The Role of Home Carers in the Management of Medicines
Highland Council
&
NHS Highland
Warning – Document uncontrolled when printed
Policy Reference:
Date of Issue: July 2007
Prepared by:A. MacRobbie & B. Nott
Date of Review: July 2009
Lead Reviewer:A MacRobbie & B Nott
Version:3
Authorised by: Chief Officers Group
Date:
CONTENTS
Page
1.
INTRODUCTION
2
2.
FLOWCHART
3
3.
ASSESSMENT OF CLIENT MEDICATION NEED
6
4.
LEVEL 2 ASSISTANCE
6
5.
LEVEL 3 ASSISTANCE
7
A.
B.
C.
D.
E
7
7
8
8
8
Responsibility/Liability
Consent
Medication Chart
Medication Administration Form
Tasks Which May be Undertaken by Home Carers after Assessment
and with Appropriate Additional Training from Healthcare Workers
6.
TASKS WHICH MUST NOT BE COMPLETED BY HOME CARERS
8
7.
DESCRIPTION OF TASKS WHICH MAY BE UNDERTAKEN BY HOME
CARERS
9
8.
SERVICE USERS WHO ARE UNABLE TO GIVE INFORMED CONSENT
12
9.
GENERAL INFORMATION – HOW THE PHARMACIST CAN HELP
12
10.
TRAINING
12
APPENDIX 1
Checklist for Assessing Client Medication Management Need
APPENDIX 2
Emergency Procedures & Form
APPENDIX 3
Medication Chart & Record of Medication Administration
APPENDIX 4
Medication Permission Form (for level 3 service user)
APPENDIX 5
Medicines Disposal Form
APPENDIX 6
Client Information Leaflet
APPENDIX 7
Information Leaflet for Health & Social Care Workers (Level 3)
APPENDIX 8
Information Leaflet for Medication Compliance and Monitored
Dosage Systems (Level 2)
1.
INTRODUCTION
The aim of the Home Care Service is to enable service users to choose to continue to live in their
own homes. The range of care tasks which Home Carers are required to undertake will be from
household to personal care. These tasks supplement self care and the support available from
informal carers.
The majority of service users are able to take responsibility for their own medicine management
and it is important that people are supported to maintain as many self-care skills as possible.
However service users may sometimes require assistance with medication. The assistance
offered must be tailored to an individual’s needs and carried out in a professional manner by
properly trained staff with the correct degree of competence.
These guidelines aim to ensure that any assistance given with medication is carried out in a safe
professional manner, within the knowledge and competence of Home Carers. It is imperative
that Home Carers observe the guidance set out in this document.
Home Care staff must feel confident to perform tasks correctly and safely.
Home Care staff should never be involved in any medicine management task unless authorised
to do so by the Home Care Senior/Manager.
Home Care staff must not perform any activity out with the guidelines.
Medicines Administration by Home Carers in the Community
Flow Chart
Identification of Client Medicine Management Problem from e.g. single shared assessment (SSA)
( by Home Carer, Care Manager, Community Nurse, GP, Community Pharmacist)
Referral to Primary health care team for needs assessment

GP Practice to assess level of assistance required with medicines and full medication review e.g. Discontinue
unnecessary medication, review timing of administration to assist with compliance, synchronise prescription
supply quantities etc
Level 1
Level 2
Level 3
Level 4
Able to manage own
medicines - no problems
Able to manage medicines with
minimal assistance (ie collection of
prescriptions by home carer, return
of unnecessary medicines by home
carers to pharmacy)
Require medicines to be
managed and
administered by others
Require assistance
with medication
beyond scope of
home carer e.g.
injections
Record outcome and
planned next
medication review
date
GP Practice to
Update practice
patient record,
including
medication record
Communicate with
Community
Pharmacist to
YES
updateYESv
medication
records and to
assist patient with
appropriate
compliance
measures
Communicate
(written)with Senior
Home Care officer
Record outcome and planned
next review date
GP and Senior Home Care
Officer communicate regarding
agreement for medicines
administration by home carer
- Senior home care officer(SHCO) to
update register of level 3 clients, flag
Care First system and activate
communication cascade to key
stakeholders
NO
YES
-
-
-
-
-
GP to identify patient's preferred
community pharmacy (all dispensing
requires to go through one pharmacy for
the service to operate effectively)
GP to update and flag practice patient
record (including medication record)
and advise community nursing staff
GP to include information on patient
emergency summary to identify to
unscheduled care additional records if
prescribing or to flag if hospital
admission is required
SHCO to Communicate with
Community Pharmacist to confirm
client status and to update records
SHCO to advise Community Nursing
team
Monitor for change in circumstances and/or review date for client/patient reached

If no change in assessment - record, communicate outcome to stakeholders and continue

