MEDICATION MANAGEMENT – COMMUNITY RESPONSE SERVICES 06/09 – WEB V1.
MEDICATION MANAGEMENT PRACTICE GUIDELINES
COMMUNITY RESPONSE SERVICES
IMPORTANT NOTE
The medication management practice guidelines for Community
Response Services require some revision which is currently in progress.
This revision is necessary to fully reflect the key changes to the main
Medication Management policy document.
However the guidelines continue to detail the safe operating procedures
for managers and staff working in Community Response Services
services.
Managers must ensure that all staff are aware of, and operate to these
current guidelines and for ensuring that all documents printed include
this 'caution' page.
Every practice guide has a front cover directing staff to refer to the key
areas of the revised medication management policy relevant to their
service. Managers are responsible for ensuring staff are aware of these
changes and the implications for their service.
REFER TO MAIN MEDICATION MANAGEMENT POLICY:
The main changes contained within the medication management policy
that will replace those contained within the practice guidelines for
Community Response Services are:
Medication Management Policy Section 5:
- Medication Consent and capacity
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COMMUNITY RESPONSE SERVICES
CONTENTS
PART ONE
General information
1.
How to use these guidelines
2.
Responsibility of the staff
3.
Resources
4.
Levels of support
5.
Liability
6.
Consent and capacity
PART TWO
Approved procedures and practices for staff in community
care services
1.
Ordering medication
2.
Collecting medication
3.
Receiving medication
4.
Storage of medication
5.
Disposal of medication
6.
Helping service users with medication
7.
Administration of medication
8.
Use of the medicine administration record
9.
‘When required’ or ‘prn’ medication
10.
Types of medication and methods of administration
11.
Refusal of medication
12.
Medication incidents
13.
References
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Hampshire County Council
Practice Guidelines for Community Care
PART ONE
General information
1.
How to use these guidelines
These guidelines, together with the Medication Policy, describe how service users may be
supported by staff, within a community care setting, to use their medication effectively.
They are intended to provide a comprehensive guide to clarify the scope of the medication
policy for staff working in Hampshire County Council community care. Other services
have specific procedural guidance and these residential care guidelines must never be
applied to other care services.
Key principles for community care services
 Service users must always be encouraged to retain responsibility for their medication,
and support must be given so that they can remain independent for as long as
possible
 ‘Enabling’ rather than ‘doing’ is the fundamental principle when addressing
difficulties that service users may have, and community carers must be aware of both
the responsibility of recognising and reporting difficulties, and the limitations of their
role with regard to giving advice. Where necessary, prescribers, community and
practice-based pharmacists may be able to advise service users on alternative ways of
managing their medication
 Community pharmacists are able to assess service users to determine any help
required in taking their medication, for example easy-open bottle caps
 Help with medication should only be undertaken following an assessment of need,
by a care manager as part of a planned care package or by a community team leader
who takes the lead responsibility for a care package, as directed by the district team
manager. Before assisting the service user, the relevant documentation must be in
place and appropriate procedures must be followed
 Community care staff must always be aware of the limitations of their role when
providing help to service users
 Special arrangements apply when service users require out of office hours support
e.g. post-hospital discharge.
2.
Responsibility of the staff
The Registered Manager

Is responsible, with the support of the service manager, for ensuring that all staff
are aware of the systems for the control and administration of medication and how
these are implemented medication
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

