SUPPORT THE USE OF MEDICATION IN A SOCIAL SETTING
The Legislation that governs the use of Medication in social care settings
Understanding the legal framework The Medicines Acts 1968 and various amendments cover the legal management of medication. While care staff is not expected to have detailed knowledge of the legislation, they do need to be aware of the legal difference between types of drugs and the legal framework that allows them to handle medicines on behalf of the service user.
Read more
The following is a list of legislation that has a direct impact upon the handling of medication within a social care setting. The Medicines Act 1968; The Misuse of Drugs Act 1971; The Misuse of Drugs (Safe Custody) Regulations 1973 SI 1973 No 798 as amended by Misuse of Drugs Regulations 2001; The NHS Scotland Pharmaceutical Service (Regulations) 1995; The Social Work (Scotland) Act 1968 as amended by The Regulation of Care Act 2001 ; The Children Act 1989; The Children’s Act (Scotland) 1995; The Data Protection Act 1998 ; The Care Standards Act 2000; The Regulation of Care (Scotland) Act 2001; The Health and Social Care Act 2001; Adults with Incapacity (Scotland) Act 200;The Health Act 2000; Health and Safety at Work Act (1974); The Control of Substances Hazardous to health Regulations (1999-COSHH); Hazardous Waste Regulations (2005); Mental Capacity Act (2005) and The Access to health records Act (1990)[1].
Also the other legislation is “ Administration and Control of Medicines in Care Homes and Children’s Services June 2003”
The legal classification system for medication: The Medicines Act 1968 and Council Directive 2001/83/EC control the sale and supply of medicines. The legal status of medicinal products is part of the marketing authorisation (MA) and products may be available: 1. on a prescription (referred to as Prescription Only Medicines (POMs)) 2. in a pharmacy without prescription, under the supervision of a pharmacist (P) 3. on general sale (GSL) and can be sold in general retail outlets without the supervision of a pharmacist[2].As per The Medicines Act 1968 the drugs are classified as:
1) POM- Prescription only medicines, the prescriptions can be issued by doctors, dentists, nurse independent prescribers, pharmacist independent prescribers and supplementary prescribers. The retail sale or supply of product is prohibited.
For example: Acyclovir, Albendazole, Adrenaline, Ampicillin, Azithromycin, Azlocillin Sodium, Aztreonam, and Bacampicillin Hydrochloride, Bacitracin etc. 2) P – Pharmacy Medicines, includes all those medicines which are not in POM (prescription only medicines) or GSL (general sales list), and includes all medicines made in a pharmacy for retail sale under the exemptions from licensing granted to retail pharmacies. For examples: Paracetamol, Antibiotic eye drops etc. 3) GSL- General Sales List, includes those medicinal products which in the opinion of the appropriate minister can with reasonably safety be sold or supplied otherwise by or under the supervision of a pharmacist. For example: Schedule 1&2 excipients, glycerine extract, bovine blood[3]. | ||||
How and why policies and procedures or agreed ways of working must reflect and corporate legislation requirements.
The policies and procedures put in place make sure that legislation is being followed so that all people in the setting, practitioners and those being cared for are safe. This includes all necessary steps to be taken to make sure that needs of all the children and young people are being met, inclusive practise and diversity is being followed, and that the setting is staying within the law. The law should be reflected so that those who are employed by the setting can be able to understand what the law expects of them. The policies and procedures are the interpretation of the law by the setting.
For example if a health and safety procedure was put in place and was not in line with legislation then this could cause the setting to get in trouble with the law and could cause harm to the to the service users and visitors[4].
Employers must examine and write down these workplace risks and what to do about them. Ultimately, assessing risk means that anything in the workplace that could cause harm to your employees and other people (including customers, visitors and members of the public) must be carefully examined. This allows you to estimate the magnitude of risk and decide whether the risk is acceptable or whether more precautions need to be taken to prevent harm [5] .