If change in circumstances - commence from start of pathway
Record outcome
and planned next
review date
- GP Practice to
Communicate
with community
nursing team
- GP to advise
SHCO
Hospital Admission/Discharge of Previously Identified Level 3 Medication Patients
Hospital admission
-
-
Ward staff to identify if relative/carer
involved in medicines administration
and request if patient has SSA and
obtain copy
Flag PAS (Patient Administration
System) system with 'Level 3
medication patient' if not already done
Acute Hospital Discharge
Community Hospital Discharge
-
-
-
Hospital Pharmacy process discharge
prescriptions for both Acute Hospital and
Community Hospitals
PAS system flagged to identify level 3
patients
Home care service (SCHO) require to be
advised of discharge and medication needs
by hospital social worker (new, temporary
or ongoing, include level 2 patient needs ie
prompting, compliance devices etc.) or ward
staff as appropriate. 48 working hours
notice required of changes.
-
Will be included in list of destination for
register of level 3 patients
Flag PAS system to identify level 3 patients
Home care service (SCHO) require to be
advised of discharge and medication needs
(new, temporary or ongoing) - for RNI may be
done by Raigmore hospital social worker or
ward staff as appropriate. 48 working hours
notice required of changes.
Medication dispensed by
hospital pharmacy
department
Medication dispensed from
community pharmacy on GP10
or HBP prescription
Hospital discharge (IDL)
-
IDL information should match
discharge medication labels
Quantity of medicine supplied is
ideally for a 28day period
IDL copy sent to GP must record
this is a level 3 patient for accuracy
checking (so that copy of IDL can
be sent to community pharmacy to
trigger generation of medication
chart from CP)
Hospital discharge (IDL)
-
-
IDL information should match
discharge medication labels and
checked by GP. IDL must
record this a level 3 patient
Quantity of medicine supplied is
ideally for a 28day period
IDL copy sent to community
pharmacy by community
hospital staff to trigger
generation of medication chart
from CP)
GP to send checked
copy of IDL marked
Level 3 patient to
community pharmacy
with request for
medication chart from
community pharmacy
for home carer
CP prepares
medication
chart for home
carer
Hospital Discharge
- GP10 or HBP script must
record this as a Level 3 patient
- script sent to CP for
dispensing
Role and Responsibilities for team Members involved with a Level 3 medication patient
Senior Home Care Officer Responsibilities
- liaison between home carer and health care team
- obtainRole
client
consent
for home carer
medicine
administration
and
Responsibilities
for team
Members
involved with a Level 3 medication patient
- authorises home carers to administer medicines and maintains supplies and storage of documentation (include
carer ID)
- trains and supports home carers
- monitors and feeds into systems review
- Hold, maintain and keep stakeholders informed of changes to register of level 3 patients
Community Prescribers'/Practice responsibilities
- advise senior home care officer of any changes in medication
- advise community pharmacist of any changes in medication
- all medicines prescribed with full directions. As required medicines need a maximum dose stated.
- completes Incapacity forms if required
- flagging clients with unscheduled care service and on own GP system
- ensuring prescriptions/IDL identify patient as Level 3 medication patient when sending to community pharmacy
- advise community nursing staff
Community Pharmacist responsibilities
- prepare and maintain medication record chart
- update patient medication records including flag ‘level 3’ patient
- Flag labels on patients medicine bottles with ‘level 3’ patient if needed
- advise and support home carer on medicine related issues
- communicate with prescribers and other stakeholders as appropriate
- if available assist with collection/delivery service
Home Carer Responsibilities
- Orders, collects, arranges appropriate storage e.g. putting refrigerated items in fridge and administers medicines
and maintain records of administration.
- Arranges for disposal of medicines if required.
- advise senior home care officer/GP practice of possible side effects/difficulties
Unscheduled Care Responsibilities
identifies patient on system as a level 3 patient when advised by GP practice
- ensure GP, home care manager and Community Pharmacist advised of medication changes for level 3 patients
- records medicines administration/prescription changes in home care documentation
- advises hospital of Level 3 medication needs if patient admission required
Community Nursing responsibilities
- use of home care documentation for administration of medicines if necessary e.g. where home carer usually
administers medication
- liaise with senior home care officer to discuss administration issues where health care advice required (as
indicated in policy)
- administer medicines by routes identified as inappropriate for home carers to administer where required
Family/other carer responsibilities
- Use home care documentation if administering medications
- Communicate concerns or changes to SHCO or GP
Hospital responsibilities
- obtain information of level 3 status by ward staff asking who look after patients medication at home or from
single shared assessment
- flag PAS system if not already done
- Ward discharging nurse ensures IDL matches dispensed medication and if community hospital copy sent to
community pharmacist
- liaise with relevant stakeholders at discharge e.g. social work for home carer, ward staff for GP/Community
Pharmacy/Community nurse
Client responsibilities
- consent to home carer administration of medicines
- provide any equipment e.g. locked medicine cabinet necessary for effective management of medication
3.
ASSESSMENT OF SERVICE CLIENT NEED
Assessment of service client need is key to the whole process. This will identify what, if any,
assistance is required. Assessment of need is the responsibility of a member of the GP Practice
team and may not be carried out by the Home Carer Service.
Assessment of need must be carried out in a structured manner using for example the checklist
(Appendix 1.)
The result of the assessment will be one of the following:
 Able to manage their own medicines (Level 1 user) These service users will retain control of
their medication, preserving their independence and choice. This should be encouraged
wherever possible.

Able to manage their medicines with minimal assistance (Level 2 User) These service users
will retain maximum control of their medicines and will require minimal input. The service user
will retain overall responsibility for the management of their medicines.

Assistance required (Level 3 User) These service users are unable to manage their medicines
themselves. They will not retain responsibility for the management of medicines. The service
user or their carer must agree to assistance being given.

Assistance required beyond the knowledge and skills of Home Carers (Level 4 user) Any
procedure other than those detailed for level 2 and level 3 users should only be performed by
competent persons with medical knowledge and skill.
The results of this assessment must be recorded and made available to all who will be involved in
the care of the service user.
Reassessment may be necessary at any time to take account of changes in the medication needs of
the service user. Any change in medication needs should be notified to the Home Care
Senior/Manager by the GP Practice Team.
4.
LEVEL 2 ASSISTANCE
The level 2 service user is responsible for the management of his/her own medicines but may, after
assessment by the Home Care Senior/Manager, including risk assessment, be offered help with the
following tasks.

Ordering prescriptions from the medical practice at the request of the service user. The
service user must indicate the medicines, dosages and quantities to be ordered.

Collecting prescriptions from the medical practice and delivering to the pharmacy.

Collecting medicines from the pharmacy.

Confirming the reading of medicine labels.

Opening containers such as medicine bottles, removing tablets/capsules from strip
packaging. Assistance with opening compliance aids may only be given if these have been
dispensed by a Pharmacist. Administration, where agreed by Senior Home Care Officer
(SHCO), of short term temporary medications e.g. post surgical eye drops, where client is
otherwise able to manage their own medication.

