NHS Highland Care at Home medicines management policy · 2016-12-05 · 6. Care at Home Service...

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Policy Reference: id305 Date of Issue: December 2014

Prepared by: Care at Home Medicines Working Group Date of Review: December 2016

Lead Reviewer: Clare Morrison, Lead Pharmacist (North) and Gill Brown, Area Care at Home Manager (Ross, Skye and Lochaber)

Version: 6

Authorised by: Policies, Procedures and Guidelines Subgroup of ADTC of 47

Role of Care at Home staff in the management of medicines

All Care Settings, NHS Highland

(not Argyll and Bute)



Prepared by: Care at Home Medicines Management Short Life Working Group

Date of Review: December 2016

Lead Reviewer: Clare Morrison, Lead Pharmacist (North), and Gill Brown, Area Care at Home Manager (Ross, Skye and Lochaber), NHS Highland

Version: 8

Authorised by: Policies, Procedures and Guidelines Subgroup of ADTC

Date: December 2014

Distribution

Care at Home staff

Community pharmacists and staff

GPs and practice staff

Hospital staff

Community nurses

Allied health professionals

Non-medical prescribers

Social work

For onward distribution: o Director of Pharmacy o Medical Director o Director of Nursing

Method CD Rom E-mail Paper Intranet





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CONTENTS

Section Topic Sub-sections Page(s)

1 Executive summary 3

2 Introduction 4

3 Definitions

3.1 Levels of support 3.2 Prompting, assisting and administration

5 5

4 Medicines management assessment and review

4.1 Initial assessment and referral 4.2 Formal assessment 4.3 Outcome of assessments 4.4 Review 4.5 Flowchart summarising review process

7 7 10 10 11

5 Assisted support

5.1 Types of support 5.2 Record keeping (including consent) 5.3 Monitored dosage systems 5.4 New technology – telehealth system 5.5 Raising concerns

12 13 13 14 14

6 Managed support

6.1 Types of support 6.2 Record keeping (including consent) 6.3 Medication administration record (MAR) chart 6.4 Administration of medicines 6.5 Documentation on MAR charts by Care at Home worker 6.6 When required medicines 6.7 Warfarin 6.8 Controlled Drugs 6.9 Refusal to take medicines 6.10 Medicines sick day rules, dealing with illness 6.11 Involvement of family/informal carers

15 15 16 18 19 19 20 20 20 21 22

7 Health professional input support

23

8 Storage and disposal of medicines

8.1 Storage 8.2 Disposal

24 24

9 Hospital admission

9.1 Admissions 9.2 Discharge

25 25

10 Errors and incidents 27

11 Education and training

11.1 General medicines management training 11.2 Medicines that require additional training 11.3 Education for NHS staff and contractors

28 28 29

Appendices 1. Compliance Needs Assessment referral form 2. Compliance Needs Assessment tool 3. Care at Home managed support assessment (part 2) 4. Interim assessment form 5. Medicines needs assessment report form 6. Care at Home Service User pack specification of agreed tasks (contract) 7. Medicines assistance form 8. Medicines disposal form 9. Example MAR chart generated by pharmacy computer system 10. Paper based managed support medication chart 11. Emergency procedures form 12. When required medicines form