| ||||
Conditions for which each type of medication may be prescribed
The conditions of which each type of medication prescribed and administered to individuals: a)antibiotics :used to fight infection;
b) analgesics: used to relieve pain;
c) antihistamines: used to relieve allergy symptoms, [ e.g. hay fever);
d)antacids :used to relieve indigestion);
e)anticoagulants: used to prevent blood clotting, e.g. following heart attack, thrombosis, some surgical procedures);
f)psychotropic medicine: used to treat depression);
f)diuretics :used to get rid of excess fluids in the body;
h)laxatives: used to alleviate constipation;
I)hormones: insulin, contraceptives, steroids, Hormone Replacement Therapy;
j) cytotoxic medicines: used to treat some forms of cancer[6].
| ||||
The changes to an individual's physical or mental wellbeing that may indicate an advance reaction to medication.
| ||||
Adverse Drug Reaction (ADR) is a form of adverse consequence. It may be either a secondary effect of a medication that is usually undesirable and different from the therapeutic effect of the medication, or any response to a medication that is noxious and unintended and occurs in doses for prophylaxis, diagnosis, or treatment. The term “side effect” is often used interchangeably with ADR, however side effects are but one of five ADR categories, the others being hypersensitivity, idiosyncratic response, toxic reactions, and adverse medication interactions. A side effect is an expected, well-known reaction that occurs with a predictable frequency and may or may not constitute an adverse consequence[7].
Problems with medications can take many forms and may not readily be seen as a consequence of drug therapy. It is important to consider the possibility that the changes in condition may be medication induced or influenced.
If a resident has been transferred to acute care and/or has, in the last three months, experienced a change in condition or currently has signs and symptoms such as the following, there is the possibility of adverse medication consequences.
• Anorexia and/or unplanned weight loss, or weight gain.
• Behavioural changes, unusual behaviour patterns including increased distressed behaviour.
• Bleeding or bruising, spontaneous or unexplained.
• Bowel dysfunction including diarrhoea, constipation and impaction.
• Dehydration, fluid/electrolyte imbalance.
• Depression, mood disturbance.
• Dysphagia, swallowing difficulty.
• Excessive sedation, insomnia, or sleep disturbance.
• Falls, dizziness, or evidence of impaired coordination.
• Gastrointestinal bleeding.
• Headaches, muscle pain, generalized or nonspecific aching or pain.
• Mental status changes such as new or worsening confusion, new cognitive decline, or worsening of dementia including delirium.
• Rash, pruritus.
• Respiratory difficulty or changes.
• Seizure activity.
• Urinary retention or incontinence[8].
The roles and responsibilities of those involved in prescribing, dispensing and supporting use of medications.
| ||||
The Doctors role is to determine what medication the patient needs. It is his responsibility to prescribe the correct medication, the dose, the type and amount.
The chemist’s role is to dispense the medication that is written on the prescription, it is their responsibility to make sure that the items they give out are correct and exactly the same as what is written on the prescription. If there are any mistakes they must contact the doctor. The carer’s role is to make sure that the patient gets their medication. It is their responsibility to give the patient the correct medication, at the correct time with the correct dose. Everything that is given out must match what is printed on the Mar sheet and must be signed for[9].
The prescriber must be trained appropriately (may be a GP or nurse prescriber for example) and update themselves as required by any professional body that they might belong to - prescriptions should be written clearly, ensuring the patient understands any side effects and the reasons for the prescription be given to them and how long they should take it for. Medication should only be prescribed after careful consideration of the patient's best interests - cost, unfortunately (but realistically) may also be a factor to consider. The prescriber should have access to the most up to date version of the British National Formulary (BNF) which is the prescriber's 'bible' (there is a version for prescribing for children and an on line version).
The person dispensing must also be appropriately trained, follow safe systems of work and understand the side effects of various drugs; be able to access appropriate information and understand when to access advice or further information (the dispenser may not necessarily be a trained pharmacist but should be working alongside one). By supporting medication, means how does the person administering the medication support an individual to take it? This is through following care plans or support plans; staying with the person to support them to take it; using appropriate equipment (spoon etc) and a drink of water and of course reassuring communication and of course time[10].
Where responsibilities lie in relation to use of 'over the counter' remedies and supplements.
People who purchase and use Over The Counter drugs should read and follow the instructions carefully. It is the person's discretion to use the drug or supplement. Make sure that the self-diagnosis is as accurate as possible. Do not assume the problem is something that is going around.[11]
Safety depends on using a drug properly. For OTC drugs, proper use often relies on consumer self-diagnosis, which leaves room for error. For example, most headaches are not dangerous, but in rare cases, a headache is an early warning of a brain tumour or haemorrhage. Similarly, what seems like severe heartburn may signal an impending heart attack. Ultimately, people must use common sense in determining when a symptom or ailment is minor and when it requires medical attention and consult a doctor if they are unsure.