Must ensure that all medication are administered only by appropriately trained and
competent staff
Is responsible for maintaining his/her own competence in the administration of
medication and for ensuring the administration of medication is managed safely
within the community care service
Is responsible for ensuring the competence of team leaders who will assess and
confirm competence of care workers.
Team leaders
 Are responsible, with the support of the Registered Manager, for ensuring that all
the systems for the control and administration of medication are implemented and
that staff are aware of them
 Will assign ‘designated’ care workers to look after the medication of those service
users who are unable to manage their own. The designated carers must be
appropriately trained and competent to do this
 Must ensure that all medication is administered only by appropriately trained and
competent staff
 Are responsible for maintaining their own competence and for ensuring the
administration of medication is managed safely within the community care service
 Must ensure that all service users have a current care plan and associated risk
assessments
The Community Reablement Assistants
 Must understand the limitations of the their role in relation to medication
 Must follow the policies and procedures of the community care service for which
they are working
 Must have undergone suitable training for their role and been assessed as competent
 Are required to undertake refresher or specific training as requested by their manager
 Must report any discrepancies in the records, errors with medication or changes in
the service users condition, immediately to the team leader or out of hours team
manager
 Must not administer intrusive medication
 Carers may not administer injections.
Before agreeing to help a service user, each carer should have undertaken the appropriate
training and be able to identify:
 The tasks that can be undertaken by the carer
 The tasks which should be undertaken by a healthcare professional
 Common problems and the appropriate actions to be taken
 When to refer problems with a manager or other professionals
 How a community pharmacist can help.
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3.
Resources
All staff should have access to the current medication policy and guidelines for
administering medication in community care. All teams should have a copy of the CQC
guidance for administration of medication and a copy of the Royal Pharmaceutical Society
of Great Britain handling of medicine in social care, available at
www.rpsgb.org.uk/adminmedguid.pdf
4.
Levels of support
The levels of support available for service users are defined in the medication policy as:
Prompt: to remind a resident verbally or, where appropriate, physically, to take their
medication.
Assist: to support the resident to access their medication so they can administer it
themselves by the prescribed route.
Administer: to give the resident medication via the prescribed route.
A service user’s needs may change and it is essential that these needs are monitored and
assessed regularly and a risk assessment carried out.
Risk Assessment
A risk assessment must be carried out for all new service users on entering the service, to
establish the level of support they require. For those service users who self-medicate, there
should be an ongoing assessment of their continuing ability to do so.
5.
Liability
The following statement has been agreed by Hampshire County Council and their insurers.
It intends to clarify the position of staff in relation to their role when supporting service
users to manage their medication needs as part of a care package or programme of care.
“Providing that staff act in accordance with the policy and guidelines, they will be covered by the
organisation insurance policy in the event of any complaint or action resulting in legal liability arising from
duties associated with medication. Where staff act outside their contract of employment or authorised duties,
or where there is fraud, dishonesty, criminal or unlawful acts, there will be no such cover”
6.
Consent and capacity
All staff have a clear responsibility to ensure they understand their role in relation to
situations where an individual service user exercises their right to refuse to take medication.
Where a service user is assessed not to have the mental capacity to make decisions in
relation to medication staff must also be clear about their responsibility to refer this to the
multi-disciplinary team,..
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Section 5 of the medication policy sets out the responsibilities of all staff in relation to
issues of consent and capacity. If there is any need for further clarification the service
manager must be involved immediately.
General principles for all staff to be aware of:
 Service users who are capable of giving or withholding consent can refuse to take
medication at any time, in these circumstances staff must not attempt to administer
medication
 Giving and obtaining of consent is a process not an isolated event, residents may
change their minds and withdraw consent at any time. Consequently, consent must
be sought before any administration
 Capacity to consent may fluctuate and must therefore be assessed continually
 Covert administration of medication for service users who are capable of giving or
withholding consent is NOT PERMITTED UNDER ANY CIRCUMSTANCES
 People who have a mental disorder must be assessed to determine their capacity to
make decisions. It must never automatically be assumed that they are not able to give
or withhold consent to take medication.
PART TWO
Approved procedures and practices for staff in community care services
1.
Ordering medication for a service user
This can be done at the request of the service user, or on a regular basis as part of the care
plan. The service user’s preferred method should be used and the level and specific details
of the service must be in the care plan. Only medication which has been prescribed or
authorised by a prescriber can be ordered or bought for service users. This includes
specified ‘homely remedies’.
