Medication Management in HACC Services:
A Snapshot of Existing Practises
July 2010
About the HACC Program
The Home and Community Care Program (HACC) is a joint Australian, State and
Territory Initiative which provides basic maintenance and support services to frail
older people, people with disabilities and their carers. Clients can receive a variety of
services from the HACC Program including nursing care, personal care, meals and
other food services, home modification and maintenance, counselling, allied health
care, respite care and transport. The aim of the program is to promote independence
and to assist frail older people and people with disabilities to continue living in the
community.
The HACC Program is part of a broader framework of community and health
services funded by the Australian Government, States and Territories or jointly. The
services within this framework are both residential and community based.
Within the ACT, the HACC Program is administered by ACT Health. Currently within
the ACT there are 30 HACC funded Agencies.
About ACTCOSS
ACTCOSS acknowledges that Canberra has been built on the traditional lands of the
Ngunnawal people. We pay our respects to their elders and recognise the
displacement and disadvantage traditional owners have suffered since European
settlement. ACTCOSS celebrates Aboriginal and Torres Strait Islander cultures and
ongoing contribution to the ACT community.
The ACT Council of Social Service Inc (ACTCOSS) is the peak representative body
for not-for-profit community organisations, people living with disadvantage and lowincome citizens of the Territory. ACTCOSS is a member of the nationwide COSS
network, made up of each of the state and territory Councils and the national body,
the Australian Council of Social Service (ACOSS).
ACTCOSS receives funding from the ACT HACC Program, a joint Commonwealth
and State/Territory Program providing funding and assistance for Australians in
need.
1
ACTCOSS Contact Details
Phone:
Fax:
Mail:
E-mail:
WWW:
Location:
02 6202 7200
02 6281 4192
PO Box 849, Mawson, ACT, 2607
actcoss@actcoss.org.au
http://www.actcoss.org.au
Level 1, 67 Townshend Street Phillip, ACT, 2606
Director:
Deputy Director:
Project Worker:
Roslyn Dundas
Kiki Korpinen
Faraz Ghazi
and Mary Lander
ISBN 978-1-921651-35-9 (electronic version)
July 2010
© Copyright ACT Council of Social Service Incorporated
This publication is copyright, apart from use by those agencies for which it has been
produced. Non-profit associations and groups have permission to reproduce parts of
this publication as long as the original meaning is retained and proper credit is given
to the ACT Council of Social Service Inc (ACTCOSS). All other individuals and
Agencies seeking to reproduce material from this publication should obtain the
permission of the Director of ACTCOSS.
2
Acronyms
ACT
Australian Capital Territory
ACTCOSS
ACT Council of Social Service Inc
APAC
Australian Pharmaceutical Advisory Council
DAA
Dose Administration Aid
GP
General Practitioner
HACC
Home and Community Care Program
UK
United Kingdom
US
United States
VIC HACC
Victoria Home and Community Care Program
WA HACC
Western Australia Home and Community Care Program
3
Contents
About the HACC Program ....................................................................................... 1
About ACTCOSS ...................................................................................................... 1
Acronyms .................................................................................................................. 3
Contents .................................................................................................................... 4
The purpose of this report ....................................................................................... 5
Method of obtaining information from agencies ................................................. 5
HACC-funded agencies grouped into categories .................................................. 6
Additional information from respondents whose agencies don’t have medication
management policy ............................................................................................ 6
What currently exists: policy and best practice .................................................... 8
On the national level .......................................................................................... 8
Best practice ...................................................................................................... 8
What exists internationally ................................................................................. 9
Further resources................................................................................................... 10
Future discussion .................................................................................................. 12
Consistent themes ........................................................................................... 12
Ways forward ................................................................................................... 12
Appendix 1: List of HACC-funded agencies in the ACT ..................................... 13
Appendix 2: Extracts from documents referenced in this report ...................... 14
Appendix 3: International References .................................................................. 19
4
The purpose of this report
This report seeks to analyse current medication management policy and practice
within ACT HACC-funded agencies. In essence, it is a scoping exercise to see what
is happening in the sector regarding medication management. Within the ACT there
are 30 HACC-funded agencies operating. The size and scope of these agencies
varies greatly from one agency to the next. For example, there are agencies with
less than 10 staff, and other agencies with staffing numbers in the hundreds. So
there is a big difference in staffing numbers and levels. The services they provide
vary also, and this is in accordance too with the diversity of the HACC program.
Services range from social support, case management and transport to respite,
personal and nursing care. Additionally, some HACC-funded agencies do not
provide services directly relevant to medication management. For example, a service
which focuses on training does not come into contact with clients directly in a care
capacity. This being the case, indicates only 10 HACC agencies need to have a
medication management policy in place.
Method of obtaining information from agencies
For this report, most of the 30 HACC-funded agencies within the ACT were
contacted via phone and asked about their medication management practices and/or
policy. In rare instances, agencies were contacted via email. In each instance the
aim of this project was briefly outlined, before the appropriate contact within that
agency was identified (in many instances, this was a case manager or HACC
program coordinator). Afterwards, a qualitative survey ensued. Participants were
asked questions similar to those below:

Do you have a written medication management policy? (If not, then proceed
with below questions.)

How does [your HACC-funded agency] work with people who are on
medications? How do you assist people around their medicines and tablets?

For example, if a worker comes into contact with a client and it becomes
evident that this person hasn’t taken their medication, what happens?
The confidentiality of data obtained was a condition outlined before discussions
started. As such, measures have been taken to ensure agencies are not uniquely
identifiable in this report.
5
HACC-funded agencies grouped into categories
For the purposes of this study it is evident the 30 agencies can be grouped into three
categories in regards to medication management policy:
1.
Agencies that provided a written medication management policy
2.
Agencies who do not require written medication management policy
3.
Agencies whose medication management policy is in progress (not submitted)
Several agencies without medication management policy stated the following
explanations:

Service provided is not relevant to medication management, therefore no policy
is required; or

Support or other such service is contracted out to relevant agencies, and these
agencies are thus responsible for medication management policy.
HACC-funded agencies in the ACT grouped into categories
Category
1. Agencies with written medication mgt policy
10
2. Agencies who do not require medication mgt policy
18
3. Agencies whose medication management policy is in progress (not
submitted)
2
TOTAL
30
Additional information from respondents whose agencies
don’t have medication management policy
Additional information was provided by participants in this category, which is of
significant benefit. Naturally, these participants were well-versed in legal issues
surrounding medication management. These participants were sometimes hesitant
when probed further regarding the issue of medication management, and seemed
uncertain about the term ‘medication management’ versus ‘medication
administration’ – which became evident throughout this project. This category of
respondents initially reported that “we don’t dispense medications.” To further
explore medication management policy, the situation was presented of a client who
seems ‘non-compliant’ regarding medication, ‘what would you do’?
These participants predominantly reported they were guided by a commonsense
approach. In general, if a client seems to have missed their medication and exhibits
obvious signs, workers refer the issue to relevant health authorities. The following is
typical of the responses received from agencies without medication management
policy:
“This comes up a lot. Usually the care worker’s case manager knows about this
issue – they would have someone in charge who will come around.”
6
“We are a brokerage agency – so we engage HACC funding, and contract out
support to support agencies. The onus is on these agencies to manage
medication management and have policy. If there are concerns around
medication management, for example, a client who has Webster Packs, we
could contact their GP and say we have these concerns. We would leave this
with the client’s GP, and get advice from the GP about who best to contact from
there – i.e. a support worker or agency.”
Another brokerage agency: “…when we do come into contact with clients, people
manage their own medication and are independent in this aspect.”
“If a scenario happens where someone appears to not have taken medication
(which is rare) we may get in touch with the client’s carer or other relevant
authority.”
“We do sometimes remind clients to take their medication; prompting. You’ll find
that most organisations won’t do more than prompting – and would contact the
relevant health authorities.”
“A couple of people do have medications taken at the time when they’re with
support workers – and all our workers will do is prompt.”
“…there are dilemmas which come up. For instance, is it acceptable to prompt?
But the person has to physically do all the medication taking themselves…there
was a case where one client with a severe disability couldn’t pop the medication
pill packet themselves…it’s a practical situation – what do you do? This client
also had various prescription and non-prescription creams, drops etc. But the
client couldn’t apply these himself. It created a constant dilemma...”
Overall, prompting wasn’t regarded as a component of medication management by
this category of participants.
Several participants also indicated there is definitely a ‘grey area’ when it comes to
the issue of community workers and medication management issues. When asked if
there is a grey area, a number of others also agreed. For example, a scenario
outlined was of a client needing an aspirin. Legally, a care worker who is not
medically-trained (i.e. does not possess the relevant level of qualification) cannot
source this tablet and/or hand the tablet to the client. What if the client has a severe
disability, and cannot source the tablet themselves but really requires it? Such
situations do occur. As outlined by one participant, such situations are thus “a tricky
area”.
7
What currently exists: policy and best practice
On the national level
Currently, the Victorian HACC program and Western Australian HACC program do
cover medication management policy. This would be of interest to the ACT HACC
sector. The WA HACC has a Medication Policy Framework, and policy examples
(including Example: Policy - No Involvement, Administration Policy and Management
Policy). There are also forms, guidelines and reports examples – all of which is