Returning unwanted medicines to the pharmacy at the request of the service user. The
service user must indicate those medicines to be returned and the medicines disposal form
(Appendix 5) be completed.
Home carers should ascertain which pharmacy is preferred by the service user and use this
pharmacy at all times (see how the pharmacist can help).
The home carer must not fill compliance aids, e.g. dosette boxes.
All requests for assistance other than those listed above and agreed by Home Care Senior/Manager
must be reported to the Home Care Senior/Manager.
GP Practices will be informed by the Home Care Senior/Manager of service users being supported
at level 2
Mismanagement of Medicines
If the Home Carer suspects that a service user is not taking his/her medicines as prescribed they
should discuss their concerns with the service user and try to support them to take their medicines
appropriately. If this fails the Home Carer should inform the Home Care Senior/Manager who will in
turn contact the appropriate GP Practice team member in writing to ask for a re-assessment.
5.
LEVEL 3 ASSISTANCE
Before assistance can be given to a service user at level 3, a review of medicines must be
undertaken by the GP Practice team or pharmacist. All medicines must be prescribed with specific
directions – the use of the term ‘as directed’ must be avoided.
A. Responsibility/Liability

Home Carers may only give medication to service users in their own homes after authorisation
by the Home Care Senior/Manager as an agreed task on the Care Plan (see later). Procedures
to be followed in emergency situations are set out in Appendix 2 to these guidelines e.g changes
to medication, hospital discharge and verbal instructions.

As a general rule, Home Care staff should be able to provide assistance with oral medication,
some skin care and eye/ear/nasal preparations. Individual needs may also be provided
following guidance and demonstration with the individual service user (see later).

The Home Carer Service has the responsibility for ensuring that Home Carers assisting with
medication have had proper training and receive appropriate support and that medication
administration charts (Appendix 3) are completed.

Home Carers will only assist with medication if a Medication Permission Form (appendix 4) has
been signed.

If the Home Carer has any concerns about any aspect of a service client’s medication regime,
she/he must notify the Home Care Senior/Manager immediately.

It is the responsibility of the service user to purchase any compliance aids or locked medicine
cabinet necessary for the proper management of their medication.
B. Consent
Following an Assessment of Need, the Senior Home Care Officer/Manager will discuss medication
issues with the service user and/or his/her representatives, agree the task to be undertaken and
complete the Medication Permission Form. (See Appendix 4).
The Senior Home Care Officer/Manager will liaise with all others providing support to the service
user (i.e. formal and informal carers, health care team) so that each party is aware of the input being
provided. It will be emphasised that, in the interests of safety, any other carers involved in
administration of medication must agree to use the medication administration form. This will be
documented in the Care Plan. Any difficulties will be reported by the Home Care Senior/Manager to
the GP Practice.
C. Medication Chart
Responsibility for assisting service users with medication at Level 3 will only be taken after the
completion of a Medication Chart. (See Appendix 3). This responsibility will be undertaken by the
pharmacist except in areas where dispensing practices are in place and the GP practice team will
undertake this. A review of medication by a member of the GP Practice team, which could include
the pharmacist, should take place to ensure that all medication continues to be indicated.
The Home Care Senior/Manager will be advised of any changes to the medication chart and it will
be his/her responsibility to ensure that any new task is within the competency of the Home Carer.
D. Medication Administration Form
Senior Home Care Officers/Managers will be responsible for ensuring Home Carers complete the
Medication Administration Forms (See appendix 4), for monitoring record-keeping and supporting
and supervising staff. Home Carers will be responsible for following instructions from the
Medication Chart and for recording actions showing date and time of actions in the Medication
Administration Form. Any problems encountered with the administration of medication must be
recorded on the reverse of the Administration Record under the headings “Date”, “Problem”,
“Actions Taken” and “Outcome” Medication Administration forms will be removed from the service
user’s home on a monthly basis by the Home Care Senior/Manager and a new sheet supplied. Old
medication charts will be stored in the service users file.
E. Tasks Which May be Undertaken by Home Carers after Assessment and with Appropriate
Additional Training from Healthcare Workers (Level 3)












6.
Changing catheter leg bag, where this does not disturb the catheter
Changing colostomy bags
Changing dressings, simple dry dressings, covering a minor wound with sticking plaster or
as a first-aid measure until medical advice is sought
Application of creams, ointments or lotions
Eye drops, eye ointments
Ear drops, ear ointments
Nasal drops, nasal ointments
PEG feeding
Inhalation devices, nebulisers, oxygen.
Insertion of pessaries if agreed appropriate by the health care team.
Insertion of suppositories or microenemas if agreed appropriate by the health care team.
Mouthwashes
TASKS WHICH MUST NOT BE UNDERTAKEN BY HOME CARER (Level 4)


Filling compliance aids
Any invasive procedures, for example
Injections
Removal of stitches
Insertion of catheters
Changing of dressings, unless simple dry dressings
Stoma care in post-operative phase
Testing for diabetes
Eye drops/ointments/creams/lotions when medical or nursing assessment indicates
trained health staff should be involved
Administration of medicines which need skilled observations either before or after
administration (e.g. taking pulse) which have been so designated by the health care team.
7
DESCRIPTION OF TASKS WHICH MAY BE UNDERTAKEN BY HOME CARERS
LEVELS 2&3

Ordering Prescriptions
This will involve ordering prescriptions from the medical practice. At level 3 only those medicines
which are listed as regular medicines on the Medication Chart should be ordered. The chart will
also indicate the frequency of ordering and the amount to order. Requests for repeat prescriptions
are usually made to the medical practice 48 hours in advance of collection, although this interval
may be longer if a weekend or public holiday intervenes.

Collecting Prescriptions
This will involve collecting prescriptions from the medical practice and delivering to the pharmacy.
Many pharmacies collect prescriptions directly from the medical practice.

Collecting Medicines
This will involve collecting medicines from the pharmacy. Many pharmacies have collection/delivery
services. The Home Care Senior/Manager should ascertain if one is in operation locally and use
this if possible. She/he will also ascertain whether family or friends can undertake this task.
Collection of medicines will only be undertaken after an assessment of risk to the Home Carer by
the Home Care Senior/Manager.
Home carers should be provided with a means of identification (badge or letter of introduction) for
use at the surgery/pharmacy when ordering/collecting prescriptions or medicines.
Requests for purchasing over the counter (OTC) medicines - Home carers may purchase OTC
medicines for Level 2 clients where agreement has been sought from the community pharmacist or
GP. Purchase should ideally be made from the pharmacy supplying the clients prescribed
medication. The client must be able to manage these medicines themselves.
Returning medicines which are no longer required for disposal - this is the responsibility of the client
or family. In exceptional circumstances, following risk assessment by the SHCO, the carer may be
given permission to return medicines for disposal.
LEVEL 3