From the GP surgery Determine the method in which prescriptions can be ordered from
the GP practice. This may include using the current repeat request slip, a dedicated
telephone number or on line.
From a community pharmacy the service user may have an agreement with a specific
community pharmacy that medication can be ordered by phone. The pharmacist then
makes the request and collects the prescription. When ordering:
 Check the existing stock
 Use the latest repeat request form and tick the items clearly
 Keep a record of the order.
If there have been changes to any medication since it was last ordered, the designated staff
must ensure the latest repeat request form is used to order ongoing medication. Carers
must not buy herbal remedies and ‘over the counter’ medication for service users unless
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they are included in the care plan and have been agreed with their GP or responsible
prescriber.
2.
Collecting medication for a service user
Many community pharmacies will collect prescriptions from a GP surgery, dispense the
medication and deliver it to homebound service users. (There is usually no charge for the
service.) When collecting a prescription from a GP practice or a pharmacy, the carer may
be asked for identification. An authorised HCC staff identification card should be used for
this purpose. Where possible a service user’s prescription should always be dispensed by
the same pharmacy.
Repeat dispensing: Some prescribers may issue a batch of prescriptions for a service user.
These are usually kept at a designated pharmacy, and the medication can be collected
directly from that pharmacy each month. Carers may be asked questions about the general
health of the service user. Disclosure of this specific information will be covered under the
‘Permission to share’ signed by the service user or authorised carer. Care should however
to taken to ensure that any such disclosure is made in a confidential setting and not in
public.
3.
Receiving medication for a service user
On receipt into a service user’s home, all medication must be checked against the order to
ensure that the name, form, strength, dose and quantity is correct. A note should be made
if there is any medication still to be collected/delivered. If there are any queries these must
be discussed with the dispensing pharmacist as soon as possible. A record should be made
of all medication accepted on behalf of the service user.
Where service users are discharged from hospital with medication, it is essential a team
leader visits them, within 12 hours of discharge, in order to complete the risk assessment
and coordinate their medication regime and documentation.
4.
Storage of medication
Some medication is susceptible to changes in the atmosphere, which may make the
ingredients unstable. If stored incorrectly, the service user may not receive the correct
amount of medication, or it may be in a form that renders it inactive or potentially harmful.
Pharmacists are able to give advice on the correct storage of medication. The medication
should be stored in a designated place within a service user’s home.
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Temperature
Medication should be stored below 25o C. Some must be stored ‘in a cool place’ while
others have specific conditions e.g. between 2-8o C. Items which require storage in a
refrigerator will always have ‘store in a refrigerator’ on the pharmacy label. If an item is left
out of the fridge for more than two hours, the pharmacist should be contacted to see if a
new supply will be needed. If items are stored in a domestic refrigerator, they should be
stored in a sealable labelled container.
Humidity
Many tablets are affected by moisture, either because of the coating, the medication itself,
or other ingredients. For this reason the medication must be kept in the original containers
supplied by the pharmacist.
Light
All medication is dispensed in light-proof containers, and should be stored away from
direct sunlight.
Formulation
Some formulations are not stable once the container has been opened. e.g. The antibacterial element in eye, ear and nose drops, Peppermint water in Mist Magnesium
Hydroxide.
The length of time the product can be used is always written on the container e.g. 28 days,
and the date of opening should be written on the bottle.
5.
Disposal of medication
Unwanted medication should always be returned to a pharmacy. It cannot be reused, and
will be disposed of safely.
Medication should be disposed of:
 When it is no longer needed because it has been deleted or the treatment has been
completed
 When the expiry date has been reached. The expiry date is always printed on the
original container and on foil packs.
If there is any confusion about which medication should be returned, advice can be sought
from a pharmacist or prescriber. Where possible a family member or friend should be
asked to return the medication to the pharmacy. Carers should have permission from their
manager to return medication to a pharmacy. A form, sign by the service user, giving
permission for the carer to take the medication to the pharmacy, should be included in the
care plan. This form should be taken to the pharmacy with returned medication and the
pharmacist must sign that the medication has been returned. Thisform should be kept in
the service user’s notes.
The form should include:
 The date
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6.
The name of the service user
The form (e.g. tablets) and strength of the medicine
The service user’s signature as permission to dispose of the medication
The carers signature
The pharmacists signature obtained on receipt of the medication
Helping service users with their medication
Any changes from the service user’s ‘normal’ state should be reported to the team leader or
manager. This must include any possible side effects from the medication.
Information about side effects is always available in the ‘patient information leaflet’ , which
should be provided by the pharmacist when the medication is dispensed. If a leaflet is not
available, ask the pharmacist for a copy. Carers must not give specific advice about any