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1 EXECUTIVE SUMMARY Safe medicines management is a core component of all NHS services. The vast majority of people manage their medicines on their own, or with the support of family and friends, following advice from a health professional. This policy is specifically for the small group of people who need the help of a formal carer. It describes how the Care at Home service will support this group of people with their medicines. The policy defines three levels of support that people may need with medicines: assisted support, managed support and health professional input. The key defining factor between assisted and managed support is whether the person has the capacity to be responsible for his/her medicines. If the person retains capacity but lacks the physical capability, then s/he will be offered an “assisted” level of support to continue to self-manage. If the person lacks capacity, then a Care at Home worker will administer medicines under the direction of the person’s prescriber: this is known as the “managed” level of support. The types of support within the assisted level include: collecting medicines from a pharmacy/dispensing GP, reading medicines labels, prompting people to take medicines, opening medicine packaging and assisting in the application of a medicine when the person cannot physically apply it but can instruct the Care at Home worker on how to do it. Medicines administration in the managed support level involves the Care at Home worker administering medicines from original packs using a medication administration record (MAR) chart. The MAR chart is produced by a community pharmacy/dispensing practice. Only medicines listed on the chart can be administered. It is essential that the MAR chart is kept up to date. It is the responsibility of the community pharmacist to update the chart. However, prescribers must ensure that they inform the community pharmacist of any changes to prescribed medicines so that the pharmacist can update the chart. A prescription issued by the prescriber and presented to the pharmacist will trigger the updating of the MAR chart by the pharmacist. All health and social care professionals involved in a person’s care are required to be vigilant to recognise if a person is having problems with medicines and, if these problems cannot be addressed with simple measures and the involvement of family members/informal carers, refer the person for a formal assessment. Initially, people should be referred to a community pharmacist (or if there is no pharmacy, the person’s dispensing GP) for assessment. Community pharmacists/dispensing practices will determine the level of support required. This fits within their existing roles and professional responsibilities around assessing suitability for compliance aids. For the assisted level of support, the community pharmacist/dispensing GP will recommend the specific types of support required. For the managed level of support, the community pharmacist/dispensing GP will refer the person to the person’s GP practice for further assessment. The primary care clinical pharmacist/prescribing support pharmacist working with the person’s GP practice will complete a medicines review and the GP will complete an assessment of capacity (in relation to medicines management only). This certificate should be issued by the person with the lead responsibility for the person’s care which is nearly always a doctor. Ongoing support to the Care at Home worker is primarily provided by community pharmacists/dispensing practices through the production of MAR charts and compliance support. GPs also have ongoing responsibilities to ensure any changes in medication are communicated to the community pharmacy promptly. Similarly, good communication is needed when people are treated out of hours or in hospital. The Care at Home service must ensure that accurate records of all medicines management activities are maintained. This policy provides a number of forms to enable record keeping.





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2 INTRODUCTION This policy describes how the Care at Home Service will support people with their medication in their own homes. The policy’s aim is to ensure a safe and professional service that is delivered consistently by all Care at Home staff. This policy was written for the NHS Highland Care at Home service. A consultation will take place with private providers of home care by December 2015 with a view to producing a universal policy for all home care providers. The Care at Home Service supports people to continue to live in their own homes. Support with medicines is one aspect of a range of tasks that Care at Home workers provide to enable people to live at home and retain as much independence as possible. Care at Home staff should never be involved in any medicine management task unless authorised to do so by the Care at Home Officer/Manager and the task is stated in the person’s Service User Pack. Staff must be appropriately trained to meet the standards of competence defined in this policy and feel confident to perform tasks correctly. Staff must observe the guidance set out in this policy and must not provide any assistance with medication that is outwith this policy.





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3 DEFINITIONS 3.1 Levels of support The table below defines the three levels of support with medicines that a person may require.

Level Description – the Person: Summary of assistance required

Assisted support (previously known as “level 2”)

Has the capacity to make decisions about medicines, although may be forgetful

Retains responsibility for managing medicines

Requires physical assistance or prompting to take or use medicines

Prompting to take medicines Assistance in opening packs

(usually in original packs; monitored dosage systems are only useful in limited situations)

Assistance with ordering of medicines, plus collecting and disposal of medicines

Assistance with applying/using medicines

Managed support (previously known as “level 3”)

Does not have the capacity to make decisions about medicines

Requires medicines to be managed

Administration of medicines from original packs using a medication administration record (MAR chart)

Health professional input (previously known as “level 4”)

Unable to manage a particular medicine(s) that requires specialist support from a health care professional (usually nursing team)

Invasive procedures, eg, injections, changing dressings

Administration of medicines requiring specialist skills beyond Care at Home Worker’s training

