucked or chewed
TWICE daily. Complete the course
Mr A.N. OTHER
03 OCT 04 56 TABLETS
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
7
8
9
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
ZOPICLONE TABLETS
ASPIRIN 75 MG DISPERSIBLE
TABLETS
PHENYTOIN 100 MG CAPSULES
Take ONE tablet EACH day. Warning:
Causes drowsiness which may
continue the next day. If affected do
not drive or operate machinery. Avoid
alcoholic drink
Ms A.N. OTHER
03.OCT 02 28 TABLETS
Mr A. N. OTHER
03 Oct 02 28 Tablets
Take TWO capsules TWICE a day. DO
NOT STOP TAKING THIS MEDICINE
EXCEPT ON YOUR DOCTORS
ADVICE.
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Mrs A.N. OTHER
21 NOV 03 112 CAPSULES
ANYTOWN PHARMACY, ANYTOWN
03923 555321
10
11
ANYTOWN PHARMACY, ANYTOWN
03923 555321
12
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
PRAVASTATIN 20 MG TABLETS
Take ONE tablet daily
CO-DYDRAMOL TABLETS
Take ONE or TWO tablets every 4-6
hours with or after food when required
for pain relief. DO NOT TAKE MORE
THAT 2 AT A TIME OR 8 IN 24 HOURS.
Mr A.N. Other
FUROSEMIDE 40 MG TABLETS
Mrs A.N. OTHER
28 TABLETS
Take ONE tablet TWICE a day
Mr A.N. OTHER
03.OCT 02 56 TABLETS
CONTAINS PARACETAMOL
21 NOV 04 30 TABLETS
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Page 90 of 142
Tablets and capsules continued
13
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
AMOXYCILLIN 250mg & CLAVULANIC
ACID 125 MEG TABLETS
Miss A.N. OTHER 21 NOV 03
14
15
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
1mg TABLETS
Take ONE tablet TWICE a day.
WARNING: May cause drowsiness. If
affected do not drive or operate
machinery. Avoid alcohol.
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
PARACETAMOL
Take ONE or TWO tablets every FOUR
to SIX hours if needed for pain relief,
dissolved in water. Take no more than
2 at a time, or 8 in 24 hours.
Miss A.N. OTHER 21 NOV 04
Miss A.N.OTHER 21 NOV 03
ANYTOWN PHARMACY, ANYTOWN
03923 555321
16
ANYTOWN PHARMACY, ANYTOWN
03923 555321
17
ANYTOWN PHARMACY, ANYTOWN
03923 555321
18
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
METOCLOPRAMIDE 10 MG TABLETS
BENDROFLUAZIDE 5 MG TABLETS
DICLOFENAC SODUIM 25 MG
TABLETS
Take ONE tablet DAILY
Mr A.N. OTHER
21 NOV 03 28 TABS
Take one tablet swallowed whole
three times a day.
Take ONE tablet when required every
eight hours for the relief of sickness.
DO NOT TAKE MORE THAN 3 IN
TWENTY FOUR HOURS.
Mrs A.N. OTHER
21 NOV 03 28 TABS
21 Nov 04 28 Tablets
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
19
20
21
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
PREDNISOLONE 5 mg
Enteric Coated TABS.
TEMAZEPAM 10 mg TABLETS
FERROUS SULPHATE 200mg TABS
ONE to be taken at NIGHT. Warning:
may cause drowsiness
ONE tablet to be taken each day.
Take TWO tablets in the MORNING.
Warning: Follow the printed
instructions you have been given with
this medicine.
Ms. A.N. Other
21NOV 03 28 TABS
ANYTOWN PHARMACY, ANYTOWN
03923 555321
22
03OCT 05 28 Tablets
Miss A.N. OTHER
03 OCT 03 28 TABS
ANYTOWN PHARMACY, ANYTOWN
03923 555321
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
DILTIAZEM 120 mg Capsules ADIZEM
SR
Swallow this medicine whole. Do not
chew or break
Mrs A.N. OTHER
03 OCT 02 56 Capsules
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Page 91 of 142
ANYTOWN PHARMACY, ANYTOWN
03923 555321
23.4.2
Oral liquids
23
24
25
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
GAVISCON LIQUID
SHAKE WELL BEFORE USE
FLUCLOXACILLIN 250 mg/5ml liquid
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
MAGNESIUM HYDROXIDE & LIQUID
PARAFFIN
MILPAR LIQUID
SHAKE THE BOTTLE
Mrs A.N. OTHER
500 mls
Take ONE 5 ml spoonful FOUR times a
day for 5 days. Take ONE hour before
food or on an empty stomach. Take at
regular intervals. Complete the
course.
A.N. OTHER 03 OCT 03 100 mls
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
26
27
28
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
SHAKE THE BOTTLE & STORE IN THE
FRIDGE AMOXYCILLIN &
CLAUVULANIC ACID 250/62
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
SUSPENSION (CO-AMOXYCLAV)
Mr A.N. OTHER
21 NOV 02 300 mls
Take TWO 5ml spoonfuls FOUR times
a day after meals and at bedtime.
Take ONE 5ml spoonful THREE times
a day for SEVEN days. Take at regular
intervals. Complete the course.
Take ONE 5ml spoonful TWO times a
day.
ANYTOWN PHARMACY, ANYTOWN
03923 555321
TAKE FOUR 5ML SPOONFULS TWICE
A DAY.
Mrs A.N. OTHER
21 NOV 002 200 ml
% 01245-513241
SHAKE THE BOTTLE
CHLOROPHENIRAMINE 2 MG IN 5ML
SYRUP (PIRITON).
Mrs A.N. OTHER 03 OCT 02 150 ml
03 OCT 03 100 mls
ANYTOWN PHARMACY, ANYTOWN
03923 555321
29
SHAKE THE BOTTLE
ERYTHROMCYCIN SUSPENSION 125
MG/5ML
Take 5ml FOUR times a day for SEVEN
days.
Store in the fridge. Take at regular
intervals. Complete the course.
ANYTOWN PHARMACY, ANYTOWN
03923 555321
30
31
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
SENNOSIDE B (SENOKOT) 7.5MG/5ML
(SENOKOT)
IBUPROFEN 100MG/5ML SYRUP
(BRUFEN)
Take 10 mls at bedtime.
Take SIX 5ml spoonfuls (30mls)
THREE times a day with or after food.
Mrs A.N. OTHER 21 NOV 04
21 NOV 03 500 mls
Mrs A.N. OTHER
03 OCT 03 100 mls
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
32
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
TRIMETHOPRIM 50 MG/5ML
SUSPENSION
Take 0.8mls ONCE a day in the
EVENING using the oral syringe
provided.
SHAKE THE BOTTLE
Mrs A.N. OTHER
03 OCT 03 100 ml
% 01245-513241
Page 92 of 142
ANYTOWN PHARMACY, ANYTOWN
03923 555321
23.4.3
Creams and ointments
33
34
35
FOR EXTERNAL USE ONLY
AQUEOUS CREAM
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
Apply to the affected area(s) as
directed
For external use only Povidone iodine
10% ointment (Betadine)
Apply to the affected areas Twice a