medication to a service user. They may only identify a risk e.g. storing medication in a place
where the temperature is potentially too high.
It is not usually appropriate for a care worker to influence:
 How the person chooses to obtain medication
 How and where the person chooses to store medication
 How medication which is no longer in use is disposed of
 The choice of over-the-counter medication that the person wishes to buy.
Levels of assistance with medication as Section 4.
Prompting to remind a service user verbally or where appropriate physically to
take their medication. Prompting does not involve any physical contact with the
medication and may only be done from the container provided by the pharmacist.
Assisting to support the service user to access their medication so they can use it
themselves by the prescribed route.
Administering the carer gives the service user medication via the prescribed route.
7.
Administration of medication
The prescriber must provide sufficient information to enable a designated carer to
administer medication correctly, by written instructions on the prescription. The
pharmacist will transcribe those instructions to the container label. If the instructions are
insufficient or unclear , the prescriber must be contacted before the medication is
administered. Any additional information must be written clearly and legibly in black ink,
in the care plan.
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Designated staff must not:
 Crush or break tablets unless authorised by the prescriber or pharmacist
 Remove medication or medication records from the home
 Entice or coerce residents to take medication by mixing it with food
 Fill a medication aid
 Physically force a resident to take medication which they do not wish to take
 Administer pessaries, enemas, suppositories
 Administer injections, unless they have received specific training e.g. for an insulin
pen or an auto injector
 Ignore any inaccuracies identified in the medication record
 Ignore any change in the service user’s behaviour, or other possible side effects of
the medication
 Administer any medication which has not been prescribed or agreed by the service
user’s current prescriber
 Administer medication which is not stored in the original container supplied by the
pharmacy.
Before administering any medication designated staff must check the dose has not already
been given and that the following ‘five corrects’ are observed:
1.
2.
3.
4.
5.
The correct Service user: Identify the service user and make sure their correct name
is on the medication.
The correct Medication: Check the name of the medication corresponds with the
name given on the medication administration record (MAR) sheet. If there is any
discrepancy it may be because there is a generic or brand name in use, if there is any
doubt, this must be checked with the dispensing pharmacist.
The correct Dose: Check the strength and quantity of the medication being
given with that recorded on the MAR sheet.
The correct Time: Check the dose is being given at the correct time, this
includes any additional instructions such as before or after food.
The correct Route, check how the medication must be administered e.g. eye, ear and
nose drops.
No medication must be given until the designated carer is sure that all the above are
correct. If there is any concern, the duty manager must be contacted.
8.
Use of medication administration records (MAR sheets)
It is the responsibility of the designated person administering the medication to keep
accurate records of all medication they have administered to service users. All medication
given must be recorded on the MAR sheet. Team Leaders are responsible for ensuring that
this information has been entered and is up to date.
The MAR sheet must be signed immediately after the resident has taken their medication.
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To ensure the MAR is an accurate record that the medication has been administered: The resident must be observed to have taken oral medication.
 The dose must then be signed, as having been taken, on the MAR sheet.
 The MAR sheet must not be signed using any initials which have been
designated for certain information e.g. R for ‘resident in hospital’, as this will
cause confusion. Initials of designated staff must also be recorded with their
signatures
 A record of all medication, internal and external must be kept on the MAR sheet
 Registered Managers must keep a record of the signatures and initials of designated
staff as they may appear on the MAR sheets. This must be updated regularly
 If there is a variable dose e.g. ‘one or two tablets’ the exact quantity given must be
recorded
 If there is any reason why a dose is not given, or if a dose is refused, this must also
be entered. This information is as important as doses taken. A detailed explanation
must be added to the service user’s notes.
 When a medication is refused, this must be reported to the duty manager
 If there is any change in a dose or drug, a new section must be used in the MAR
sheet and a line, in this form |----------------|, put through the remaining days of the
original prescription
 If a drug is discontinued the date must be entered on the MAR sheet and a line
drawn, as above, through the remaining days
 Any problems that arise whilst taking the medication must be recorded in the care
plan so that this information is available to all relevant people
 Any problems whilst taking the medication must also be reported to the prescriber
 If a cream or drops are administered by a healthcare professional e.g. district nurse,
they must also sign the MAR sheet when this has been completed.
The condition of the service user must be monitored both before and after a dose of
medication is given and any changes must be noted.
9.
‘When required’ or ‘prn’ medication
Some medication such as pain relief, laxatives and indigestion remedies, do not need to be
taken regularly and will be prescribed ‘prn’ or ‘when required’.
When a ‘prn’ medication is prescribed
 There must be a clear indication of the use of the medication written in the care plan
and on the MAR sheet e.g. Paracetamol for pain
