Practice No.
128
Reference: 10/06
Version 3
Page 1 of 6
HCC AS 06/09
HCC AS 10/06 112
HCC AS 10/06 125
HCC AS 10/06 126
HCC AS 10/06 127
HCC AS 10/06
128a
HCC AS 10/06
128b
HCC AS 10/06
128d
HCC AS 10/06 306
CSCI/CQC: Quality
Performance and
Methods Directorate :
The Safe
Management of
Controlled Drugs in
Care Homes (Jan 07)
The Royal Marsden
Hospital Manual of
Clinical Nursing
Procedures
Last up-dated
October 2010
NMC Code of Professional
Conduct
NMC Standards for
Medication Management Aug
2008
GSCC Code of practice for
social care workers and
employers
ADMINISTRATION OF MEDICATION
This defines the arrangements for ensuring that residents and service users receive
their medication as prescribed, in a safe manner, and that the medication is safely
recorded, auditable and correctly administered by designated staff:
1.
GENERAL PRINCIPLES
Responsibility of Staff
The Registered Manager

Is responsible, with the support of the service manager, for ensuring that
all staff are aware of the systems for the control and administration of
medication and how these are implemented

May appoint a ‘designated’ person to look after the medication for those
residents who are unable to manage their own. The designated person
must be appropriately trained and competent to carry out this duty. The
designated person must know and be known to the prescriber and
dispensing pharmacist

Must ensure that all medication, including controlled drugs are
administered only by designated and trained staff

Must ensure that all residents have a current care plan and associated
risk assessments
 Registered managers of nursing units must ensure that all nurses have a
current, valid, UK registration with the NMC. (valid being - not barred from
administration of medication under disciplinary rulings)
The





Designated Staff
Must know the limitations of the their role in relation to medication
Must follow the policies and procedures within the home
Must have undergone suitable training for their role
Must immediately report any discrepancies in the records, errors with
medication or changes in a resident’s condition, to the duty manager
Carers must not administer intrusive medication unless they have had
specific training from an appropriately qualified professional, and are
competent to do so.
Registered nurses
 Must ensure that their knowledge of medication related issues is up to
date
 Are responsible for their own actions and omissions
 Must exercise their professional judgement and apply their knowledge
and skill to all situations
 Must immediately report any discrepancies in the records, errors with
medication or changes in a resident’s condition, to the duty manager
 Must ensure they comply with NMC professional codes and guidance.
2.
PRESCRIPTION OF MEDICATION
All medication must have been prescribed, recorded and stored, in line with
Practice guidelines 125, 126 and 127.
The prescriber must provide sufficient information to enable a designated
person to administer medication correctly, by written instructions on the
prescription. The pharmacist will transcribe those instructions to the container
label. If the instructions are insufficient or unclear, the prescriber must be
contacted before the medication is administered. Any additional information
must be written clearly and legibly in black ink, in the care plan.
3.
GENERAL GUIDELINES FOR THE ADMINISTRATION OF MEDICATION
Designated staff must not :

Crush or break tablets unless authorised by the prescriber or pharmacist

Remove medication or medication records from the home

Entice or coerce residents to take medication by mixing it with food

Fill a medication aid

Physically force a resident to take medication which they do not wish to
take

Administer pessaries, enemas, suppositories

Administer injections, unless they have received specific training e.g. for
an insulin pen or an auto injector

Ignore any inaccuracies identified in the medication record

Ignore any change in the resident’s behaviour, or other possible side
effects of the medication

Administer any medication which has not been prescribed or agreed by
the resident’s current prescriber

Administer medication which is not stored in the original container
supplied by the pharmacy

LEAVE A MEDICATION TROLLEY, OR CUPBOARD, UNLOCKED
WHILST UNATTENDED, FOR ANY REASON. This includes whilst
administering medication to a resident or service user

Disguise medication. Disguising medication in the absence of informed
consent may be regarded as deception. A clear distinction must always
be made between those residents who have the capacity to refuse
medication and whose refusal must be respected, and those who lack
this capacity.
Where a person has been assessed as lacking capacity to consent to
medication, a further distinction must be made between those for whom
no disguising is necessary because they are compliant, or are unaware
that they are receiving medication, and others who would be
noncompliant but aware, if they were not deceived into thinking otherwise.
Medication may only be disguised or given covertly, under the
circumstances detailed in the Medication Management Policy 06/09.
Before administering any medication :
 Designated staff must check the dose has not already been given and
that the following ‘five corrects’ are observed:
1.
The correct Resident: Identify the resident and make
sure their correct name is on the medication
2.
The correct Medication: Check the name of the
medication corresponds with the name given on the
medication administration record (MAR) sheet. If there is
any discrepancy it may be because there is a generic or
brand name in use, if there is any doubt, this must be
checked with the dispensing pharmacist
3.
The correct Dose: Check the strength and quantity
of the medication being given with that recorded on
the MAR sheet
4. The correct Time: Check the dose is being given at
the correct time, this includes any additional
instructions such as before or after food
5.
The correct Route: Check how the medication must
be administered e.g. eye, ear and nose drops.
No medication may be given until the designated member of staff is sure
that all the above are correct. If there is any concern, the duty manager
must be contacted.