day as directed.
For external use only Clobetasol
Propionate 0.05% ointment
Mrs A.N. OTHER
21 NOV 02 30g
Apply sparingly as directed to the
affected area daily
Mrs A.N. Other
03 Oct 03
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Discard 28 days after opening
Mrs A.N. Other Date opened……..
21 Nov 03 80 grams
36
ANYTOWN PHARMACY, ANYTOWN
03923 555321
37
ANYTOWN PHARMACY, ANYTOWN
03923 555321
38
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
DIPRO BASE CREAM FOR EXTERNAL
USE ONLY
CLOTRIMAZOLE 1% CREAM
CANESTAN
KETOPROGEN 2.5% GEL (Oruvail)
For external use only.
Apply to the affected area(s) as
directed.
Apply to the affected area as directed
THREE times a day.
FOR EXTERNAL USE ONLY
Mr A.N. Other
21 Nov 03 20g
ANYTOWN PHARMACY, ANYTOWN
03923 555321
39
Mrs A.N. OTHER
20g
ANYTOWN PHARMACY, ANYTOWN
03923 555321
40
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
FOR EXTERNAL USE ONLY
HYDROCORTISONE 1% CREAM
Ointment
HYDROCORTISONE 1% &
MICONAZOLE 2% (DAKTACORT)
CREAM
03 OCT 03 50g
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Apply SPARINGLY to the affected area
ONCE a day
Apply thinly as directed TWICE a day
for SEVEN days
FOR EXTERNAL USE ONLY
Mrs A.N. OTHER
03 OCT 03 30gms
41
Apply thinly to the affected area as
directed TWICE a day.
STORE IN A FRIDGE.
Mrs A.N. OTHER
03 OCT 03 30g
21 NOV 02 30grams
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
% 01245-513241
42
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
HYDROCORTISON 1% OINTMENT
FOR EXTERNAL USE ONLY
Apply TWICE a day to the affected
area(s) as directed
Mrs A.N. OTHER 30g
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Page 93 of 142
23.4.4
Eye preparations
43
44
45
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
CHLORAMPHENICOL EYE DROPS
0.5% NOT TO BE TAKEN
Put ONE drop into the LEFT eye FOUR
times a day for 5 days
STORE IN THE FRIDGE. Allow to warm
before use.
Miss A.N. OTHER
03 OCT 02 10ml
BRIMONIDINE TARTRATE EYE
DROPS 0.2% (Alphagan)
Insert ONE drop TWICE a day into the
LEFT eye.
DISCARD 28 DAYS AFTER OPENING
HYPROMELLOSE EYE DROPS O.3%
NOT TO BE TAKEN.
Put ONE drop into the RIGHT eye
FOUR times a day for 5 days
DISCARD 28 DAYS AFTER OPENING
21 NOV 03 5ml
Miss A.N. OTHER 10ml
ANYTOWN PHARMACY, ANYTOWN
03923 555321
46
ANYTOWN PHARMACY, ANYTOWN
03923 555321
47
ANYTOWN PHARMACY, ANYTOWN
03923 555321
48
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
BETAMETHASONE eye ointment 0.1%
Put one drop into the LEFT eye FOUR
times a day for 5 days
NOT TO BE TAKEN
TIMOLOL eye drops 0.5%
NOT TO BE TAKEN
Instil ONE drop into the LEFT eye
ONCE a day in the evening.
STORE IN THE FRIDGE. ALLOW TO
WARM BEFORE USE.
A.N. OTHER
03 OCT 03 5ml
STORE IN THE FRIDGE BEFORE
OPENING
Mrs A.N. OTHER
03 OCT 03 2.5ml
Miss A.N. OTHER
03 OCT 02 10ml
ANYTOWN PHARMACY, ANYTOWN
03923 555321
% 01245-513241
49
ANYTOWN PHARMACY, ANYTOWN
03923 555321
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
NOT TO BE TAKEN
CHLORAMPHENICOL EYE OINTMENT
1%.
Apply a little into BOTH eyes at
NIGHT. DISCARD 28 DAYS AFTER
OPENING.
03 OCT 03 4g
ANYTOWN PHARMACY, ANYTOWN
03923 555321
23.4.5
Patches
55
56
57
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
ESTRADIOL 50 MCG/24HRS &
NORETHISTERONE 170MCG/24 HRS
EVOREL CONTI PATCHES
FENTANYL 25 MCG/hour Durogesic
‘25’ patch
1mg/72 hours Patches
Apply ONE patch TWICE weekly.
21 NOV 04 8 patches
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Apply as directed every 72 hours.
WARNING: May cause drowsiness. If
affected do not drive or operate
machinery. Avoid alcoholic drink.
Apply ONE patch as directed 5-6
hours before journey. WARNING:
Causes drowsiness which may
continue the next day. Avoid alcohol
Mr A.N. OTHER 5 PATCHES
Mr A.N. OTHER
21 NOV 03 1 PATCH
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Page 94 of 142
23.4.6
Inhalers
50
51
52
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
BECLOMETASONE BP 200MCG
ROTOHALER BECOTIDE
FLUTICASONE 50 MCG ACCUHALER
FLIXOTIDE
SALBUTAMOL INHALER 100MCG
VENTOLIN
Inhale the contents on ONE rotocap
using the rotahaler TWICE a day. Do
not stop taking this medicine except
on your doctors advice..
Miss A.N. OTHER
03 Oct 02 112 DOSES
Inhale the contents of TWO blisters
TWICE a day. Rinse mouth after use.
Do not stop taking this medicine
except on your doctors advice.
Shake well and inhale one puff FOUR
times a day
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Miss A.N. OTHER 200 doses
MS A.N. OTHER
03 Oct 02 60 BLISTERS
53
ANYTOWN PHARMACY, ANYTOWN
03923 555321
54
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
SALMETEROL DISKHALER 50 MCG
SEREVENT
BUDESONIDE 200 MCG
TURBOHALER PULMICORT
Shake well and inhale the contents of
ONE blister using the diskhaler TWICE
a day.
MS A.N. OTHER
03 OCT 02 100 DOSES
ANYTOWN PHARMACY, ANYTOWN
03923 555321
03 OCT 02 20 DOSES
ANYTOWN PHARMACY, ANYTOWN
03923 555321
23.4.7
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Miscellaneous
58
59
60
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
KEEP OUT OF REACH AND SIGHT OF
CHILDREN
ISAGHULA HUSK 3.5G SACHETS
FYBOGEL
GLYCERYL TRINITRATE SPRAY
400MCG
GLYCERYLTRINITRATE 500 MCG
SUBLINGUAL TABLETS.
Take ONE sachet TWICE A DAY
dissolve or mix with water before
taking.
03.OCT 02 60 SACHETS
DO NOT SWALLOW. Spray ONE spray
under the tongue when required for
chest pain.
Dissolve ONE tablet under the tongue
when needed for chest pain. Do not
transfer from this container. Discard 8
weeks after opening.
Mr A.N. OTHER
03 Oct 02 100 Tablets
Mr A.N. OTHER
03 Oct -2 75 Doses
ANYTOWN PHARMACY, ANYTOWN
03923 555321
ANYTOWN PHARMACY, ANYTOWN
03923 555321
Page 95 of 142
24 Related tasks - Catheter Care
Objectives
By the end of this section you will:

Understand what can be done and what cannot be done in relation to Catheter Care

Be competent to undertake day to day care of catheters

Know the signs to look for to detect problems with the catheter and surrounding area

Understand the rationale of the daily routine of catheter care

Be able to educate the Service User in the daily routine of catheter care.
Assessment method
1.
Complete Worksheets 29 and 30
Guidance
In this context Catheter care does not include:

Changing Catheters

Bladder washouts or clearing blockages
24.1 Care of the long-term urethral catheter
This is a catheter inserted into the bladder via the urethra, the normal channel for urine
flow. It is held in place by a small balloon inflated at the point of entry into the bladder
and will be visible in the genital area.
When handling catheter bags, to help prevent infection wash own hands before
commencing treatment and wear disposable gloves.
Action
Daily washing of the genital area is essential;
wherever possible the Service User should be
encouraged to do this themselves.
Observe that urine is free flowing.
Ensure that catheter is secure.
Observe for any debris, odour or blood clots.
Rationale
Catheter insertion site kept socially
clean and comfortable for the
Service User.
Early detection of any blockage.
Prevention of unnecessary or
accidental pulling of the tubing.
Early detection of possible infection.
Educate the Service User on the care of the
catheter.
Service User able to actively
participate in their care.
24.2 Care of the long-term supra-pubic catheter
This is a catheter inserted into the bladder via a surgical incision into the abdominal wall.
This catheter is held in place by a small balloon inflated at the point of entry into the
bladder.
Page 96 of 142
When handling catheter bags, to help prevent infection wash own hands before
commencing treatment and wear disposable gloves.
Action
Daily washing of the abdominal site around the
entry point of the catheter is essential, wherever
possible Service Users should be encouraged to
do this themselves.
Rationale
To help prevent infection.
Catheter insertion site kept socially
clean and comfortable for the
Service User.
Observe the urine is free flowing.
Early detection of any blockage.
Ensure the catheter is secure.
Observe for any debris, odour or blood clots.
Prevention of unnecessary or
accidental pulling of the tubing.
Early detection of possible infection.
Educate the Service User on the care of the
catheter.
Service User able to actively
participate in own care.
24.3 Care of the drainage bag for urethral and supra-pubic catheters
The external end of the catheter is inserted into the tube of a catheter bag where urine
flows into and is collected.
Catheter bags can be separated into two categories:


Day Bags
Night Bags
Day bags are smaller than night bags and vary from 250mls capacity up to a maximum
of 750mls.
24.4 Day bags
There are many manufacturers producing bags, all of which perform a similar function.
When handling catheter bags, to help prevent infection wash own hands before
commencing treatment and wear disposable gloves.
Action
Empty the bag regularly either directly into the
toilet or a receptacle for that sole purpose.
Service Users should be encouraged to do this
themselves. Where they are having difficulty
e.g. due to arthritis in their fingers, an alternative
bag should be explored – consult your District
Nurse or Pharmacist.
Page 97 of 142
Rationale
To avoid extra strain on the catheter
tip and bladder wall due to a heavy
bag pulling on the catheter.
Comfort of the Service User, a full
bag is heavy.
To help avoid build up of bacteria in
the bag resulting in possible
infection.
Action
Bags come in different sizes and with differing
lengths of tubing, secure the bag appropriately,
depending on the most convenient position for
the Service User, i.e. men sometime like longer
tubing so they can wear the bag strapped to the
calf. This makes it easier for them to lift the
trouser leg up and empty the bag. Some ladies
like to wear the bag on the upper thigh.
Catheter bags should be changed in accordance
with the Support Plan, but usually every 5 days is
sufficient. Remove the old bag from the end of
the catheter and replace immediately with the
new bag having removed the cap from the end of
the tubing. Do not allow the ends of the tubing to
come in contact with surrounding items.
Rationale
To stop the weight of the bag and
its contents pulling the catheter and
causing pain.
The bag can be disposed of in the normal refuse
bin. It is preferable to wrap used bags either in
newspaper or in a plastic bag before disposal.
Safe disposal of the bag protects
the Service User, Care Worker/
Personal Assistant and others.
For the dignity of the Service User.
Avoid infection.
Keep the catheter bag socially
clean and protect both the Service
User and Care Worker/Personal
Assistant.
24.5 Night bags
Night bags, as the name implies, are primarily used for overnight drainage from the
catheter. However, in certain circumstances some Service Users may wish, or it may be
more appropriate for them, to use a night bag as their only means of collecting urine. An
example of this is Service Users who are bed bound, seriously or terminally ill, or Service
Users who use a wheelchair. The Support Plan should indicate what system the Service
User is using.
There are many manufacturers of night bags the capacity being between 1000mls and
2000mls.
When handling catheter bags, to help prevent infection wash own hands before
commencing treatment and wear disposable gloves.
Action
When a “closed system” of drainage is required
i.e. both a day and night bag, both bags must be
from the same manufacturer to ensure a sealed
connection. The night bag is attached to the
emptying point of the day bag. Once connected
the valve is opened on the day bag allowing
urine to flow into the night bag.
Rationale
Maintain closed system of drainage
to reduce the risk of infection.
To remove the night bag, close the valve on the
day bag, remove the night bag. Where the night
bag is of the disposable variety, tear the top of
the bag and empty the contents down the toilet.
Dispose of as per day bags.
Remove stale urine and avoid
infection.
Page 98 of 142
Action
Rationale
If the night bag is of the long-term type, remove
Keep the bag clean between
as above, empty contents down the toilet and
changes.
rinse the bag in cold water. Store the bag as per
the Support Plan. The bag should be changed
every 5 to 7 days. This method is only
appropriate for home care settings.
Disposal of night bags – as per day bags.
24.6 Catheter valves
Where a Service User is unable to empty their bladder efficiently, but still has the bladder
function of storing urine, the catheter used may have a valve attached to the end rather
than a bag.
The valve stops the free flow of urine from the catheter and the urine is held in the
bladder until a convenient time is found to empty it, which is usually every 2-4 hours,
depending on the fluid intake. Normally the Service User does this however a Care
Worker/Personal Assistant may need to.
If Care Workers/Personal Assistants are required to perform this task then hands must
be washed and disposable gloves must be worn.
The overall care and responsibility of the catheter remains with the health professional.
They are responsible for changing the catheter at regular intervals and to attending to
any problems as they arise.
Page 99 of 142
25 Meeting needs not covered in the guidelines
Managers at senior level or higher, have the authority to vary the instructions in these
guidelines in consultation with health professionals and other relevant people.
26 Legislation and Guidance
Key References and Bibliography
The following is a list of some useful reference points
Regulations and National Minimum Standards, England
www.cqc.org.uk
Long Term Conditions
http://www.dh.gov.uk/en/Healthcare/Longtermconditions/index.htm
Mental Health and Wellbeing
http://www.dh.gov.uk/en/Healthcare/Mentalhealth/index.htm
Safer Management of Controlled Drugs
http://www.drugslibrary.stir.ac.uk/documents/04141667.pdf
The Legal Framework

The Medicines Act 1968

The Misuse of Drugs Act 1971

The Misuse of Drugs (Safe Custody) (Amendment) Regulation 2007

The Data Protection Act 1998

The Care Standards Act 2000

The Health and Social Care Act 2008

The Health Act 2006

Health and Safety at Work Act (1974)

Hazardous Waste (England and Wales) Regulations (2005)

Control of Substances Hazardous to Health Regulations (2002)

Health publication Health Technical Memorandum 07-01: Safe Management of
Healthcare Waste

Mental Health Act 1983

Mental Capacity Act 2005

Access to Health Records Act (1990)
Page 100 of 142
Other Useful References

Dignity at Work

Protection of Vulnerable Adults scheme in England and Wales for adult placement
schemes, domiciliary care agencies and care homes: A practical guide