 Directions must include a specific dose or range of doses e.g. one or two tablets as
required
 There must be an indication of the timing, e.g. at night; no more than 4 hourly
 There must be an indication of the maximum daily dose e.g. no more than 4 doses in
24 hours
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All requests for ‘prn’ medication must come from the service user. However some service
users may need to be asked if they require ‘prn’ medication. Designated staff should use
professional judgement and knowledge of the individual to determine when service users
may need to be asked
When a ‘prn’ medication is administered
 The MAR must be checked to ensure another dose has not been given within the
minimum time limit
 The reason for giving the medication must be checked. This is especially important
for pain relief, as pain in a new area may indicate an undiagnosed condition. If this is
the case, it must be reported to the duty manager
 The medication must be administered in accordance with agreed procedure.
 The medication administration record must be completed as for all administrations.
10. Controlled Drugs (CDs)
Controlled drugs
Controlled drugs (CDs) are prescribed medication which are usually used to treat severe
pain and they have additional safety precautions and requirements. There are legal
requirements for the storage, administration, recording and disposal of CDs. These are set
out in the Misuse of Drugs Act Regulations 2001 (as amended). However, they do not
apply when a person looks after and takes their own medication.
Obtaining controlled drugs
CDs are prescribed and dispensed for individually named people, in the same way as other
medication. There are special legal requirements for CD prescriptions. A prescription that
does not comply with these requirements may have to be sent back to the prescriber for
altering before it can be dispensed. If community care workers collect CDs from a
pharmacy on behalf of someone else, they should be asked to provide identification. If not
asked, they should offer proof of identity by use of the HCC authorised identification card.
Administration of controlled drugs
In order to administer a CD designated care staff must comply with the procedure for
administration of any medication. It is good practice if a second appropriately trained
member of staff witnesses this process and where two carers are present both should sign.
This can be done by a third party who may be present, such as a family member, however,
in a community setting no witness is required.
Records of controlled drugs
Administration should be recorded on the MAR sheet in the usual way.
Disposal of controlled drugs
CDs should be returned to the dispensing pharmacist who supplied them, at the earliest
opportunity, for safe denaturing and disposal. When CDs are returned for disposal a record
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of the return must be made in the service user’s records. It is good practice to obtain a
signature of receipt from the pharmacist or dispensing doctor. This can be done on the
‘return to pharmacy’ form, as for the return of any other medication.
Handling non-prescribed controlled drugs and their disposal
A community carer must be aware that some service users may use illicit drugs. In this
situation, the care workers should vacate the premises. If a service user is smoking,
consuming or injecting illegal substances this must be reported to the duty manager
immediately. The incident must be reported on an incident report form. Legal advice will
be sought, by the duty manager, in situations where care workers may be at risk of aiding
and abetting a service user to perform an illegal act.
11. Types of medication and methods of administration
Tablets and Capsules
11.1.
Tablets
There are many different types of tablets. If in doubt about how they should be given, the
pharmacist should be consulted.
Uncoated tablets often have a scored line across them, these can be broken in half before
administration. If it is necessary to do this, it should be entered in the care plan, and a
tablet cutter purchased from the pharmacy. Cutters must be cleaned after every use to
ensure that no residue remains.
Coated tablets have a shiny outer layer to enable them to be swallowed more easily. These
must not be cut.
Enteric coated tablets (e/c or e/n in the drug name) should be swallowed whole with
plenty of water so that the coating, which prevents the tablet from dissolving in the stomach, is
not damaged.
Slow release tablets (S/R, M/R, C/R, XL, LA) should be swallowed whole with water. They do
not work properly if chewed or crushed. All these tablets should be taken with a glass of water.
Dispersible or soluble tablets should always be dissolved in half a tumbler of water before
taking. They are very useful if an individual has difficulty swallowing.
Oro-dispersible tablets are a newer form of tablet made to dissolve in the mouth. They should
be sucked, and this information will be on the label.
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Pastilles and lozenges should be sucked, and the individual should not have a drink for at least
half an hour after taking this form of medication.
Buccal and sublingual tablets are made to dissolve quickly in the mouth. Buccal tablets are
placed between the upper lip and the gum and sublingual tablets are dissolved under the tongue.
This medication is absorbed directly into the bloodstream and can act very quickly e.g. for pain
relief. They are also very useful if an individual is unable to tolerate swallowing a tablet
11.2 Capsules
Capsules may contain either liquid, powder or pellets and should be swallowed whole with
half a glass of water. If necessary, capsules may be opened and the contents sprinkled on to
food, but this must only be done when it is part of the care plan, and with the agreement of the
prescriber or dispensing pharmacist. Some capsules are designed to be inhaled, either by adding
to hot water, or for use in inhalers, and these should not be swallowed. They will be labelled
‘not to be taken’.
11.3 Administering tablets or capsules
 Always wash your hands before administering medication and keep
everything as clean as possible