Wash hands
Prepare equipment required e.g. PPE; medication; sharps disposal box;
clinical waste bag
Deal with one resident at a time. Explain what you are doing and confirm
their consent
Prepare the drug by checking the following:
- The MAR sheet, read it carefully and check that the
medication has not already been given or given within a
minimum interval e.g. less than 4 hrly
- The 5 Corrects
- Any special instructions e.g. ‘with food’
- The expiry date of the drug
- Any calculation necessary
- Any allergies the resident has been recorded as having
When all checks have been made, administer the medication and observe it
being taken.
Complete and sign the MAR sheet in black ink.
Return the medication to safe storage.
All specialist procedures must be undertaken in reference to specific
guidelines
4.
RECORDING THE ADMINISTRATION OF MEDICATION
USE OF MEDICATION ADMINISTRATION RECORD (MAR) SHEETS:
It is the responsibility of the person administering the medication to keep
accurate records of all medication they have administered to residents and
service users. All medication given must be recorded on the MAR sheet.
Regular medication reviews involving the pharmacist and GP will ensure this
information is accurate. (For persons who self administer their medication,
reference must be made to Guideline 112)
To ensure the MAR is accurately recording that the medication has been
administered :
The resident must be observed to have taken oral medication

The MAR sheet must be signed immediately after the resident has taken
their medication

The MAR sheet must not be signed using any initials which have been
designated for certain information e.g. R for ‘resident in hospital’, as this
will cause confusion. Initials of designated staff must also be recorded
with their signatures

A record of all medication, internal and external must be kept on the MAR
sheet

Registered Managers must keep a record of the signatures and initials of
designated staff as they may appear on the MAR sheets. This must be
updated regularly

If there is a variable dose e.g. ‘one or two tablets’ the exact quantity
given must be recorded

If there is any reason why a dose is not given, or if a dose is refused, this
must also be entered. This information is as important as doses taken. A
detailed explanation must be added to the resident’s or service user’s
notes

When a medication is refused, this must be reported to the duty manager

If there is any change in a dose or drug, a new section must be used in
the MAR sheet and a line, in this form |----------------|, put through the
remaining days of the original prescription

If a drug is discontinued the date must be entered on the MAR sheet and
a line drawn, as above, through the remaining days

Any problems that arise whilst taking the medication must be recorded in
the care plan so that this information is available to all relevant people

Any problems whilst taking the medication must also be reported to the
prescriber

If a cream or drops are administered by a healthcare professional e.g.
district nurse, they must also sign the MAR sheet when this has been
completed.
The condition of the resident must be monitored both before and after a dose
of medication is given and any changes must be noted.
Recording and administration of CDs
In addition to the MAR sheet which must be completed as for all
administration : A separate ‘Controlled Drugs’ register must be maintained for the
recording of storage, administration and disposal of CDs. (Disposal
includes administration)
 Two members of staff must check all stock received or disposed of, and
both must sign the CD register
 Stock levels must be checked every time CDs are entered into stock or
administered
 A running balance of the quantity of each prescription held, must be kept
 When a CD is administered the dose must be measured and checked by
the administering person and a competent witness
 Both the administrator and witness must see the resident take the
medication and then both must sign the CD register immediately
 Both administrator and witness must also sign the administration record
 Stock checks must be carried out regularly and at a minimum of weekly
 Each home must have a record of the signatures of all staff permitted to
sign CD registers
 CDs must be denatured before disposal, the licensed company will
advise on this. A Registered Nurse and competent witness must sign the
record of disposal in the CD register.
When required’ or ‘prn’ medication
Some medication such as pain relief, laxatives and indigestion remedies, do
not need to be taken regularly and will be prescribed ‘prn’ or ‘when required’.
When a ‘prn’ medication is prescribed
 There must be a clear indication of the use of the medication written in
the care plan and on the MAR sheet e.g. Paracetamol for pain
 Directions must include a specific dose or range of doses e.g. one or two
tablets as required
 There must be an indication of the timing, e.g. at night; no more than 4
hourly
 There must be an indication of the maximum daily dose e.g. no more
than 4 doses in 24 hours
 All requests for ‘prn’ medication must come from the resident. However
some residents may need to be asked if they require ‘prn’ medication.
Designated staff should use professional judgement and knowledge of
the resident to determine when residents may need to be asked.
 When a ‘prn’ medication is administered the MAR must be checked to
ensure another dose has not been given within the minimum time limit
 The reason for giving the medication must be checked. This is especially
important for pain relief, as pain in a new area may indicate an
undiagnosed condition. If this is the case, it must be reported to the duty
manager
 The medication must be administered in accordance with agreed
procedure
 The medication administration record must be completed as for all
administrations.
5.
Refusal of medication
All residents have the right to refuse medication. If this happens the following
procedure should be applied :
Offer the medication again after an appropriate, short period

Ask another designated member of staff to present the medication,
possibly accompanied by a staff member who has the resident’s trust

Never allow the resident to be coerced into taking medication by
sanctions e.g. turning off the TV, as this can be construed as abuse.
If the medication is still refused, complete the MAR sheet and record the event
in the care plan. A risk assessment must be carried out, on prescription of
medication, to record if the resident is likely to come to any harm from refused
doses of any prescribed medication. The pharmacist will be able to advise on
this and the GP must be contacted if this is the case. Any such risk must be
recorded in the risk assessment, whether there is or is not likely to be harm
from refusal.
6.
Drug Alerts
When a Department of Health Drug Alert is received, the Manager is
responsible for checking whether any residents or service users are currently
being administered the specified medicine.
If any residents are affected, the relevant GP must contacted.
If any day service users are affected their main carer should be alerted and
advised to contact the GP.
7.
Medication Errors
In the event of a medication error, the procedures set out in Practice
Guidelines 128b and 306 must be followed.
8.
Oxygen therapy
Whilst the above guidelines will also apply to Oxygen therapy, ALL STAFF
must ensure that they also comply with the guideline 128d on the Management
of Oxygen
.