The Handling of Medicines in Social Care
Websites
Care Quality Commission (CQC)
www.cqc.org.uk
Department of Health
http://www.dh.gov.uk/en/index.htm
Royal Pharmaceutical Society
http://www.rpharms.com/home/home.asp
Medicines Information Website
http://www.medicines.org.uk/
Medicines and Healthcare products Regulatory Agency
http://www.mhra.gov.uk/
United Kingdom Homecare Association Ltd (UKHCA)
http://www.ukhca.co.uk/
Skills for Care, responsible for creating a well-trained social care workforce
www.skillsforcare.org.uk
Association for Real Change, support for providers of services to people with learning
disabilities
www.arcuk.org.uk
Information about medications used in the mental health setting
http://www.choiceandmedication.org.uk/
Essex Community Pharmacist website
http://www.essexlpc.org.uk/
Page 101 of 142
27 Useful Contacts
There are also a number of advocacy and support agencies available in Essex that will
be able to offer useful information and advice, such as
Essex Coalition of Disabled People (ECDP) For information on Personal Budgets
Contact: Self Directed Support Service (SDSS), Essex Coalition of Disabled People,
Ivan Peck House, 1 Russell Way, Chelmsford, Essex, CM1 3AA
Telephone: 01245 392300
Textphone: 01245 392302
Fax: 01245 392329
Email: sdss@ecdp.org.uk
Independent Living Advocacy (ILA Essex) offers face-to-face advocacy and
employment advice.
Contact: Unit 4, Whitelands, Terling Road, Hatfield Peverel CM3 2AQ
Tel: 01245 380888
Email: enquiries@ilaessex.co.uk
Website: www.ilaessex.com
Self Directed Support Services - offers telephone advice and information on direct
payments and personal budgets.
Contact: Ground Floor, 1 Russell Way, Chelmsford CM1 3AA
Tel: 01245 392312
Email: dpss@ecdp.co.uk
Essex PASS (Personal Assistant Support Scheme) - offers support and advice on
managing direct payments and provides payroll services.
Contact: Ground Floor, 1 Russell Way, Chelmsford CM1 3AA
Tel: 01245 392302
Email: essexpass@ecdp.co.uk
Website: www.ecdp.org.uk/ecdppass/
Direct Payments User Network (DPUN) - a user group for direct payment, personal
budget and individual budget holders, offering peer support.
Contact: Unit 12, Whitelands Business Centre, Terling Road, Hatfield Peverel CM3
2AG
Tel: 01245 382288
Email: enquiries@dpun.org.uk
Care Quality Commission (CQC) - to find a registered care agency.
Tel: 0845 0150120
Email: enquiries@cqc.gov.uk
Website: www.cqc.org.uk/
in Control - general information on Self Directed Support and Individual Budgets
Website: www.in-control.org.uk/
Page 102 of 142
28 Appendices
Below is the electronic version of each appendix document.
Daily Communication Record Sheet
Communication sheet
.doc
Medicines Administration Record
ECC942.pdf
MAR sheet.doc
Disability Discrimination Act Assessment form
DDA Pharmacy
info.doc
Information to Service Provider form
ISP_2009-07-03_152
0.doc
Page 103 of 142
29 Acknowledgements
This Guidance adheres to the principles of The Royal Pharmaceutical Society document
“The handling of medication in Social Care” and the Care Quality Commission Outcome 9
– Management of Medicines.
This document has been produced with the assistance of the people listed below. Many
thanks go to all those who have contributed their time and knowledge from Essex County
Council Departments, our Health Colleagues and our Service User representatives.
Paula Wilkinson, Chief Pharmacist, Mid-Essex Primary Care Trust.
Carol Sampson, North Essex Primary Care Trust.
Mita Upadhyaya, Senior Practitioner; Community Assessment Team, Epping/Harlow.
Tracey Fitzgerald, Self Directed Support Facilitator; Older Adults, Colchester.
Andrea Williams, Team Manager; Older Adults Mental Health, Maldon.
Lindsay Youngs, SDS Advanced Practitioner - Standards & Service Improvement Team.
Samuel Crawford, Operational Team Manager SAFE project.
Tracey Field, Standards and Service Improvement Team.
Kay Gunn, Standards and Service Improvement Team.
Telecare Development Team.
Service Users from the Adults, Health and Community Wellbeing Older Adults Planning
Group.
Page 104 of 142
PART THREE
Competency Assessment
Worksheets
Page 105 of 142
Page 106 of 142
This workbook should be reviewed annually at the Commissioner’s,
Care Worker’s or Personal Assistants annual review.
Date
Reviewed
Reviewed by
Print Name
Signature
Page 107 of 142
Candidate
Print Name
Signature
Page 108 of 142
Level 1 - Worksheet 1: Commissioning Services and Commissioned
Providers
1.
What is a ‘Commissioner’ and who might this be?
2.
What does the term ‘to Commission’ mean?
3.
Who can be ‘Commissioned’ to provide medication support?
4.
What ‘Standard’ must be met by the Commissioner with regards to the information
recorded in the ‘Commissioning Document’?
5.
What ‘Standard’ must a Commissioned Provider meet in order to provide
medication support?
6.
As a minimum, what do the policies and procedures that a Commissioned Provider
has in place need to cover in relation to medication support?
7.
Does a Personal Assistant directly employed by a Service User have to meet the
Standard and have policies and procedures in place?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 109 of 142
Level 1 - Worksheet 2: Capacity, Consent, Covert Administration
and Choice
1.
When should the two types of Mental Capacity Act assessment be completed and
by who?
2.
What are the five key principles of the Mental Capacity Act?
3.
What are the four ‘time specific’ tests used to assess a Service Users mental
capacity?
4.
What is meant by Consent, when is it needed and who obtains it?
5.
Can medication be disguised in food or drink? If medication is disguised what must
be considered?
6.
A Care Worker/Personal Assistant is supporting a Service User to take their
medication. When the Service User is informed that it is time for their medication,
they are uncooperative and say they are not taking it. What action should be
taken;
a) Try again a bit later?
b) Insist that the medication is taken?
c) Agree to the medication not being taken and take no further action?
d) Record the refusal and seek advice from the GP, pharmacist or line manager?
e) Mix the medication with some jam or other sweet substance and give it to the
Service User without their knowledge?
Page 110 of 142
7.
You are administering medication to a Service User for the first time, you become
concerned because the Service User is having difficulty communicating with you.
Do you:
a) Assume that consent has been obtained for the medication to be
administered?
b) Check in the Support Plan to see whether consent has been obtained?
c) Make every effort to be sure the Service User understands what you are doing
and then go ahead?
d) Administer the medication and ignore any indication from the Service User that
they may not be in agreement with this?
Assessors only
1.
Which documents can be consulted to assist in deciding the position with regard
to consent in individual cases?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 111 of 142
Level 1 - Worksheet 3: Prompting and Assisting
1.
What does the term ‘Prompting’ with medication or related tasks mean?
2.
What does the term ‘Assisting’ with medication or related tasks mean?
3.
How would a Care Worker/Personal Assistant know whether they are required to
Prompt, Assist or Administer?
4.
When the Support Plan states that the Care Worker/Personal Assistant is required
to assist or prompt a Service User with their medication, who has responsibility for
the medication?
5.
If a Service User is experiencing problems with their medication, i.e. difficulty in
swallowing tablets, who can be asked for advice on how to help them? Name two
possible sources.
6.
The Care Worker/Personal Assistant is experiencing problems in assisting a
Service User with their medication or with related tasks, who would they ask for
advice? Name three possible sources.
7.
Where would the Care Worker/Personal Assistant record information relating to
prompting and assisting?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 112 of 142
Level 1 - Worksheet 4: Administration
1.
What does ‘administer’ mean?
2.
Why would a Care Worker/Personal Assistant be ‘administering’ medication?
3.
What is the Care Worker/Personal Assistant responsible for when they administer
medication?
4.
Where should the administration of medication or related tasks be recorded?
5.
A Care Worker/Personal Assistant arrives at a Service Users home to find that