Explain the procedure to the recipient so they know what to expect

Prepare half a tumbler of cold water. In some cases medication may be given
with other liquids, but this should be checked with the pharmacist and
documented in the care plan

Help the recipient to sit as upright as possible

Check the label on the container and follow the ‘five corrects’ protocol. If
there is any discrepancy, or concern the duty manager must be contacted.

Follow the directions for giving the medication e.g. ‘after food’

Avoid handling the medication and give it to the recipient

Encourage the recipient to take the drink if appropriate (see lozenges and
pastilles), this ensures the medication is washed into the stomach

Complete the MAR sheet and return the medication containers to a safe
storage place.
11.4 Crushing tablets and opening capsules
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If a person has difficulty swallowing their medication, the reason must be identified and
reported to the GP. Various alternatives are available and this should be discussed with the
pharmacist or prescriber. On no account should the tablets be crushed or capsules opened unless
the specific actions are agreed by the prescriber and the details and reason written in the care
plan. Crushing tablets can alter the way in which the drug works, and may have adverse effects.
If an individual has swallowing difficulties:

Determine the reason

Record this in the care plan

Inform the duty manager/ nurse

Contact the pharmacist or GP depending on the reason

When a solution is agreed, record it in the care plan.
11.5
Liquid medication
11.5.1
These include emulsions, linctuses, mixtures, suspensions and syrups. Directions
must be followed carefully as these may need shaking well before use, and some have to be
used within two or three months after opening. Where there is a ‘used before’ warning, the date
of opening of the container must be written on the label. The pharmacist should be contacted if
further information is needed.
11.5.2
Administering liquid medicines

Wash hands

Prepare half a tumbler of water

Explain what you are about to do and help the recipient to sit as upright as
possible

If the medication requires shaking, check the cap is tight and
shake the bottle

Check the label on the container using the ‘five corrects’ protocol. If there is
any discrepancy, or concern the duty manager must be informed

Follow the directions for administering the medication

Measure the dose always keeping the instruction label uppermost, to prevent
any liquid which may trickle down the bottle, from obscuring the directions.
Some liquids where larger quantities are needed, e.g. lactulose and magnesium
hydroxide mixture, can be measured in a medicine cup. Other liquids should
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always be measured using a 5 ml spoon, oral syringe, or an accurate measure
purchased from a pharmacy or a pharmaceutical supplier

Some liquids may be given orally as drops. The dropper supplied with the
medication must be used, and the drops placed directly in the recipient’s mouth.
The dropper must be rinsed and drained between doses.

After administering the medication, where appropriate, offer the recipient a
drink of water. Some liquids should be taken in water, in which case the liquid
should be added to the water prior to administration

Replace the cap on the bottle. The neck of the bottle may first need to be wiped
with a clean tissue

Complete the medication administration record (MAR) sheet

Return the bottle to a safe storage place.
11.6 Eye ointments
Eye ointments have an expiry date after the tube has been opened, which is usually 28
days. The date of opening must therefore be written on the label.
Individuals who wear contact lenses should not wear them while they are using eye
ointments.
11.6.1 Administering eye ointments

Check the ointment is still in date

Explain what you are about to do and help the individual to a position where
they can comfortably tilt their head back

Check the label on the container using the ‘five corrects’ protocol. If there
is any discrepancy or concern the duty manager must be informed

Follow the directions for giving the medication

Wash your hands and put on gloves

With your finger, gently pull down the lower eyelid to form a space between
the lower eyelid and the eye

Squeeze about 1cm (1/2 inch) or as directed, of ointment into the space,
taking care not to touch the eye with the tip of the tube

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Ask the person to blink several times to spread the ointment and then to close
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their eye for about a minute. Warn them that their vision might be impaired
for a short time.
11.7

Dispose of the gloves in the contaminated waste bin and wash your hands

Replace the lid/cap on the tube/jar

Complete the medication administration record (MAR) sheet

Return the medicine to a safe storage place.
Ear, eye and nose drops
It is very important that the correct number of drops are administered in the correct place for the
correct length of time. Specific instructions need to be given by the prescriber. Drops should not
be administered until specific instructions are obtained.
All ear, eye and nose drops have a maximum number of days effectiveness once the bottle is
open. This is usually 28 days, but some may have expiry dates of 14 or 7 days. It is very
important that the date of opening the bottle is written on the label, and that any liquid
remaining after the expiry date is returned to the pharmacy for disposal. Some eye drops are
dispensed as single use, and the plastic container can be discarded in the normal rubbish.
11.7.1 Storage
Some drops must be kept in a refrigerator, and this will be specified on the dispensing label.
11.7.2
Administering eye drops
 Check the eye drops are still in date
 Explain what you are about to do and help the individual into a comfortable
position where they can tilt their head back
 Ensure any contact lenses have been removed
 Check the label on the container using the ‘five corrects’ protocol. If there is
any discrepancy, or concern the duty manager must be informed.
 Wash your hands, put on gloves and remove the top of the bottle
 Follow the directions for giving the medication.
 Ask the individual to look at the ceiling and with your finger, gently lower their
bottom eyelid to form a space between the eyelid and eye
 Squeeze one drop inside the lower eyelid, taking care not to touch the eye with
the bottle nozzle. If more than one drop is given at a time, the second drop will
run out of the eye
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 Ensure the individual keeps their head tilted back whilst blinking gently,
without squeezing the eyelids. This will retain as much fluid as possible
 Provide a clean tissue or gently dab round the eye with a tissue if necessary
 Dispose of the gloves in the contaminated waste bin and wash your hands
 Replace the cap on the bottle
 Complete the medicines administration record (MAR) sheet
 Return the drops to a safe storage place.
 If the individual is prescribed more than one type of eye drop to be
administered at the same time, leave at least five minutes between prescriptions
to ensure that the first medication has been absorbed.
11.7.3
Administering ear drops