Storage of Medicines
Medicines should be stored in a cool dry place or refrigerator as appropriate (i.e. preferably not in
bathrooms or kitchens) and out of direct sunlight.
Medicines must be stored so as to ensure that they cannot be taken inappropriately by the service
user or any visitors to the house, particularly children.
Medicines should be stored in their original containers as dispensed from the pharmacy; they should
not be decanted into other containers.
When the administration of medicines is the responsibility of the Home Carer they should be stored
in a sealed container labelled in a manner to inform relatives/friends not to administer medicines
(unless part of the written agreement) without informing the Home Carer.
The label of the medicine should be inspected for special storage instructions such as store in the
fridge. Medicines stored in the fridge should be placed in a container (e.g. plastic box) and kept
separate from food and other consumables
The “Medication Chart” should be stored in the client's care plan or alongside the medicines.
All medicines in the service user’s home should be stored in one place unless there is special
instructions for storage. Creams and ointments should be stored in a separate container from other
medicines.

Administration of Medicines
The following procedure should be followed on every occasion that medicine is administered to a
service user
1. Check the name on the container is that of the service user.
2. Check the name and strength of the medication.
3. Check the time of administration
4. Check the dose to be administered.
5. Check for any other specific instructions, such as timing of administration in relation to
meals
6. Compare this with the information on the medication chart. If there is any discrepancy or
if the Home Carer is unsure about any aspect of giving the medicines, the Senior Home
Care Officer/Manager or primary care professional e.g. NHS 24 if out of hours, should be
contacted .
7. Check the expiry date of the medicine.
8. . Check the record sheet to ensure the medicine has not already been given. Where
appropriate, double check with the service user that they have not already received the
medication
The Home Carer should then:
1.
Explain the procedure to the person to ensure they know what to expect and what to
do.
2.
Ensure good hygiene by washing hands before and after administering medicines
and by keeping everything as clean as possible.
3.
Help the person into a comfortable upright position.
4.
In order to avoid handling the medicine, the appropriate numbers of tablets or
capsules should be tipped into the lid of the container and then placed into a clean
medicine cup or the service user’s hand. In the case of foil wrapped medicines, the
appropriate dose can be pressed out or torn out of the wrapping into a clean
medicine cup or the service user’s hand. The service users will take their own
medicine, but the Home Carer should encourage them to wash over tablets/capsules
with approximately half a tumblerful of water to ensure that the medicine is washed
down into the service user’s stomach.
5.
For soluble tablets, the dose should be measured out from its original container as
previously described, but it should then be placed in half a tumblerful of water and
allowed to dissolve before giving to the service user to drink. If the service user
wishes, a cold drink may be taken after.
6.
For buccal tablets (i.e. tablets from which the medication is absorbed through the
lining of the mouth) the tablet should be placed high up between the upper lip and the
gums to either side of the front teeth, where it will soften and adhere to the gum. For
service users who wear dentures, the tablet should be placed in any comfortable
position between the lip and the gum.
7.
For sublingual tablets (i.e. tablets to be placed under the tongue) the tablet should be
placed under the tongue and left to dissolve.
8.
In the case of liquid medicines, first shake the bottle then measure the appropriate
dose into a clean 5ml spoon, medicine measure or oral syringe. When pouring the
medicine, tip the bottle with the instruction label facing upwards so that if any of the
medicine dribbles down the bottle it will not mark the instruction label. Give the
measured dose to the service user to take. Unless it is inappropriate for the particular
medicine (e.g. indigestion remedy, cough linctus), a cold drink may be taken after if
the service user wishes
Wipe the neck of the bottle and any liquid which may have dribbled down the side of
the bottle with a clean tissue prior to replacing the lid.
9.
Giving Medicine from a Compliance Aid
Home Care staff will not give tablets from a compliance aid, only from a labelled
bottle. Compliance aids can only be used by level 2 service users who take
responsibility for their own medication.
Administration of medicines must be recorded on the medication administration form.

‘As Required Drugs’
Some service users may only need to take medicine on an ‘as required’ basis. In this situation,
assistance with medication (Level 2) rather than management of medication (i.e. Level 3) is what
the Home Carer can offer since the service user will need to be able to let the Home Carer know of
their need for the ‘as required’ medicine. This will generally mean that people who cannot make an
informed choice about this will be unable to be supported to take ‘as required medicines’. It is
acknowledged, however, that some level 3 service users, while incapable of managing their own
medication, may still be able to make informed choices about the need for some medication such as
analgesics. In these cases as required, drugs may be given by the home carer if the GP Practice
team indicate that it is appropriate for this particular patient. The Home Care Senior/Manager will
be responsible for assessing this with Health Care Staff. Instructions regarding the reason for
administration (indication) and maximum dosage must be clearly stated on the label.

Refusal to Take Medication
The Home Carer must not force a person to take their medication against their will. The
Home Carer should note on the medication administration form that medicines were refused.
The Home Carer should inform the Home Care Senior/Manager as soon as possible who in
turn will inform the appropriate Health Care Staff member.
Under no circumstances should home carers become involved in concealing medication
e.g. in food or drinks, in order to get a service user to take medication.

Health Check
GP Practice team will make the Home Care Senior/Manager aware of any specific side effects of
particular medication to be reported back to them.
The Home Care Senior/Manager will, in turn, ensure this information is brought to the attention of
the Home Carers involved. The Home Carer will be responsible for reporting any concerns back to
the Home Care Senior/Manager (or GP Practice team in an emergency) who, in turn, will report to
the relevant GP Practice team. The Home Carer should also report back any other health related
concerns.

Alcohol
If the service user appears to have taken excessive amounts of alcohol at the time medicines are
due to be administered, the carers should arrange to speak to the GP practice or NHS 24 as soon
as possible and this recorded on the Medication Administration Form. Some medicines
should not be given even if a small amount of alcohol has been ingested. This will be clearly stated
on the label of the medicine. If excessive alcohol consumption is known to be a problem this will be
recorded in the care plan drawn up with the help of the service users GP.

