Medication Policies and Procedures Are You Covered

1
Medication Policies and Procedures Are You
Covered?

• Presented by
• Judith Manners MRPharmS
• Consultant Pharmacist
• Opus Pharmacy Services

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Why Do We Need a Policy With Standard Operating
Procedures?

• Ensuring safety of the service user
• Reducing risk
• Protecting staff

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What Is Risk?

• Risk likelihood x consequences
• A hazard is something with the potential to cause
  harm e.g. a medicine
• Risk is a measure of the likelihood that the
  potential harm from a hazard may arise

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Risk from Medicines

• Risk from certain medicines can be high
• E.g. warfarin, methotrexate

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How Can This Risk Be Managed?

• Reduce factors that contribute to the risk
• Likely factors
• Inappropriate handling of medicines
• Poor recording
• Insecure storage
• Inaccurate measuring
• Poor communication

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The Need for Standard Operating Procedures (SOPs)

• Storage
• Administration and handling
• Recording
• Disposal
• Homely remedies
• Controlled Drugs
• Self medication
• Medication errors

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SOP for Storage

• Key security
• Temperature checking
• Date checking stock
• Internal / external preps
• Self medicators
• No excess /overstock

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SOP for Administration and Handling of Medicines

• Basic hygiene
• Shaking liquids
• Dating containers on opening
• Giving medication with water
• Detailed procedure for administration
• Checking against label and MAR
• Photos on MAR to aid ID
• Witnessing s/u taking the medication

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How Easy Is It to Make a Mistake?

• HIT THE
• NAIL ON THE
• THE HEAD

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SOP for Recording

• MAR sheet recording (codes)
• Discontinued items
• Dose changes
• Warfarin
• Interim supplies e.g. antibiotics
• PRNs

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Recording Issue Examples (1)

• Discontinued items e.g. flucloxacillin
• Dose changes e.g. Tramadol 150mg daily changed to
  50mg three times a day

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Recording Issue Examples (2)

• Warfarin different strengths
• Are all strengths still required on the MAR
  sheet?
• How long is the current dose for?
• A dose changing from 2mg to 3mg do you give
  3x1mg or 1x3mg?
• How do you record the new dose?
• How do you reference it back to the original
  authorisation?

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SOP for When Required Medication PRNs

• Do you record every time it is offered?
• Do you only record when you administer?
• Details on back of MAR
• State dose given i.e. one or two
• Protocol max in 24 hours, when required for
  what?, how often can dose be repeated?

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SOP for Disposal

• Return to pharmacy/waste contractor
• Refused doses
• Paperwork

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SOP for Homely Remedies

• Accurately reflect the situation in your home
• GP letters/ signed policy
• 2 day limit

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SOPs for Controlled Drugs (1)

• Administration by 2 people
• Storage
• Recording
• Physically counting the balance
• Reporting errors

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SOP for Controlled Drugs (2)

• S/u who self medicate CDs
• Stock checking and audit
• Disposal pharmacy /DOOP kit

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Use of a Witness

• Witness needs to confirm
• Care worker selects correct CD
• Name on the label is the same as the person
  receiving the CD
• Care worker has prepared the right dose
• Care worker gives it to the right resident
• Administration is recorded on MAR and CD register

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SOP for Self Medication

• Risk assessment and monitoring
• Reassessment
• Storage
• Partial self medicators

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SOP for Medication Errors

• Open culture
• Who to report to
• Stay with the resident
• Action advice from HCP
• Document
• Team meeting
• Audit

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What if.? Case Study 1

• The service user is a 90 year old gentleman who
  is physically and mentally able. Staff administer
  the following medication to him. He finds it
  personally insulting to be watched taking it.

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Case Study 1

• Digoxin
• Furosemide
• Ferrous sulphate
• Omeprazole
• Flucloxacillin
• Lisinopril
• Paracetamol
• Lactulose

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Case Study 1

• Staff dispense it and leave it out for him
• He has his door open all the time
• Never leaves the room except to go to the
  bathroom
• A few residents wander
• How will you manage this?

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Case Study 1

• What are the risks?
• He doesnt take the meds straight away
• Knocks them off his table by mistake
• Reduces his independence
• Hoards the meds
• Someone else takes them
• Independence v safety of others

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Case Study 1

• What must be put in place?
• Risk assessment
• Minimise risks to that s/u and others
• If staff dispense but dont witness how will you
  record this?
• Explain to him his responsibilities to the people
  he lives with
• SOP

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What if..Case Study 2

• Other HCPs coming into your care home
• District Nurse
• CPN
• MacMillan Nurse

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Case Study 2

• A District Nurse comes into your home to
  administer a flu vaccine to one of your
  residents. She asks the resident for her consent
  and administers the vaccine.
• What are the pitfalls?

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Case Study 2

• You were not aware the DN was coming
• She did not inform you before visiting the
  resident
• The resident has dementia
• The resident has consented but has forgotten that
  she has already received the vaccine

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Case Study 2

• How will you manage this?
• SOP
• Inform manager when HCP arrives
• Any alteration, addition, discontinuation of
  medication must be made on MAR sheet
• Recording must be clear and legible
• Sample signature /initials
• Communicate changes to senior person

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What if.Case Study 3

• A service user goes to the day centre with an
  escort every Thursday and takes his medication
  with him. The medication is prescribed PRN
  (when required).
• What are the issues that need considering?

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Case Study 3

• How should the medication be supplied risks and
  options
• Record for handing it over to the escort
• PRN protocol for use at the day centre
• Communication to day centre of what s/u has
  already taken
• SOP

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What if Case Study 4

• You are a nurse working in a care home providing
  nursing care. Healthcare assistants administer
  creams.
• What are the issues?

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Case Study 4

• Training required for healthcare assistants
• Delegated task
• Competency assessment
• Documentation

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Case Study 4

• Training for creams
• Reading the label
• Reading the PILs
• Wash hands
• Wear gloves
• Date creams on opening
• Do not put unused cream back into the container

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Case Study 4

• One container for each resident
• Only administer to person whose name appears on
  label
• Full instructions needed for prn dosage
• When to use/when not to use
• What to look out for (side effects)
• Signing for administration

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Cast Study 4

• Specific creams-rub in, apply liberally, apply
  sparingly, fingertip units
• Storage requirements of cream
• Allergies
• Reporting back concerns
• SOP

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Conclusion

• Trained and competent workforce
• Human beings make mistakes because the systems,
  tasks and processes they work in are poorly
  designed
• Dr Lucian Leape (US medical errors research
  expert)

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Questions?

• Judith Manners MRPharmS
• Opus Pharmacy Services
• E-mail info_at_opuspharmserve.com
• Tel [phone]
• Website www.opuspharmserve.com