there is only enough medication for that day. What should they do?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 113 of 142
Level 1 - Worksheet 5: Levels of Training
1.
What is Level 1 training and who should complete this?
2.
Does a Care Worker/Personal Assistant need to successfully complete Level 1 or
Level 2 training to prompt a Service User to take their medication?
3.
A Care Worker/Personal Assistant is trained to carry out a specialist healthcare
task following Level 3 training. Can more than one Service User be supported with
this task and why?
4.
Once a Care Worker/Personal Assistant is assessed as competent at Level 2,
what levels of support can they give to the Service User?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 114 of 142
Level 1 - Worksheet 6: Risk Assessment
1.
Does a risk assessment need to be completed for every Service User?
2.
Which sections of the Assessment/Review Notes should be used to identify any
risks associated with the management of the Service User’s medication?
3.
What aspects of medication management should be covered in the risk
assessment?
4.
What aspects of medication management should be covered in the Contingency
Plan?
5.
Who else could contribute to the risk assessment?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 115 of 142
Level 1 - Worksheet 7: The Support Plan and Support Plan Summary
1.
What is a Support Plan?
2.
Who prepares the Support Plan?
3.
What is a Support Plan Summary?
4.
Who prepares the Support Plan Summary?
5.
What information should be included in the Support Plan Summary?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 116 of 142
Level 1 - Worksheet 8: Roles and Responsibilities
1.
Where should information regarding the roles and responsibilities of key people
involved in the Service User’s medication support be documented?
2.
Who is responsible for ensuring staff are appropriately trained to carryout the tasks
they are requested to do?
3.
Who is responsible for the medication if the Service User has mental capacity?
4.
Who has an advisory role around the safe management of medication?
5.
Who is responsible for deciding what level of support is required?
6.
How will the Service Placement Team know what essential aspects of medication
support to request from the Provider?
7.
What information sources should a Care Worker/Personal Assistant work to when
prompting, assisting and administering?
8.
Who should obtain the Service User’s consent and when?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 117 of 142
Level 1 - Worksheet 9: Core and Specialist Competencies and
Tasks a Care Worker/Personal Assistant must not do
1.
Which level of training will a Care Worker/Personal Assistant need to successfully
complete before being able to administer tablets?
2.
Is Administering pre-assembled injection devices a core or specialist competency?
3.
Who would train a Care Worker/Personal Assistant to carry out a specialist
competency?
4.
Which related task is a core competency task?
5.
Tick the appropriate box according to whether each of the following is a core
competency, specialist competency or a task that a Care Worker/Personal
Assistant must not do.
Core
Specialist
Instil Eye, ear or nose drops
Insert catheters or re-insert catheters
Rectal administration
Provide support with inhaled
medication (e.g. for asthma)
Instil specialist eye/ear, drops, e.g.
short course of antibiotics
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 118 of 142
Must not do
Level 1 - Worksheet 10: A Brief Explanation of Medication
1.
A medication is a preparation that contains a drug. What is medication used for?
2.
For which types of medication must a Pharmacist be present when they are sold?
Tick the box/es below for the medication type/s that require the Pharmacist to be
present.
a
GSL (General Sales List)
b
POM (Prescription Only Medicine)
c
P (Pharmacy)
d
POM-CD (Prescription Only Medicine-Controlled Drugs)
3.
How could a GSL Medicine be obtained?
4.
Explain what is meant by POM and how to obtain medication of this type.
5.
Controlled drugs have special prescription requirements. Where can you find
these requirements?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 119 of 142
Level 2 - Worksheet 11: Recording Procedures
1.
Where should details of prompting or assisting be recorded?
2.
Where should details of administering be recorded?
3.
If medication is not ‘prescribed’ should details of prompting or assisting Service
Users to take it be recorded?
4.
What details need to be recorded for prompting or assisting with medication?
5.
What details need to be recorded for administering medication?
6.
What should happen if a Service User refuses to take their administered
medication?
7.
Other than the Care Worker/Personal Assistant, who else may need to see or
record information on a MAR chart?
8.
What is best practice when a Service Users dosage of Warfarin is changed?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 120 of 142
Level 2 - Worksheet 12: The Medication Toolkit
1.
Why do hands need to be washed with soap and water and dried carefully before
using medication?
2.
What are the five rights and what needs to be checked for each of these?
3.
What is a MDS and what is its purpose?
4.
Can a Care Worker/Personal Assistant administer from a family filled MDS?
5.
If a Service User cannot swallow tablets or capsules, can they be crushed and
added to food/liquid. What should be considered before doing this?
6.
If there are any changes to medication where must they be clearly documented?
7.
Telecare products are designed to help people live independently in their own
home. Which level of medication support could a Telecare solution be used for?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 121 of 142
Level 2 - Worksheet 13: Possible Side Effects
1.
When are side effects from medication most likely to seen?
2.
Name six of the most common side effects.
3.
Read each of the ‘Patient Information’ leaflets for four medications and list the
most common side-effects that may be seen for each medication.
4.
If a Care Worker/Personal Assistant thinks that a Service User does not seem to
be their ‘normal self’, what should they do?
5.
How are side effects and adverse reactions reported?
Tip:
It is strongly recommended that where the opportunity arises, you attend a
training session led by a Pharmacist or a registered pharmacy technician on sideeffects of medication.
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 122 of 142
Level 2 - Worksheet 14: Errors with Medication
1.
When can an error occur?
2.
Give three examples of typical errors that could occur.
3.
If a Care Worker/Personal Assistant is aware of having made an error or notices
that an error has been made, what action must be taken?
4.
Why do errors need to be reported to a Care Worker’s line manager?
5.
What are the timescales for reporting errors in;
a)
a residential/nursing care home?
b)
any other location?
6.
When would an error in medication be treated as a disciplinary offence?
7.
Discuss the three scenarios below with your assessor. What action would need to
be taken? Think about the steps that could be taken to prevent these happening.
Scenario 1
You have just finished administering Mrs A’s medication to her, when you discover
a note left by her daughter to tell you she has already given Mrs A her tablets.
Scenario 2
You work in a Day Centre. Mrs B normally self administers her own tablets, but
you discover that she has been giving some of her tablets to another Service User.
Scenario 3
Now think about another situation (you may use a real example) and discuss.
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 123 of 142
Level 2 - Worksheet 15: Storage of Medication
1.
If a Service User is receiving support in their own home, who decides where to
store the Service User’s medication?
2.
Name two factors that can lead to the deterioration of a medication?
3.
Why would these factors cause medication to deteriorate?
4.
If the instructions on a medication say it should be stored at room temperature,
what temperature range is meant by this?
5.
In residential care homes and day centres, where should medication which can be
stored at room temperature be stored? When would there be an exception to this?
6.
Why should Service Users be encouraged not to store tablets in the kitchen or
bathroom?
7.