People who purchase OTC drugs should read and follow the instructions carefully. Because different formulations—such as immediate-release and controlled-release (slow-release) formulations—may have the same brand name, the label should be checked each time a product is purchased, and the dosage should be noted. Assuming that the dosage is the same is not safe. Also, different formulations with the same brand name may have different ingredients, so checking the ingredients on the label is important. For example, there are several dozen different Tylenol formulations with a vast array of ingredients. Some Maalox products contain aluminium and magnesium hydroxides, while others contain calcium carbonate.
When selecting a product, people should read the label carefully to determine which product is most appropriate for their particular problem. Labels on OTC drugs can help people understand a drug's benefits and risks as well as how to use the drug correctly. People should ask a pharmacist if they have any questions about an OTC product.
Often, the labels of OTC drugs do not list the full range of possible side effects. As a result, many people assume that these drugs have few, if any, side effects. For example, the package insert for one analgesic cautions people not to take the drug for more than 10 days for pain. However, the possible serious side effects that can occur with long-term use (such as life-threatening bleeding from the digestive tract) are not mentioned—not on the box, bottle, or package insert. Consequently, people with chronic pain or inflammation may take the drug for a long time without realizing that such use could lead to serious problems[12].
If I saw a client taking over the counter remedies I would ask where they got them from and why they needed to take them, I would then inform the manager and document it in the care plan. If the client was not capable of telling me I would remove the remedy and inform the manager again[13].
| ||||
The routes by which medication can be administered
Medication route refers to the way that a drug is introduced into the body. This is based on the specific medication being used, [the rate of absorption desired and the specific site of action (where the medication needs to have an effect). Most drugs are manufactured for a specific route of administration and must be used as directed for safety and efficiency[14].
There is not one correct route but eight correct routes through which medication can be administered to a patient, depending upon the requirement of the treatment and the mode of administering the medication.
The first common route of medication is through the PO, in medical terms. PO refers to administering medication by oral means in the mouth – either as a tablet, capsule or as a syrup. When the patient is to be provided a tablet or syrup, then PO is the best route of medication.
The second route for administering medication is the sublingual form where the medication is administered not orally but from under the tongue of the patient.
The third form of administering medication is through the skin, wherein the advised medication is spread over on the skin – such as creams. The third form of medication is called as topical medication.
If the medication is administered through the skin into the body, then it is referred to as subcutaneous mode of medication. In subcutaneous method, the adipose tissue is located by the nurse, and once found, the medication is administered at a 45 degree angle preferably using a long needle.
The fifth form of medication is called as intramuscular medication. As the name suggests, the medication is administered through the muscles in to the body. For intramuscular medication, the nurse has to use a relatively longer needle and should administer the dosage keeping the needle at 90 degree, such that the needle passes through the adipose tissue into the muscle for administering the dosage into the muscle.
The sixth route of medication is intravenous method. In this form, the medication is administered through the veins in the body. The ideal example for intravenous medication is administering saline or glucose to the patient.
The seventh route of medication is the rectal method, where the medication is administered through the rectum, a part of the large intestine.
The eighth mode of medication is the intrathecal method, where the medication is administered into the spinal cord of the patient. Normally, this type of medication is not done by the registered nurse, but only under the supervision of a trained physician or specialist doctor[15].
| ||||
Different forms in which Medication may be presented
| ||||
Here are different forms in which medication can be presented. Tablets and capsules, Syrups and liquids, Dispersible tablets (melt-in-the-mouth), Injections (depot or long-acting) and Skin patches. The choice of how you take your medication should be offered to you. The advantages and disadvantages should also be explained. Not all medicines are available in each of the forms. You will need to consult the specific question relating to that medication e.g. How I should take medication?[16].