accessible via their website:
http://www.health.wa.gov.au/hacc/publications/medication.cfm.
Likewise, the Victorian HACC has its HACC Program Manual, which includes:
Assistance with Medication by HACC Community Care Workers September 2009.
This is obtainable via their website, visit:
http://www.health.vic.gov.au/hacc/prog_manual/index.htm. As stated: “This advice
supplements the HACC Personal Care Policy in the Victorian HACC Program
Manual (Chapter 7.6). This September 2009 advice updates the advice of May 2008
by including reference to competency units in CHCO8 Community Services Training
Package, which was endorsed in December 2008.”
The HACC Service Development, Victorian Department of Human Services created
the following document which is of relevance: May 2008, Assistance with medication
by HACC Community Care Workers. This document is downloadable directly via the
following link (PDF file):
http://www.dhs.vic.gov.au/__data/assets/pdf_file/0019/252073/Assistance-withmedication-by-HACC-Community-Care-Workers-May2008.pdf.
Following is a brief excerpt:
Assistance with medication by HACC Community Care Workers is part of
personal care and is provided in accordance with the HACC Personal Care
Policy. This advice and all HACC policies are consistent with the Australian
Pharmaceutical Advisory Council’s Guiding principles for medication
management in the community, June 2006. Staff of HACC funded organisations
are advised to read this guide which is available from the APAC…This guide is
applicable to all HACC activities including HACC funded respite and Planned
Activity Groups.
Best practice
The APAC document: Guiding Principles for medication management in the
community appears to be the current best practice model in Australia. It is available
online, via the Department of Health and Ageing Website:
http://www.health.gov.au/internet/main/publishing.nsf/Content/apac-publicationsguiding. The Guiding Principles themselves are relevant. Several sections are of
particular interest, including the following on page 24, in the section relating to
‘Guiding Principle 3 – Dose Administration Aids’:
8
Role of care workers
A care worker should only physically assist a consumer in using their DAA if the
consumer is responsible for their own medication management, and where
agreement has been reached between the consumer and service provider in
accordance with relevant Australian, state or territory legislation.
The care worker might remove medicines from a DAA or prompt a consumer to
remove and take the medicine. Care workers should have competency-based
training in accordance with organisational policy and Australian, state or territory
legislation.
Care workers should monitor medication management by consumers and be
guided by their organisations’ medication management policies and procedures if
there are any suspected adverse medicine events.
In addition, the section ‘Guiding Principle 4 – Administration of medicines in the
community’ is of particular interest and goes into some detail, on page 28.
What exists internationally
In the United Kingdom (UK), home care is known as ‘domiciliary care’. This is
defined as follows:
Domiciliary care is a range of services you can receive in your own home, to help
you cope with disability or illness, and to become or remain independent for as
long as possible.1
The UK Department of Health has published Domiciliary care: national minimum
standards and regulations (February 2003). This document is available via:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAn
dGuidance/DH_4083661. It may be of interest in regards to looking for medication
management standards. Under the section, ‘Personal Care (Standards 7 – 10) 16’,
see ‘Medication and health related activities’ on page 19.
The UK Homecare Association also has publications relating to medication
management which may be useful. The first is their Medication Policy Template
(which helps you “produce a comprehensive medication policy and procedure
tailored to your homecare business”). Also, there is the Medication 'Train the Trainer'
Programme (“the complete set of course materials from our Medication 'Train the
Trainer' workshop”). These are available to purchase via their website:
http://www.ukhca.co.uk/productlist.aspx
1
Source: Bromley borough council homepage (online):
http://www.bromley.gov.uk/socialcareandhealth/Help+for+adults/Home+care/domiciliary_care.htm. Accessed 24
March, 2010.
9
The UK Care Quality Commission also has information available. The Commission is
the independent regulator of health and social care in the UK. They have published
the guide: Administration of medicines in domiciliary care (January 2009). Visit:
http://www.cqc.org.uk/guidanceforprofessionals/adultsocialcare/guidance.cfm?widCa
ll1=customWidgets.content_view_1&cit_id=2646. Excerpts of the guide which may
be of interest include: ‘What is the difference between assisting someone to take
their medicines and administering medicines to them?’ This definition could provide
assistance in regards to training around medication management versus
administration. Also, see ‘Policy and Procedures’ on page 6.
Additionally, the Hampshire County Council, Adult Services Department has its
medication management policy. The first paragraph cites: “Hampshire County
Council recognises that some forms of support with certain medication can form part
of a social care package under the direction of the prescriber”. The document is
directly downloadable via the following link (MS Word):
http://www3.hants.gov.uk/proc-0609-policy.doc.
Further resources
National level – other documents which may be of interest:

The Australian Council for Safety and Quality in Health Care has developed 10
Tips for Safer Health Care to assist patients and their carers to become more
actively involved in their own health care decision making. It is available via the
Department of Health and Ageing website:
http://www.health.gov.au/internet/safety/publishing.nsf/Content/10-tips

Guidelines for the Handling of Medication in Community-Based Palliative Care
Services in Queensland, August 2009. Downloadable via the following link
(PDF file): http://www.health.qld.gov.au/cpcre/pdf/medguidepall.pdf

The Department of Health, Victoria Drugs and Poisons Control has produced a
Resource Kit to enable implementation of the APAC Guidelines for Medication
Management in Residential Aged Care Facilities: Available via:
http://www.health.vic.gov.au/dpu/resource-kit.htm

‘Not Just Pills’ claims to have “a fully comprehensive training and resource
package to ensure safe and effective medication management”. Visit:
http://www.notjustpills.com.au
International level - other documents which may be of interest:

The UK Regulation and Quality Improvement Authority has published its
Guidelines for the control and administration of medicines, domiciliary care
agencies (January 2009). Visit:
http://www.rqia.org.uk/what_we_do/registration__inspection_and_reviews/guid
ance_for_health_and_social_care_providers.cfm

The Devon County Council in the UK has produced its Medication Support
Policy. This is “a joint policy and practice initiative between Devon Social
Services, the six Primary Care Trusts (PCTs) in Devon, and the Local
10
Pharmaceutical Committee. It provides a common policy and procedure and
one assessment tool across the NHS and Social Services in Devon”. Visit:
http://www.devon.gov.uk/contrast/index/socialcare/older_people/support_at_ho
me/medicines-support/medication_support_service_policy.htm