On checking the contents of a bottle of liquid medication, there are noticeable
changes in its appearance or smell. What should happen?
Page 124 of 142
8.
It is important that a Service User who self-medicates is aware of the correct
storage requirements. What advice could be given?
9.
Look at a range of medications, list their names, any storage instructions given
and where the medication should be stored.
Name of medication
Storage instructions
Where to store
Signature of candidate: ................................................
Date: ...............................
Signature of assessor:..................................................
Date: ...............................
Page 125 of 142
Level 2 - Worksheet 16: Refrigeration of Medication
To obtain competency with Refrigeration of medication, both Worksheet 16 and
Worksheet 17 must be successfully completed.
1.
Why do some medications need to be stored in a refrigerator?
2.
How will a Care Worker/Personal Assistant know if the medication has to be
stored in a refrigerator?
3.
In a Residential or Nursing Care Home, can medication that needs to be stored in
a refrigerator be stored in a fridge that is used for food?
4.
What is the recommended temperature for a refrigerator and how is this monitored
in a Residential or Nursing Care Home?
5.
Manufacturers specify that some creams and ointments are to be stored in a “cool
place”. Does this mean they need to be stored in a refrigerator?
6.
What should a Care Worker/Personal Assistant who administers medication in the
Service User’s home do if some of the Service User’s medication needs to be
stored in a refrigerator?
Signature of candidate: ................................................
Date: ...............................
Signature of assessor:..................................................
Date: ...............................
Page 126 of 142
Level 2 Worksheet 17: Refrigeration of Medication-Practical Assessment
To obtain competency with Refrigeration of medication, both Worksheet 16 and
Worksheet 17 must be successfully completed
1. For 5 days, record the temperature of a fridge used to store medication, or if this is
not possible, the fridge in your own home. For each occasion state whether the
temperature recorded is acceptable for the storage of medication that requires
refrigeration.
Date
Temperature
Acceptable (or) Not
Acceptable
1
2
3
4
5
6
Give details of the action to be taken if the temperature of the fridge used to store
medication in the workplace is not acceptable for the storage of medication that requires
refrigeration.
Signature of candidate: ................................................
Date:
Signature of assessor:..................................................
Date:
Page 127 of 142
Level 2 - Worksheet 18: Transfer of Medication
1.
What must the Provider’s policy regarding medication detail in respect of a Service
User transferring between care settings?
2.
When a Service User transfers to another care setting, what must be transferred
with them to ensure continuity of care?
3.
When a Service User is discharged from hospital, if the Care Worker/Personal
Assistant is responsible for administering the Service User’s medication what
should they do?
4.
If Care Workers/Personal Assistants carry medication on their person or in a
vehicle what should happen?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 128 of 142
Level 2 - Worksheet 19: Disposal of Medication and Expiry Dates
To obtain competency with Disposal of Medication and Expiry Dates, both
Worksheet 19 and Worksheet 20 must be successfully completed.
1.
There are four situations when a Service User’s medication may need to be
disposed of. What are they?
2.
How should medication belonging to a Service User in their own home, that is
either out of date or no longer required be disposed of?
3.
What does ‘Use by March 2009’mean?
4.
What does ‘Expiry date March 2009’ mean?
5.
What does ‘Use before March 2009’ mean?
6.
How can you ensure the medication is disposed of by the use by date?
7.
Where the Care Worker/Personal Assistant is responsible for managing the
medication, what must they record on the MAR regarding disposal?
8.
Where should residential care/nursing homes dispose of medication?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 129 of 142
Level 2 - Worksheet 20: Expiry Dates – Practical Assessment
To obtain competency with Disposal of Medication and Expiry Dates, both
Worksheet 19 and Worksheet 20 must be successfully completed.
Examine a variety of medication packages; record the expiry date and instructions given
for each one and also record the last date that each one should be used. Discuss with
your assessor what you would do with any medication where the expiry date has been
exceeded.
Name and type of product
Expiry date
instructions
Last date to be
used
e.g. NAPROSYN 250mg tablets
05/2012
31 May 2012
Signature of candidate: ................................................
Date: ...............................
Signature of assessor:..................................................
Date: ...............................
Page 130 of 142
Level 2 - Worksheet 21: Homely Remedies
1.
What is a homely remedy?
2.
Give some examples of the types of condition that can be treated with a homely
remedy.
3.
When can a Care Worker/Personal Assistant give a Service User a homely
remedy? Can they also offer the Service User advice?
4.
When a Service User takes a homely remedy for a minor ailment does anything
need to be recorded, and if so what should be recorded and where?
5.
If a Service User takes a ‘herbal remedy’ does this need to be recorded?
Signature of candidate: ................................................
Date: ................................
Signature of assessor:..................................................
Date: ................................
Page 131 of 142
Level 2 - Worksheet 22: Oral and Rectal Preparations and Injections
1.
Name the three forms of oral preparations and give a brief description of each.
2.
What is a ‘Suspension’ and why should this be shaken?
3.
When would an oral syringe be used?
4.
Why should the Service User be asked to swallow time release capsules/tablets or
enteric-coated tablets whole and not to chew them?
5.
Where must sub-lingual tablets be placed, and where must buccal tablets be
placed?
6.
Name the 2 forms of rectal preparations and give a brief description of each.
7.
In what circumstances would an injection be used?
Signature of candidate: ................................................
Date: ................................
Signature of assessor:..................................................
Date: ................................
Page 132 of 142
Level 2 - Worksheet 23: Topical Applications
To obtain competency with Topical Applications, which includes
Preparations, Worksheets 23 and 24 must be successfully completed.
Eye
1.
Name the two forms of skin preparation and give a brief description of each.
2.
Why would a bottle of ear drops need to be shaken?
3.
What should a Service User be asked to do before using nose drops or spray?
4.
Do eye drops need to be stored in a refrigerator and where would the storage
information be found?
5.
With combined prescriptions for eye drops and ointment, which one should be put
into the eye first and why?
6.
Explain the process that should be followed to maintain hygiene for instilling eye
drops or ointment.
7.
Why should the eye drop solution be instilled into the outer corner of the eye?
Signature of candidate: .................................................
Date:
Signature of assessor: ...................................................
Date:
Page 133 of 142
Level 2 - Worksheet 24: Eye preparations – Practical Assessment
To obtain competency with Topical Applications, which includes Eye Preparations, Worksheets 23 and 24 must be
successfully completed
You are required to instil eye medication on three separate occasions for each of the two forms of presentation (eye drops and
ointment). Your assessor will observe you carrying out these tasks and record your performance in the table below.
Date
Drops
Medication
checked
Hygiene
precautions
observed
Technique of
administration
Records
completed
Signature of
candidate
1)
2)
3)
Eye drops
Name of candidate
has successfully instilled the eye
drops and is competent to practice this procedure
Ointment 1)
2)
3)
Eye ointment
has successfully instilled the eye