Check the ear drops are still in date

Explain what you are about to do and help the individual into a comfortable
position where they can tilt their head back

Check the label on the container using the ‘five corrects’ protocol. If there is
any discrepancy, or concern the duty manager must be informed.

Wash your hands, put on gloves

Follow the directions for giving the medication.
 Warm the ear-drop bottle by holding it in your hands for a few minutes before .
shaking the bottle well and removing the cap
 Gently pull the individual’s earlobe upwards and backwards, away from the
neck
 Squeeze the correct number of drops into the ear. Do not let the dropper touch
the ear
 Ask the individual to keep their head tilted for about five minutes so that the
drops can spread into the ear
 Replace the cap on the bottle
 Ask the individual to straighten their head and wipe away any extra liquid with
a clean tissue.
 Dispose of the gloves in the contaminated waste bin and wash your hands
 Replace the cap on the bottle
 Complete the medicines administration record (MAR) sheet
 Return the drops to a safe storage place.
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 If the individual is prescribed more than one type of ear drop to be administered
at the same time, leave at least five minutes between prescriptions to ensure that
the first medication has been absorbed.
11.7.4
Administering nose drops

Check the nose drops are still in date

Explain what you are about to do and help the individual into a comfortable
position where they can tilt their head back

Check the label on the container using the ‘five corrects’ protocol. If there is
any discrepancy, or concern the duty manager must be informed.

Wash your hands and put on gloves

Follow the directions for giving the medication.

Warm the nose drop bottle by holding it in your hands for a few minutes before
shaking the bottle well and removing the cap

Ask the individual to blow their nose to ensure it is clear

Hold the dropper just above the nose and put the correct number of drops into
the nostril. Do not let the dropper touch the inside of the nose

Ask the individual to keep their head tilted back for two or three minutes to
help the drops run to the back of the nose

Dispose of the gloves in the contaminated waste bin and wash your hands

Replace the cap on the bottle

Complete the medicines administration record (MAR) sheet

Return the drops to a safe storage place.

If the individual is prescribed more than one type of nose drop to be
administered at the same time, leave at least five minutes between prescriptions
to ensure that the first medication has been absorbed.
11.8 Inhaled medication
Medicines can be inhaled via inhalers and nebulisers. Oxygen is also, generally, inhaled.
11.8.1
Inhalers
There are two main types of medication which can be used in inhalers.
Preventers, which should be used regularly to stop the individual’s condition from deteriorating
further. These are used as directed by the prescriber.
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Bronchodilators, which help to dilate the airways and increase the flow of air into the lungs.
These inhalers can be used when required.
There are many types of inhaler and it is very important that they are used correctly. Some
inhalers squirt the medication into the lungs, whereas others rely on an intake of breath to draw
the medication into the lungs. Details of how to use specific inhalers must be included in the
care plan, and can usually be found in the patient information leaflet provided with the inhaler.
An appointment may be made with an asthma nurse at the local surgery, or the dispensing or
community pharmacist, if the individual wishes to self administer.
Spacer devices. Some residents may need a spacer device to help them co-ordinate their
breathing when using the inhaler. These spacer devices must be washed and left to drain, not
dried with a cloth.
11.8.2
Nebulisers
A nebuliser is a pump which forces the liquid medication into a fine mist. This fine mist is
inhaled using a mouthpiece or mask.
The prescriber is responsible for assessing the individual’s ability to manage a nebuliser. The
medicines will be prescribed as normal and written on the medicines administration record
(MAR) sheet.
A healthcare professional should demonstrate the use of the nebuliser to the individual and
designated staff and the details should be written in the care plan
Guidelines for using a nebuliser
 Ensure the filter is clean
 Set up the nebuliser. There will be a compressor, tubing, nebuliser, mouth
piece/face mask, read the instructions if necessary

Check the label on the container using the ‘five corrects’ protocol. If there is
any discrepancy, or concern the duty manager must be informed.

Wash your hands and put on gloves

Follow the directions for giving the medication.