The Royal Pharmaceutical Society of Great Britain has produced the
publication: The handling of medicines in social care. This is directly
downloadable via the following link (PDF file):
http://www.rpsgb.org/pdfs/handlingmedsocialcare.pdf

The United States (US) Department of Health & Human Services has produced
the publication Medication Management of the Community-Dwelling Older
Adult. It includes useful medication reminder strategies for elderly clients; which
may be of use across a broader audience. These are noted on pages 4 and 5,
under ‘Cognitive Capacity’. The document is directly downloadable via the
following link (PDF file):
http://www.ahrq.gov/QUAL/nurseshdbk/docs/MarekK_MMCDOA.pdf

In the US, there is the ‘Collaboration for Homecare Advances in Management
and Practice’ (CHAMP) program, based at the Center for Home Care Policy &
Research of the Visiting Nurse Service of New York. “The CHAMP Program is
the first national initiative to advance home care excellence for older people.”
Of interest is their document: Medication Management, evidence brief April
2009. This does have a more clinical focus, and obviously does focus on aged
care, but may still be of relevance:
“…research suggests that home health care agencies should implement tools,
reminders and decision support systems that support clinicians in their efforts to
systematically assess, reconcile and manage medications.”
This document is downloadable directly via the following link (PDF file):
http://www.champ-program.org/static/CHAMP-Medication%20Management.pdf

An article has been published in the Journal of the American Pharmacists
Association: JAPhA, July 2006, named Continuity of Care: Can the Whole
Health Care Team Be Linked Together? This is available to purchase via:
http://www.britannica.com/bps/additionalcontent/18/22234800/Continuity-ofCare-Can-the-Whole-Health-Care-Team-Be-Linked-Together

In 2007, the US Food and Drug Administration cleared a computerised
medication box for the US market: “the INRange Systems' Electronic
Medication Management Assistant (EMMA), a programmable device that stores
and dispenses prescription medication for patients' use in the home... EMMA
stores prescription medications, emits an audible alert to the patient when the
prescribed medications are scheduled to be taken, and releases them onto a
delivery tray when activated by the patient at the appropriate time.” For the full
article, visit:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm10
8937.htm
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Future discussion
Consistent themes
The WA HACC Example Medication Management Policy sets out a definition for
medication management and medication administration (page 2):
Medication Management is (the prompting and/or assisting the client with self
medication) and involves:

reminding and/or prompting the client to take the medication;

assisting (if needed) with opening of medication containers for the client; and

other assistance not involving medication administration.
Medication Administration is (the actual giving of medication) involves:

storing the medication;

opening the medication container;

removing the prescribed dosage; and

and giving the medication to the client as per instructions.
Through conversations necessary for this project, it did not seem respondents were
familiar with the definition of medication management set out above. The overriding
principle is that HACC does non-clinical medication management; which means no
administering of medication. It appears a number of participants from agencies
without medication management policy tended to lump all things medication-related
into the ‘administration’ category. Consequently, the official line seemed to be “no,
we don’t touch that” (i.e. participants were aware that this is a legal issue). Yet
prompting does happen, which indicates medication management is happening
within ACT HACC organisations.
Overall, two questions arose as a result of this project:

Could principles of medication management be adopted by the whole ACT
HACC sector? (Generic policies have been developed around the HACC sector
and organisations could tailor these to suit their individual needs.)