Name of candidate
ointment and is competent to practice this procedure
Page 134 of 142
Signature of
assessor
Level 2 - Worksheet 25: Inhalers
1.
Why is there a much smaller dose of a drug in an inhaler than in a tablet/capsule
or liquid?
2.
In the treatment of asthma, the drugs inside inhalers can be grouped into three
types. What are they?
3.
Which group of inhalers can be used “as required”. What are they for and what
do they do?
4.
One group of inhalers are used to prevent symptoms from developing. Which
drug is commonly used in these?
5.
A third group of inhalers also relieve symptoms. In what way are they different to
the first group?
6.
There are several different types of inhaler available. What must a Care
Worker/Personal Assistant do before assisting or administering using an inhaler?
Signature of candidate: ..................................................
Date:
Signature of assessor: ...................................................
Date:
Page 135 of 142
Level 2 - Worksheet 26: Strengths of Preparation
1.
Put these in order of strength, with one being the highest and 4 being the lowest
Measure
Strength
1 nanogram
1 milligram
1 gram
1 microgram
2.
Which of these formats is the best practice for recording dosage and why?
Digoxin 0.125 mg daily or Digoxin 125microgram daily.
3.
If there is any uncertainty about the dose of a medication, what should happen?
4.
Fill in the blanks in the tables below;
Grams to milligrams;
Grams
10
Milligrams
500
2000
6
0.4
70
Litres to millilitres;
Litres
1
Millilitres
30
5000
0.7
10
Milligrams to Micrograms;
Milligrams
30
7
Micrograms
10
0.8
200
90
Signature of candidate:................................................
Date: ..............................
Signature of assessor:.................................................
Date: ..............................
Page 136 of 142
Level 2 - Worksheet 27: Requirements of Labels
To obtain competency with Requirements of labels, Worksheet 27 and Worksheet
28 must be successfully completed.
1.
What are the ‘general’ requirements of labels?
2.
If the instruction is that the medication should be taken once a day, what is the
best time for the medication to be taken and what could the exceptions be?
3.
Why is it important for medication that needs to be taken 2, 3 or 4 times a day to
be spaced out as evenly as possible?
4.
If the instruction on the label indicates that the dose is variable for example “one
or two tablets”, how will an administering Care Worker/Personal Assistant know
whether one or two tables should be given?
5.
What should an administering Care Worker/Personal Assistant do if medication is
labelled to be taken “as directed”.
6.
Other than name of the Service User, give 3 other legal requirements for a label.
Signature of candidate: ..................................................
Date:
Signature of assessor: ...................................................
Date:
Page 137 of 142
Level 2 - Worksheet 28: Requirements of Labels - Label Interpretation
To obtain competency with Requirements of Labels, both Worksheet 27 and Worksheet 28 must be successfully completed.
The assessor will identify 20 labels from the list in the workbook for you to examine. The candidate should place a √ in the relevant box to indicate
any prescription problems identified with the labels. If you cannot find any problems with a particular label place a √ the box marked “Nil”. Your
assessor will allocate a period of time for you to complete this assessment. Once completed it must be handed directly to your assessor for marking.
Label number from the examples in Workbook Section 23.4 - allocated by the assessor
Labelling Problems
No patient’s name
No address of dispenser
No name of medication
No date of dispensing
No instructions for use
No “Keep out of reach of children” warning
No strength per tablet
Nil
Score
Interpretation (Assessors only)
Total score (0-20)
Percentage score
(pass = 100%)
Label Interpretation
Name of assessor
Date:
Level 2 - Worksheet 29: Catheter Care
To obtain competency in Catheter Care, both Worksheet 29 and Worksheet 30
must be successfully completed.
1.
Which part of catheter care can Care Workers/Personal Assistants not do?
2.
Who has overall responsibility for catheter care?
3.
There are two types of long-term catheters, the urethral catheter and the suprapubic catheter. Describe the difference between these.
4.
What is it essential to do before any form of catheter care?
5.
What is the main difference between night and day bags?
6.
When would a catheter valve be used instead of a bag?
Signature of candidate: ..................................................
Date:
Signature of assessor: ...................................................
Date:
Level 2 - Worksheet 30: Care of Catheters – Practical Assessment
To obtain competency in Catheter Care, both Worksheet 29 and Worksheet 30
must be successfully completed.
The assessor should place a √ in the relevant box to indicate that the candidate has been
directly assessed carrying out the corresponding procedures satisfactorily. Place an ‘X’
in the box to indicate a procedure that was not carried out satisfactorily.
Date Directly supervised
Own hands effectively washed and
dried prior to commencing catheter care
Cleaning of catheter insertion site
Checking catheter insertion site for
signs of infection
Checking catheter for flow of urine
Checking appearance of urine
Checking and recording volume of urine
in bag before emptying
Care of day bags including, changing,
emptying and disposal
Care of night bags including changing,
emptying and disposal
Education of Service User
Initial of Assessor
Once the candidate has been directly supervised in the procedures outlined above and
the assessor is satisfied with the candidate’s capability on a minimum of 3 occasions, the
assessor may sign the competence agreement below.
Candidates name: ……………………………………. has successfully completed the
required elements of this section and demonstrated a competent approach to catheter
care.
Signature of candidate:.........................................
Date: ......................................
Signature of assessor:..........................................
Date: ......................................
Page 140 of 142
Administration of medication: Competence Assessment
Assessor:
Candidate:
Date commenced:
The assessor should place a  in the relevant box to indicate that the candidate has
been directly supervised carrying out the corresponding procedures satisfactorily. Place
an ‘X’ in the box to indicate any procedure that was not carried out satisfactorily. The
assessor must initial each supervision at the end of the section.
Directly supervised
Date
Preparation – ensure that:
a) medications are stored securely and
correctly at commencement of activity
b) there are adequate supplies of the
medications required
c) resources required to administer
medications are prepared ready for use
d) own hands are effectively washed and
dried prior to each administration
Initial of assessor
Page 141 of 142
Medicine administration
Directly supervised
Date
a) informs Service User, discretely, that it
is time for medication; asks if they wish to
take it and how much assistance they
require.
b) responds appropriately to any
objections, questions or issues raised by
the Service User.
c) checks that the details and instructions
on medicine label are correct for that
Service User and correspond to the
medication record; assembles the
medicines transferring from the dispensed
containers to the medicine pots/spoon.
d) makes adequate fluid available to client
and follows any special instructions given
for particular medicines.
e) gives assistance as desired by the
Service User
f) discretely checks that Service User has
taken medication
g) records outcome of activity accurately
on medication record
Initial of assessor
Once the candidate has been directly supervised competently giving medication on a
minimum of 3 occasions, the assessor, if satisfied with the candidate’s capability may
sign the competence agreement below.
Administration of Medication Competency Agreement
Candidate name:
………… has demonstrated a
competent approach to the administration of medication.
Assessor name: .......................................................... ..
Signature of assessor:................................................. ..
Page 142 of 142
Date: .................................