Open the appropriate medicine vial, pour it into the chamber and switch on
the machine. Return the remaining medication phials to safe storage

Check vapour is coming out before the mask/mouthpiece is positioned on the
resident

Let the resident breathe the vapour until the chamber is empty, or for the time
specified by the prescriber. The lid of the nebuliser should be open during this
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time

If there is any liquid left in the chamber at the end of the treatment, this
should be disposed of according to the usual procedure
11.8.3

Dispose of the gloves in the contaminated waste bin and wash your hands

Complete the medicines administration record (MAR) sheet

Clean the nebuliser according to the manufacturers instructions
Oxygen therapy
Oxygen is now provided directly from the supplier and is no longer available from community
pharmacies. There are various sizes of oxygen cylinders, and concentrators can also be used for
individuals who require constant administration. If nasal tubing is used, a water-based gel such
as KY Jelly should be used to lubricate the nose. Paraffin based products such as Vaseline
should not be used as they are flammable and may also cause irritation.
If oxygen therapy is to be administered, staff must have received specific training from a
suitably qualified person, e.g. healthcare professional or company representative. Responsibility
for this remains with the prescriber.
The use of Oxygen and lubricants must be risk assessed and relevant precautions must be made
for the overall safety of the individual, staff and other residents and visitors.
11.9
Injections
Only designated staff, who have received specific training may administer insulin to residents.
They may only do so using a pre-filled pen where the dose has been set by a healthcare
professional. The details must be written in the care plan.
They may not:
 Change the dose prior to administering it
 Change the dose and leave it for the resident to use later
No other form of injection may be administered by designated care staff.
12.
Adrenaline for Anaphylaxis
Only carers who have received specific training from a qualified healthcare
professional may administer adrenaline for anaphylaxis. This training must be
updated annually. Only pre-filled pens suitable for self-administration may be used
by carers, following appropriate risk assessment and agreement by the team leader.
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Anaphylaxis is a condition in which an individual has an allergic response e.g. to an insect
sting or food such as peanuts. Allergic reactions vary but may include:
 Swelling of the face, throat, tongue and lips
 Difficulty in swallowing
 Flushed complexion
 Rashes
 Collapse or unconsciousness.
Adrenaline needs to be injected immediately to avoid rapid collapse.
When the need for an individual to keep a pen for immediate treatment has been
identified, the care plan must include:

The cause of the allergy and possible reaction
 Clear instructions on how to use the adrenaline pen, which must be kept with the
pen
 Details of exactly where the pen is kept
 Regular checks on the expiry date of the adrenaline pen, as these can have a short
shelf life, often only six months
 Routine ordering of a new pen two weeks before the expiry date of the existing stock
A consent form, signed by the individual with the allergy, or their representative where
appropriate, with specific instructions on the circumstances in which the pen is to be used.
The individual should be given a copy of this consent form.
Administration of Adrenaline by Epipen
Most pens work as follow : Hold the pen against the thigh.
 Press the button, which automatically injects the adrenaline
 It is the responsibility of the healthcare professional to dispose of the empty pen
into a ‘sharps’ disposal container.
13. Refusal of medication
All service users have the right to refuse medication. If medication is refused it should be
offered again after a short period.
If the medication is refused a second time, the MAR sheet must be completed
appropriately. The team leader must be informed when a service user refuses medication.
If medication is refused, the contingency in the medication risk assessment in the care plan,
must be followed. If necessary, the team leader will inform the Prescriber and Care
Manager.
When advice is sought from a healthcare professional, the following details must be
documented in the care plan
 The name of the professional
 Time and date
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



Query
Advice given
Action taken as a result of the advice
Signature of the person receiving the advice
14. Medication incidents
All incidents and ‘near misses’ must be reported to the duty manager as soon as possible. It
is good practice to report incidents and ‘near misses’, as these can be used to improve
service user care and avoid future incidents.
All reports must be clear and legible and completed in accordance with Care Practice
Guideline 306.
15. References
CSCI: Quality Performance and Methods Directorate
The Safe Management of Controlled Drugs in Care Homes (Jan 07)
The Nursing and Midwifery Council
The NMC Code of Professional Conduct and Guidance for Medication Management
www.nmc-uk.org
The Royal Marsden Hospital Manual of Clinical Nursing Procedures
www.royalmarsdenmanual.com
The Royal Pharmaceutical Society of Great Britain (RPSGB)
Handling Medication in Social Care
Codes of practice for social care workers and employers
http://www.gscc.org.uk/codes/What+are+the+codes+of+practice/
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