Are HACC agencies (relevant workers) familiar with the term ‘medication
management’ when compared to ‘medication administration’?
Ways forward
Circulation of this report with appendix, to generate awareness and discussion of
medication management in the ACT HACC sector.
12
Appendix 1: List of HACC-funded agencies in the
ACT
1.
ACT Council of Social Service (ACTCOSS)
2.
ACT Disability, Aged and Carer Advocacy Service (ADACAS)
3.
Aged Care and Rehabilitation Service
4.
Alzheimer’s Australia ACT
5.
Australian Red Cross Society
6.
Belconnen Community Service
7.
Canberra Institute of Technology (Skills for Carers)
8.
Canberra Seniors Centre
9.
Carers ACT
10. CatholicCare
11. Communities @ Work
12. Community Connections
13. Community Health
14. Community Options
15. Focus ACT
16. Goodwin Aged Care Services
17. Gungahlin Regional Community Service
18. Home Help Service
19. KinCare
20. Koomarri
21. LEAD
22. Marymead Child and Family Centre
23. Mirinjani
24. Ngunnawal Aboriginal Corporation
25. North Belconnen Day Centre
26. Northside Community Service
27. Sharing Places
28. Southside Community Service
29. Tandem
30. Woden Community Service
13
Appendix 2: Extracts from documents referenced in
this report
Below extract taken from: Guiding principles for medication management in the
community, page 28, Australian Pharmaceutical Advisory Council, Commonwealth of
Australia, 2006.
(Included as part of ‘Guiding Principle 4 – Administration of medicines in the
community’)
Role of care workers in supporting the administration of medicine
Care workers should refer to organisational policies on the administration of
medication. Most states and territories have legislation that provides for some care
workers to administer medicines, for example, disability workers in Tasmania. A
trained and competent care worker can therefore help when a consumer or their
carer requires physical assistance to administer the consumer’s medicines (refer to
Guiding Principle 3 – Dose Administration Aids).
Care workers in some jurisdictions are generally able to help consumers who are
responsible for managing their own medicines, by unscrewing bottle lids, removing
tablets from dose administration aids. It is important that all care workers are
educated and competent to assist the consumer with medication management.
Some care workers have completed a vocational education course, such as an
Australian Qualifications Framework Certificate III in community services or its
equivalent. There is a unit of competency that prepares community care workers to
physically assist consumers in the community with their medicines.9 Care workers
should only provide services that are consistent with their level of training and
competence. The delivery of care will depend on the consumer and their health care
needs. Care workers are not authorised to make any decisions about whether the
medicine should be administered and should seek assistance from their supervisor if
they have any concerns about medication management. Where a consumer runs out
of their current supply of medicine, care workers should seek the advice and/or
assistance of the consumer’s doctor, pharmacist, registered nurse, or the usual
source of supply, for example, Aboriginal Medical Service, as dictated by the
particular circumstances.
9
See www.cshta.com.au
14
(From the US) Below extract taken from: Dorman Marek, Karen and Antle, Lisa,
Chapter 18,’Medication Management of the Community Dwelling Older Adult’, p 4 –
5, Edited by Hughes, Rhonda G, Patient Safety and Quality: An Evidence Based
Handbook for Nurses, Agency for Healthcare Research and Quality, USA, 2008.
Cognitive Capacity
Poor cognition is associated with both over adherence and under adherence of a
prescribed medication regimen. A study of community-dwelling women found that 22
percent were unable to accurately perform a routine medication regimen; however,
only 2 percent self-identified that they had difficulty with their medications. Forgetting
is a major reason medication doses are missed. The most prominent type of
medication noncompliance is dose omission, but overconsumption is a common
mistake, especially in persons on a once-daily dose schedule.
There are a number of interventions to assist older adults with remembering to take
their medications. One simple method is the use of memory cues that prompt
patients to take their medications. Development of memory cues must be tailored to
the patient’s lifestyle. Placing medication in a special place and use of a daily event
such as meal time improve medication adherence. A study that examined the most
common ways older adults remembered to take their medications found the following
methods to be beneficial: (1) placing containers in a particular location, (2) taking
medications in association with meals/bedtime, (3) using a timed pill box, (4)
reminders from another person, and (5) using written directions or a check-off list.
Compliance aids such as pill box organizers have been found to increase medication
adherence. Medication schedules and calendars are helpful, especially in
combination with education and use of a pillbox. In addition, electronic monitoring
that provides feedback to the user increases adherence. Older patients using a
voice-reminder-message medication dispenser were significantly more compliant
than those using a pill box or self-administering medications. Patients using topical
pilocarpine were significantly more compliant using an electronic medication alarm
device. Programs that use daily telephone reminder calls also have demonstrated
increased medication compliance. Several studies have demonstrated that dose
simplification from two times a day to one time a day produces higher compliance
and improved patient outcomes.
15
Below extract taken from: Domiciliary care: national minimum standards and
regulations, Care Standards Act 2000, Department of Health, UK, 2003, Crown
Copyright, p19,
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document
s/digitalasset/dh_4083671.pdf
Medication and health related activities
OUTCOME: The agency’s policy and procedures on medication and health related
activities protect service users and assists them to maintain responsibility for their
own medication and to remain in their own home, even if they are unable to
administer their medication themselves. In the case of standards 10.8, and 10.9,
these do not apply to employment agencies solely introducing workers.
STANDARD 10 (See regulation 14)
10.1 The registered person ensures there is a clear, written policy and
procedure which is adhered to by staff and which identifies parameters and
circumstances for assisting with medication and health related tasks and
identifies the limits to assistance and tasks which may not be undertaken
without specialist training.
10.2 The policy should include procedures if required for obtaining prescriptions and
dispensed medicines and for recording the information.
10.3 Staff only provide assistance with taking medication or administer medication or
undertake other health related tasks, when it is within their competence; they have
received any necessary specialist training and it is:

with the informed consent of the service user or their relatives or
representative

clearly requested on the care plan by a named assessor

with agreement of the care or support workers’ line manager, and

not contrary to the agency’s policy
10.4 Assistance with medication and other health related activities is identified in the
Care Plan, forms part of the risk assessment (Standard 12) and is detailed within the
Service User Plan.
10.5 Care and support staff leave medication at all times in a safe place which is
known and accessible to the service user or, if not appropriate for the service user to
have access, where it is only accessible to relatives and other personal carers,
health personnel and domiciliary care staff.
10.6 Care and support workers follow the agency’s procedures for reporting
concerns, responding to incidents and seeking guidance.
16
10.7 Care and support workers record, with the user’s permission, observation of the
service user taking medication and any assistance given, including dosage and time
of medication and undertaking any other health related tasks, on the record of the
care visit kept in the home and/or the Home Care Medication record and the
personal file of the service user held in the agency. Any advice to the service user to
see or call in their General Practitioner or other health care professional is also
recorded. The record is signed and dated by the care worker and the service user or
their representative.
10.8 Except for employment agencies solely introducing workers, where delivery of
the care package involves multiple agencies, including health care, a policy on
medication and health related tasks is agreed and followed. A key worker, generally
a health care professional from one agency who visits on a regular basis is identified
as responsible for taking the lead on medication. Care and support workers retain
responsibility for their own actions in accordance with the policy.
10.9 Except for employment agencies solely introducing workers, where necessary
and agreed the policy and procedures are approved by a suitably experienced
pharmacist, if appropriate. The functions undertaken by staff in this context need to
be covered by the employers’ insurance policy.
Below extract taken from: Administration of medicines in domiciliary care, January
2009, page 2, Care Quality Commission, UK,
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document
s/digitalasset/dh_4083671.pdf accessed 16/9/2010
What is the difference between assisting someone to take their medicines and
administering medicines to them?
The following descriptions define what assisting with medicines means and what
administering medicines means:

When a care worker assists someone with their medicine, the person must
indicate to the care worker what actions they are to take on each occasion.