8
Disposal of Medicines
If the Home carer notices there are medicines in the house which are no longer used, or have
reached expiry date he/she should contact the Home Care Senior/Manager who will ask the
appropriate GP Practice team member to identify current and discontinued medicines.
The Home Care Senior/Manager will then get the service user or their representative’s agreement to
take the medicines to the nominated pharmacy for safe disposal using the Medicines Disposal
Form. (see appendix 5).
This form, signed by the pharmacist should then be kept with the service users documentation
If the Pharmacy provides a delivery service it may be more convenient to wait to hand over drugs
when new drugs are delivered.
Return of drugs to the pharmacy by the Home Carer will only be considered by the Supervisor after
an assessment of risk to the Home Carer has been undertaken.
SERVICE USERS WHO ARE UNABLE TO GIVE INFORMED CONSENT
Anyone who lacks the capacity to give informed consent to medical treatment, whether or
not they are compliant with the treatment, should have a Certificate of Incapacity signed by
their GP which gives authority for the treatment. This applies even if the person is already
subject to Guardianship. Medication must not be administered to service users without this
authority.
9
GENERAL INFORMATION – HOW THE PHARMACIST CAN HELP
The local community pharmacist can provide a range of services which may help carers. Many
pharmacies have leaflets detailing the services they provide. The services offered may differ but
are likely to include:
Delivery service/collection of unwanted medicines
Provision of plain tops on medicine bottles on request
Advice on compliance aids to assist with taking medicines.
All prescriptions should be taken to the same pharmacy as this will allow the service user records to
be kept up to date.
The pharmacist is not at liberty to discuss a service user’s medicines in detail with a carer but will be
able to provide advice on administration and other medication related issues.
10.
TRAINING
All Home Carers will receive training in the management of medicines and they must adhere to the
guidelines taught in the training programme.
Home carers will receive general training on the management of medication, which will cover:







Basic information on the collection and storage of medicines
Basic information about the types of medical conditions which would require home carers to
administer or aid the administration of medication to service users
Practical demonstrations on how to administer medication, using different forms and types of
medication and dosage aids
Disposal of unwanted medicines
Commonly occurring side effects of medicines
Discussion of problems with administration should a service user refuse, or staff forget to
administer
Recording procedures.
Home Carers will be assessed on their knowledge of the content of these guidelines.
Competence to administer medicines will be determined by observation.
APPENDIX 1
CHECKLIST FOR ASSESSING CLIENT MEDICATION MANAGEMENT NEED
Name____________________________________
Date of Birth/CHI no__________________________
Address__________________________________________________________________________
Tick
Medication
Dose
Tick
Medication
Dose
Person Responsible for Administering Medication:
QUESTION
Circle
Answer
If answer to question is 'NO', what action
is to be taken (please tick)
1.
Does computer record match the medicines being
taken?
YES / NO
Refer to GP
2.
Are medicines being taken as prescribed?
YES / NO
Information to client/carer

Medicine Information Sheet Referral
Refer to GP

3.
Is the client free from medication related problems
such as constipation, nausea, difficulty swallowing,
drowsiness etc?
YES / NO
Information to client/carer

Medicine Information Sheet Referral
Refer to GP

4.
Does the client understand the reason for taking
medication? (optional question)
YES / NO
Information to client/carer

Medicine Information Sheet Referral
Refer to GP

5.
Is the client able to read labels?
YES / NO
6.
Can the client open all their containers?
YES / NO
7.
Does the patient have:Monitored dosage system (e.g. Dosett)
Inhaler
 Other device (……………...…..)
Carer assists or alternative
arrangements in place
Referral letter to community
pharmacist
Carer assists or alternative
arrangements in place
Referral letter to community
pharmacist
Information to client/carer
Refer to GP
Negotiate further support from GP,
carer, pharmacist or clinic









And do they
a. use them correctly?
b. Have access to a suitable system for filling
YES / NO
YES / NO
8.
Are the client's medicines suitably stored?
YES / NO
Advice given to client/carer

9.
Has the client/carer returned all discontinued
medicines to their pharmacy/GP?
YES / NO
Advice given to client/carer

10.
Has the client acceptable quantities of their present
medicines?
YES / NO
Too much - refer to GP
Too little - advice to client/carer


11.
Which over the counter (OTC) medicines are being
taken on a regular basis?
Aspirin 
Laxatives 
Other (please specify)
12.
Has the completed assessment identified that the
client has the necessary ability and skills to selfmedicate without supervision?
YES / NO
Vitamins 
NOTES/PROBLEMS
Creams 
Paracetamol 
If 'NO', what further action needs to be taken?
Signature of Assessor……………………………………………….Date…………………………………………….
Checklist for Assessing Client Medication Management Need.
Day/Week_____________________________
Date:
Can the client read and
interpret the labels?
Can the client measure
the correct dosage?
Can the client manage to
take all the medicines
without any assistance?
Does the client return the
medicines to the storage
area?
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Time
Yes/No
Day/Week_____________________________
Date:
Can the client read and
interpret the labels?
Can the client measure
the correct dosage?
Can the client manage to
take all the medicines
without any assistance?
Does the client return the
medicines to the storage
area?
Time
Yes/No
Day/Week_____________________________
Date:
Can the client read and
interpret the labels?
Can the client measure
the correct dosage?
Can the client manage to
take all the medicines
without any assistance?
Does the client return the
medicines to the storage
area?
Time
Yes/No
APPENDIX 2
EMERGENCY PROCEDURES
PERSONAL HOME CARERS MAY NOT ADMINISTER MEDICATION UNLESS IT IS DOCUMENTED ON
THE MEDICATION CHART OR ON AN EMERGENCY PROCEDURES FORM
CHANGES TO MEDICATION