Materials and equipment that can assist in administering Medication
The majority of medicines are formulated for oral administration. This means they are taken via the mouth, in the form of a tablet, capsule, liquid or suspension. These medicines come in a variety of shapes and sizes, colours and tastes. Solid dose oral formulations are made either as tablets or capsules, and are formulated to aid compliance and reduce adverse effects. As well as tablets and capsules, oral medicines can also be delivered by liquids, suspensions and syrups. Again, these are formulated to aid compliance. Liquid preparations are measured when administered, using a 2.5ml or 5ml spoon, oral syringe or a medicine tot. All liquid preparations must be shaken before measuring out the dose[17].
So to assist in the administration of the above and other medication, the following materials and equipment are used: 1. Medicine Trolley - used for medicine cart. 2. Medicine Pots - 3. Spoons 4. Syringe 5. Containers 6. Wipes 7. Drinking Glasses 8. Water Jug 9. [Disposal Bag 10. Medication Administration Record[18].
| ||||
The importance of the following principles in the use of medication
| ||||
In medication administration always bear in mind an individual's right to have their dignity & privacy respected, following organisations ' Policies & Procedures, National Standards, Codes of Conduct, Essential Standards of Quality & Safety, this also relates to consent (Mental Capacity Act 2005) & the right to confidentiality (Data Protection Act.)[19]
There are Principles that Influence Medication Administration Procedures. It is important that these principles of medication administration be known and followed by anyone (nursing and non-nursing personnel) who is administering medications.
Principle 1: Guarantee that medication administration is a clean procedure by washing hands.
Principle 2: Give medication exactly as ordered by the health care provider or indicated on manufacturer’s instructions.
Principle 3: Everything should be done to avoid “no-shows,” especially for seizure medications and antibiotics.
Principle 4: Prevent errors! Do not allow yourself to be distracted. Do not use one student’s medication for another.
Principle 5: Keep individual student information private.
Principle 6: Apply child development principles when working with students (e.g., students do not want to be considered unique.)
Principle 7: If there is an error or medication incident, it must be reported. Follow district procedure for notifying your school nurse, administration (within 24 hours), the student’s parent/legal guardian, and physician. Complete documentation. It is important to act as soon as the error is discovered. The school administrator or supervisor should evaluate errors[20]
How risk assessment can be used to promote an individual's independence in managing medication.
If someone is to self-medicate or actively encouraged to participate in the whole process of taking their medication very much depend on their ability. This will depend in knowing when they need to repeat their prescription, requesting script from GP/being supported to order it via surgery's website/taking it to pharmacy, collecting it, knowing the time to take their meds. Also depends on being able to get a glass of water to take their tablets then they are being empowered to be active in the process, not a passive recipient who has no understanding/control over a part of their life. It’s about being person-centred, doing things with the individual, promoting their independence, feelings of self-worth & esteem, hopefully less chance of mistakes being made or abuse occurring . This leads to an individual's right to have their dignity & privacy respected, following organisations ' Policies & Procedures, National Standards, Codes of Conduct, Essential Standards of Quality & Safety, this also relates to consent (Mental Capacity Act 2005) & the right to confidentiality (Data Protection Act.) [21].
For one to be able to ascertain that an individual is capable to self-medicate, a health risk assessment (HRA) is carried out on the individual. This is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.” [22].
| ||||
How ethical issues that may arise over the use of medication can be addressed
| ||||
Sometimes ethical issues arise over the use of medication. This can arise in situations where one refuses to take life saving meds ; people who want to die; people who cry when you try to give meds; people who become angry thinking you’re trying to poison them ( especially prevalent with dementia). When such situations arise follow organisational Policy &Procedures on how to deal with differing situations, working within your level of organisation, seek guidance from senior, and inform care management /GP[23].
One ethical issue which raised its head a few years ago and has resulted in changes to the way medication is administered was the covert crushing of medications and adding them to jam or other foods to disguise them when an individual declined to take them. This was considered unethical, unfair deceitful and often dangerous and is now forbidden. Medication which is crushed can be dangerous (slow release medicines can hit the system all in one go causing collapse and serious illness) and giving it in this hidden manner takes away a person's right to choose.
Now, I can't say this doesn't go on anymore as I am sure it probably does but, a good provider will call a meeting and discuss any difficulties when administering medication with professionals (pharmacist, GP etc) and of course any advocate family or carers. Other ethical issues around medication might be a person's strong beliefs around the testing of medicines on animals[24]. Remember to keep records on reports made on any issues about meds
|
|