If the person is not able to do this or if the care worker gives any medicines
without being requested (by the person) to do so, this activity must be
interpreted as administering medicine.
The extract below has been taken from page 6 of the same document.
Policy and Procedures
33. The domiciliary care agency must have a clear, comprehensive written
medication policy and procedure to support the care worker that includes:

When the care worker may prompt medication or administer medication

The limitations of assistance with prescribed and non-prescribed medication
and which healthcare tasks the care worker may not undertake without
specialist training
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
Detailed procedures for safe handling of medication, including requesting
repeat prescriptions; collecting prescriptions and dispensed medication;
procedure for administration, including action should the person refuse the
medication; records of medication procurement, administration and disposal
(return); procedure for removal of unwanted medication; procedure to deal with
a medication error
34. The domiciliary care agency, through the person’s assessment, should
determine and document the following in the person’s plan:

The nature and extent of help that the person needs

A current list of prescribed medicines for the person, including the dose and
frequency of administration; method of assistance; and arrangements about the
filling of compliance aids if these are used

Details of arrangements for medication storage in the person’s home and
access by the person, relatives or friends

A statement of the person’s consent to care worker support with medication or
relevant consent to administer medication to children
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Appendix 3: International References
International level - other documents which may be of interest:

The UK Regulation and Quality Improvement Authority has published its
Guidelines for the control and administration of medicines, domiciliary care
agencies (January 2009). Visit:
http://www.rqia.org.uk/what_we_do/registration__inspection_and_reviews/guid
ance_for_health_and_social_care_providers.cfm

The Devon County Council in the UK has produced its Medication Support
Policy. This is “a joint policy and practice initiative between Devon Social
Services, the six Primary Care Trusts (PCTs) in Devon, and the Local
Pharmaceutical Committee. It provides a common policy and procedure and
one assessment tool across the NHS and Social Services in Devon”. Visit:
http://www.devon.gov.uk/contrast/index/socialcare/older_people/support_at_ho
me/medicines-support/medication_support_service_policy.htm

The Royal Pharmaceutical Society of Great Britain has produced the
publication: The handling of medicines in social care. This is directly
downloadable via the following link (PDF file):
http://www.rpsgb.org/pdfs/handlingmedsocialcare.pdf

The United States (US) Department of Health & Human Services has produced
the publication Medication Management of the Community-Dwelling Older
Adult. It includes useful medication reminder strategies for elderly clients; which
may be of use across a broader audience. These are noted on pages 4 and 5,
under ‘Cognitive Capacity’. The document is directly downloadable via the
following link (PDF file):
http://www.ahrq.gov/QUAL/nurseshdbk/docs/MarekK_MMCDOA.pdf

In the US, there is the ‘Collaboration for Homecare Advances in Management
and Practice’ (CHAMP) program, based at the Center for Home Care Policy &
Research of the Visiting Nurse Service of New York. “The CHAMP Program is
the first national initiative to advance home care excellence for older people.”
Of interest is their document: Medication Management, evidence brief April
2009. This does have a more clinical focus, and obviously does focus on aged
care, but may still be of relevance:
“…research suggests that home health care agencies should implement tools,
reminders and decision support systems that support clinicians in their efforts to
systematically assess, reconcile and manage medications.”
This document is downloadable directly via the following link (PDF file):
http://www.champ-program.org/static/CHAMP-Medication%20Management.pdf

An article has been published in the Journal of the American Pharmacists
Association: JAPhA, July 2006, named Continuity of Care: Can the Whole
Health Care Team Be Linked Together? This is available to purchase via:
http://www.britannica.com/bps/additionalcontent/18/22234800/Continuity-ofCare-Can-the-Whole-Health-Care-Team-Be-Linked-Together

In 2007, the US Food and Drug Administration cleared a computerised
medication box for the US market: “the INRange Systems' Electronic
Medication Management Assistant (EMMA), a programmable device that stores
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and dispenses prescription medication for patients' use in the home... EMMA
stores prescription medications, emits an audible alert to the patient when the
prescribed medications are scheduled to be taken, and releases them onto a
delivery tray when activated by the patient at the appropriate time.” For the full
article, visit:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm10
8937.htm
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