When additional medication is prescribed it is the responsibility of the primary health care team
to ensure :
a. That a check has been made with the SHCO that the home carer is competent to carry out
the task
b. Ensure that the Medication Chart is updated before the next dose of the medication is due to
be administered.
If new medication has been prescribed and not added to the Medication Chart the Personal Home
Carer must contact the Home Care Senior/Manager or (if unavailable) the G.P. Practice for advice.
When medication is discontinued it is the responsibility of the of the primary health care team
including pharmacist to ensure that the entry is scored out on the Medication Chart.
If the Personal Home Carer is advised by the client or a non-professional carer that medication has
been discontinued and the Medication Chart has not been amended they should withhold the next
dose and contact the Home Care Senior/Manager or (if unavailable) the G.P. Practice to obtain
confirmation of the discontinuation.
It is the responsibility of the Senior Home Care Officer/Manager to ensure that the Personal
Home Carer is competent to carry out the new task.
HOSPITAL DISCHARGE
 If a hospital medication chart has been provided the Personal Home Carer may administer
medication according to this chart. A Home Care Medication Chart must be provided by the home
care manager within 72 hours.
 If a medication chart has not been provided by the hospital the Personal Home Carer must contact
the Home Care Senior/Manager.
VERBAL COMMUNICATION
When information about medication changes is made verbally (e.g. by telephone) the recipient of the
information must read back the information given including spelling out the name of the medication to be
administered. The information provided must include the strength of the medication, the number of dose
units to be administered and the time of administration. The relevant section of the Emergency Procedures
Form must be completed with the date and time and the name and designation of the person giving the
information. A separate emergency procedures form must be completed on each occasion.
APPENDIX 2 cont.
EMERGENCY PROCEDURES FORM
Service User
Name
Address
Form completed by
Verbal information (if applicable)
Received from
Designation
Date/Time
Designation
Date
MEDICATION TO BE ADMINISTERED
Code
Medication name, form and strength
Number of
dose units
to be given
Breakfast
Administration times
Midday
Teatime
Bedtime
meal
Reason for giving/Special Instructions
Other
times
ADDITIONAL INFORMATION
This form to be kept with and on top of the Medication Chart and removed and retained by the Home Care Senior/Manager when a revised medication chart is provided
APPENDIX 3
CLIENT NAME
MEDICATION CHART - CURRENT MEDICATION
DATE OF BIRTH
PREPARED BY
DATE
ADVERSE MEDICINE REACTIONS (IF KNOWN)
NAME OF MEDICINE
(include form and strength)
A
B
C
D
E
F
G
H
J
K
L
M
ORDERING RECORD
Amount to Order
TIME OF DOSAGE
Breakfast
Date Ordered
Frequency
A
B
C
D
E
F
G
H
J
K
L
M
Amount of
Dosage
Lunch
Drugs
Obtained
Teatime
Bedtime
Date Ordered
Other
Information
Drugs
Obtained
Reason For Taking
Date
Ordered
Drugs
Obtained
Date
Started
Drugs
Ordered
Date
Stopped
Initial
when
stop
Drugs
Obtained
MEDICATION RECORD
This is a list of your current medication. Please show this to any healthcare professional looking after you. Take this with you, along with all your medication if
you attend hospital. If your medication changes ask your pharmacist to update this record.
NAME OF PATIENT:
ADDRESS:
TELEPHONE NUMBER:
NAME OF PHARMACY:
ADDRESS:
TELEPHONE NUMBER:
NAME OF DOCTOR:
ADDRESS:
TELEPHONE NUMBER:
NAME OF
CONTACT PERSON:
ADDRESS:
TELEPHONE NUMBER:
MEDICATION ADMINISTRATION RECORD
Month/Year
Date
1
2
3
4
5
CLIENT NAME
CONTACT HEALTH PROFESSIONAL
6
7
8
9
10
DoB
APPENDIX 4
11
12
13
14
15
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Meds
Breakfast
Time
Refusal
SIGN
Midday
Mealtime
Refusal
SIGN
Evening
Mealtime
Refusal
SIGN
Bedtime
Refusal
SIGN
Other
Times
Refusal
SIGN
Date
Breakfast
Time
Refusal
SIGN
Midday
Mealtime
Refusal
SIGN
Evening
Mealtime
Refusal
SIGN
Bedtime
Refusal
SIGN
Other
Times
Refusal
SIGN
Instructions for completion of medication administration chart:
 Identify the medication you are administering from the medication chart.
 When you have administered write the code for that medication, a,b,c,d, etc. in the correct box for the date and time of day.
 If the service user refuses the medication write code for that medication in the correct refusal box for the date and time.
 Initial legibly to show you have administered the medication and completed the chart.
MEDICATION ADMINISTRATION:
DATE
PROBLEM
ACTION TAKEN
OUTCOME
HOME CARER
APPENDIX 4
MEDICATION PERMISSION FORM (for level 3 service user)
I give my permission for the Home Care Service to undertake the management of my
medication in accordance with my care plan.
NAME
________________________________________________
ADDRESS
_________________________________________________________________
_________________________________________________________________
SIGNED
_______________________________________________
DATE
________________________________________________
For people who are unable to give informed consent (may need Incapacity Act Form
Completed)
SIGNED CARER/ADVOCATE
_________________________________________________
RELATIONSHIP TO SERVICE USER
___________________________________________
DATE _____________________________________
APPENDIX 5
MEDICINES DISPOSAL FORM
I give my permission for the following medicines to be removed from my home by
________________________________________ my Home Carer, for safe disposal by the local
pharmacist.
Name of Drug
Quantity (approximate)
_________________________________
__________________________________
_________________________________
__________________________________
_________________________________
__________________________________
Name of Service Client____________________________________________________________
Address
____________________________________________________________
____________________________________________________________
Signature of Service User/Representative ______________________________________________
Date ______________________________
For Pharmacy Use Only
I __________________________________ (Pharmacist) confirm the above mentioned drugs have
been handed in for destruction.
Signed
_______________________________________________
Address
_______________________________________________
Date
_______________________________________________
Pharmacy Stamp
Information Leaflet
for Home Care
Clients
If you are receiving care at home provided by the Highland Council you may
need some help with ensuring that you are able to take your medication safely and
effectively. This leaflet tells you what home care staff can do to help you.
Taking the medication prescribed by your general practitioner safely and
effectively is one of the best ways of ensuring that you enjoy the best possible
health and remain in your own home as long as possible.
Care at Home Service
Help with Medication
There are different levels of help that people may need, maybe just the collection
of prescriptions or the return of any unused or unwanted medication to the
pharmacy. Others may need a carer to identify which medication they should be
taking and to administer it to them at the correct time.
Home Care staff will work with your local GP practice and you to identify the
level of support you need. This will then be recorded when we are planning your
care.
What can carers help with?





Do you need help with:





Ordering medication?
Collecting prescriptions?
Taking medication?
Applying medication?
Disposing of unwanted medication
Ordering and collecting prescription medication.
Returning unused or unwanted medication to the pharmacy.
Administering prescribed medication in tablet or liquid form.
Applying prescribed creams and drops with instruction from community
nurses.
Inserting prescribed suppositories and micro enemas with instruction
from community nurses.
What can carers not help with?







Injections
Diabetic testing
Insertion or removal of catheters
Administration of complementary or over - the - counter medication
unless agreed by the G.P.
Constantly changing medicine requirements
Administering medication from compliance devices, e.g. blister packs or
dosette boxes.
Filling compliance devices
How can I be sure that the help I get is safe?
The role of the Pharmacist
Carers who assist with medication management are trained using a programme
developed with NHS pharmacy staff.
You will need to get your medicines, whether prescription or bought, from the
same community pharmacy each time. Your pharmacist is an expert in the
management of medication. If you are experiencing any difficulty taking any of
your medicines e.g. side effects, difficulty swallowing or anything is worrying
you about the medication itself the pharmacist can help you. You can contact the
pharmacist yourself or ask your carer to help you to do this. Sometimes the
pharmacist can visit you at home to give advice.
Carers will complete records which show what they have done when assisting
with medication management. They will also record any problems encountered.
Carers cannot be responsible for the safekeeping of your medication when they
are not in your home but they will work with you to identify the best place to
store both the medication and the records.
The Role of Relatives
Helpful Contact Details:
If carers are administering your medication but you also have relatives or friends
who also do this at times then they need to let the local care at home manager that
they are doing this. The care at home manager will discuss with them how to
complete the administration of medication record that the carers use. This will
ensure that you receive your medication as effectively and safely as possible.
The role of your Doctor or Community Nurse
Your Doctor will discuss your medicines with you. S/he may ask to see all the
medicines you take including:
 Medicine prescribed by your Doctor that you currently take
 Medicine prescribed by your Doctor which you think are no longer
needed
 All other medications you have bought or take
Your Doctor and the healthcare professionals at the surgery will work with you,
your pharmacist and Care at Home staff to decide what sort of help you need to
take your medication to give you the most benefit.
GP…………………………………………………………………………….
Contact no:……………………………………………………………………
Community Pharmacist………………………………………………………
Contact no……………………………………………………………………
Other
NHS 24
Tel: 08454 242424
Further information on this service may be obtained from the Head of Home Care
at Highland Council Headquarters, Glenurquhart Road, Inverness
Information
Leaflet for
Health and
Social Care
Workers
Home Carer Administration of
Medicines
Background
There has been a
growing awareness
that some people in
the community have
difficulty with administering their own
medication. The majority of home care service
users are able to take responsibility for their
own medicine management and it is important
that people are supported to maintain as many
self-care skills as possible. However service
users may sometimes require assistance with
medication.
A policy which will enable home carers to
administer medication as safely as possible
has been agreed between the Highland
Council Social Work Services and NHS
Highland and we are now rolling out
implementation. Local stakeholders include:
GPs, Community Pharmacists, Community
Nurses, Home Carers, Unscheduled Care
Sevices and Home Care managers.
Community Hospital staff, Discharge liaison
staff along with others identified as having a
key role.
Identifying Potential Beneficiaries
Which Medicines are Involved
People who have difficulties managing their
medicines may be identified by any of the
stakeholders above, a relative or informal
carer or may identify a need themselves.
Where individuals have difficulties beyond
those which can be resolved following a
compliance assessment ( see information
leaflet on compliance assessment and
monitored dosage systems), a medication
needs assessment will be carried out by a
primary health care professional (usually the
GP) the home care manager and discussed
with the individual.
This service can only be provided for
individuals who are on a stable medication
regime. Home carers may administer all
oral medications. They may also be
involved in assisting administering, eye,
ear and nose drops, applying creams,
ointments and lotions, assisting with with
percutaneous endogastroscopy feeding,
inhalation devices and mouthwashes.
There are 3 levels of medicines management
capability identified within the policy
 Level 1 – Able to manage their own
medicines themselves
 Level 2 – Able to manage their own
medicines with minimal assistance ie
understand what their medicines are
for, ask for medicines to be reordered
or disposed of but require someone to
carry out the task, will remember and
know which medicines to take if
prompted, may require someone to
open medicines container tops, can
use a monitored dosage system if
appropriate
 Level 3 – Unable to manage medicines
as a result of e.g. memory or physical
impairment , sight impairment, mental
incapacity
The individuals to whom this service
applies are those assessed at level 3.
Medicines which are to be administered on
an ‘as required’ basis will require careful
assessment and have clear directions for
when to administer, maximum doses etc.
Community nurses will continue to
administer medicines which require
invasive procedures or specific clinical
monitoring.
Informing Key Stakeholders
The Home Care Services Manager will
maintain a record of all clients requiring
this service within their geographical area
of responsibility and informing key
stakeholders of patient agreed as requiring
the service. They will also advise
stakeholders of patients no longer requiring
the service either on a temporary or
permanent basis.
The policy identifies the responsibilities of
each of the key stakeholders involved in
the process.
Documentation
Medication Charts
The community pharmacist will provide
medication charts which enable the home
carer to administer the medicines. It is vital
that these medicines charts are kept up to
date. Any changes made to medication
regimens require a new chart to be
prepared.
Patients requiring this service will not
receive medicines dispensed in monitored
dosage systems.
Unscheduled Care
The GP practice will ensure that these
individuals are appropriately identified to
the unscheduled care service using the
faxed patient contact form.
Emergency Procedures Forms
Should medication be changed as a result
of a home visit, it is important that the
emergency procedures forms are
completed at the time of the visit. Home
carers cannot administer medicines which
are not identified on the medication chart,
the emergency procedures form or where
the directions on the bottle label do not
match those on the medication chart.
practice to enable new medication charts
to be prepared around the time of
discharge for continuity of care.
Relatives and Informal Carers
If relatives and informal carers are involved
at any time in the administration of
medicines for a patient receiving a level 3
service from home carers, they must agree
to complete the home care medicine
administration records.
Summary
The management of chronic diseases
relies heavily on the appropriate use of
medicines by those for whom they are
prescribed. Inappropriate management of
medicines has been identified as being
involved in approximately 10% of hospital
admissions. Solutions to this problem have
been difficult to implement. This new
service should assist in addressing this
problem and enable individuals to be cared
for within their own homes for as long as
possible.
Further information may be obtained from the,
Head of Home Care at Highland Council
Headquarters, Glenurquhart Road, Inverness
Hospital Admissions/Discharge
It should be identified on the single shared
assessment form that patients receiving
level 3 medicine administration assistance
from home carers. The patient should be
identified on the hospital patient
registration system to enable
communication to take place with the GP
Prepared by A MacRobbie February 2007
Information
Leaflet for
Health and
Social Care
Workers
An MDS will only be provided if compliance
cannot be addressed by other methods. The
pharmacist will review the patient at one week
and one month and check that the patient is
able to use the MDS.
Medication
Compliance
and
Monitored Dosage Systems (MDS)
The ability to take medication as prescribed is one
of the key tasks that must be supported if a person
is to remain well and independent in their own
home.
Patients who live on their own and have
difficulties taking their prescribed medication
may be referred to a community pharmacist
for review of compliance issues. Referral can
be made by nurses, hospital clinicians on
discharge, social workers, carers (either formal
or informal), the patient, their GP or the
community pharmacist.
It is important for referrers to include
appropriate information about the facts of
the difficulties being experienced by the
patient and avoid anticipation of particular
outcomes prior to formal assessment.
The pharmacist will assess compliance issues
and decide what steps can be taken to help
patients take medication as prescribed. A
report will be sent to the referrer.
NB. Research has identified that MDS are
suitable for less than 20% of patients
referred for assessment.




MDS are NOT
helpful/necessary where
patients are:
 Confused
 Poorly motivated
Have frequent changes to their medication
regimen
Take medicine ‘as required’
Formal Carers are administering medicines.
(an MDS is not essential to the process of
“prompting” the client to take their
medication.)
Unable to use the device
The following groups of patients may benefit
from a MDS
 Blind or partially sighted patients
 Patients on more than 4 medicines
 Patients who have difficulty handling
original containers e.g. bottles or foil packs
 Some compliance problems
 Some learning disabilities
When a pharmacist fills an MDS it is dispensed
and labelled according to professional
standards. The pharmacist will advise on the
stability of medication in the device as certain
medications should not be placed in monitored
dosage systems.
There is limited capacity for safe provision of
MDS for patients and a pharmacist assessment
must take place to ensure the most effective
provision of the service. Patients who do not
benefit from an MDS but receive their
medicines dispensed this way deprive those
patients who would benefit from this service
from receiving it. The pharmacist may be
unable to accept additional patients for MDS
supply and there may be a waiting list. Regular
review of patients receiving MDS should be
carried out to ensure this is still an appropriate
presentation for their dispensed medicines.
The following information summarises some
problems and offers some solutions for those
most frequently encountered,
it is not intended to be an
exhaustive list. Some of the
solutions may not be
available to you.
COMMON PROBLEMS and SOLUTIONS
1. Patient is running out of medication due
to poor ordering system, lack of
synchronisation in repeat cycle or inability
to leave house
 Carer requests and/or delivers prescriptions
 all medication should be on a 28-day cycle
and only 28 days supplied at a time.
2. Patient has poor understanding of the need
for a medicine
 Offer verbal and/or written advice. A
medication chart may be useful
3.Frequency or timing of dose, the patient may
be unaware of the dose or it may not fit in with
their life style.
 Ensure full directions are on prescription/
label
 Review medication for rationalisation and
simplification of regimen
 The mid-day dose is the most difficult to
remember. Changing to a single or twice daily
dose frequency can significantly reduce the
complexity of the regime. There is little
difference in compliance between once a day
and twice a day dosing.
4. Forgetfulness
 Set up a routine linked to daily activity eg
mealtimes
 Use of 28-day calendar packs
 Use of reminder charts to help the patient
to remember to take their medication.
 Compliance aids if the person is committed
to taking their medication
 Weekly dispensing into ordinary
containers.
 Involve the informal carer if possible. How
able are they to help? You may need to
discuss the issue of arranging formal carer
input. ( see policy for home carer
administration of medicines )
5. Intentional non-compliance
 Discuss non-compliance with patient, it
may be a result of side-effects, interactions
or as a because of their beliefs about their
illness or medication. Clarify the issues
where possible and refer to prescriber if
necessary.
6. Cannot read the label/information leaflet due
to poor eye sight
 Make the best use of clear, easily
understandable information.
 Large print instructions
 Braille labels
7. English is not the patients’ first language and
they cannot understand oral or written
instructions
 Different language patient information
leaflets (PILS) are available from Drug
Manufacturers and some Health Promotion
Departments
 Enlist the help of a family member or
friend who can help with translation
8. Dexterity problems
 Patients with arthritic or rheumatoid
conditions can be offered oversized bottles
that they can grasp, with plain tops that
they can open
 Patients can be shown homemade options
such as putting rubber bands around the
caps, to aid grip.
 The use of plain caps
 The use of different sized bottles can help
the blind or partially sighted to differentiate
between medicines.
 Arrange for transfer of medication from
blister packs to bottles.
 Compliance aids/monitored dosage systems
may help some patients
9. Cannot measure liquids
 Patients with handling difficulties may
prefer two small light liquid bottles. They
may not be able to hold or accurately
measure from a heavy 500ml bottle.
10. Dexterity problems affecting ability to use
inhaler/eye drops
 Advise GP/nurse for an alternative
 Aids to help administration of eye drops or
aerosol inhalers are available for sale.
Refer to local formularies and guidelines
11. Cannot swallow medication
 Check if available in liquid/soluble form
and refer to prescriber
 Tablet crushers and splitters are available
for sale. Check the medication is suitable
for crushing or splitting before
recommending
If you require further information, contact your local
community pharmacist or Alison MacRobbie,
Palliative/Community Care Pharmacist tel. 01463 706829 or
Alison.macrobbie@hpct.scot.nhs.uk
AMacR obbie October 2006