The key difference between assisted and managed support is that assisted support is about reduced physical capability to take/use medicines, whereas managed support is about not having the capacity (cognitive function) to make decisions about medicines. Forgetfulness is included within assisted support because a person may have the capacity to make decisions about medicines but may forget to take them, therefore a simple prompt is all that is required. However, it is acknowledged that people with dementia may initially need assisted support such as prompting but gradually decline towards needing managed support. Therefore, the level of support provided should be regularly reviewed. Some people may require mixed levels of support. For example, someone may not be able to manage any of their tablets and therefore require “managed” support yet have no difficulty in using an inhaler appropriately so can self-manage this. 3.2 Prompting Prompting is reminding a person that it is time to take or use a medicine. The person retains the responsibility for his/her medicines. Therefore, prompting is in the “assisted” level of support. Prompting may involve the Care at Home worker:

Telling/reminding the person the time Reminding the person to take/use medicines Asking if medicines have already been taken/used

An example of a prompt is: “It is 9am, are you going to take any tablets this morning?” In order to prompt someone, the Care at Home worker must know the times of day when a prompt is required: this should be stated in the Service User pack.





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The person must have been assessed in the initial needs assessment as being able to follow a prompt and still be capable of knowing which medicines to take at each time, because the Care at Home worker is not responsible for checking which tablets are being taken. The Care at Home worker should record when the prompt was given (date and time) in the team communication record. It would also be appropriate to record how the person responded (eg, said they had taken/used medicines already, or taken/used them while Care at Home worker was there). Assisting Assisting covers a number of tasks, depending on the individual person’s need. The person always retains responsibility/capability for his/her medicines: he or she makes an active choice about what medicines to take and when and how to take them. This fits into the “assisted” level of support. The Care at Home worker’s role is to provide assistance, not to take any decision-making responsibility. These tasks include:

Ordering and collecting repeat prescriptions from GP practices

Collecting medicines from a pharmacy/dispensing practice and delivering to the person

Bringing medicines to a person to allow that person to take the medicine

Opening medicines packaging at the request of the person who is going to take it (and then offering the medicine to the person to take, rather than administering it)

Reading labels on medicines

Checking the time at the request of the person

Assisting with the application of a medicine (eg, a cream) where the person can instruct the Care at Home worker on the application of the medicine but cannot physically apply it him/herself. If the person cannot instruct the Care at Home worker, then this becomes “administration” – see below. If a specialist skill is required to apply a medicine that the Care at Home worker is not or cannot be trained in, then this type of assistance becomes a “health professional input” level of support (requiring a health professional’s input, see section 7 of this policy).

All general assistance with medicines must be recorded on the team communication record. Any assistance with applying a medicine should be recorded on a medicines assistance form (as defined in section 5 and Appendix 7 of this policy). Administration Administration involves a Care at Home worker administering a medicine to a person who is not responsible for managing his/her medicines. This is the “managed” level of support. The Care at Home worker is following the written direction of the prescriber to ensure that the person is offered the right medicine, at the right dose, in the right form, at the right time and in the right way. Administration is distinct from assisting or prompting because the Care at Home worker is taking an element of control away from the person by deciding (under the direction of the prescriber) what the person is going to take and when it will be taken. Administration of medicines involves the following tasks:

Deciding which medicines have to be taken or applied Being responsible for selecting those medicines Giving a person a medicine to swallow, apply or inhale where the person receiving them

does not have the capacity to know what the medicine is for or be able to identify it. This may include physically assisting with administration (eg, applying a cream).

The Care at Home worker must record medicines administered on a medication administration record (MAR chart) and must only administer medicines listed on the person’s medication chart.





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4 MEDICINES MANAGEMENT ASSESSMENT AND REVIEW Assessment of a person’s needs is essential to ensure an appropriate Care at Home service is put in place that best supports the person with taking/using medicines. 4.1 Initial identification and referral It is expected that, as part of their usual role, any professional may recognise that a person has a problem with his/her medicines. These professionals may include a community nurse, pharmacist, GP, carer or allied health professional. It may be that appropriate support can be arranged with a family member or informal carer. However, if a problem is identified for which further support is needed, that professional should then refer the person for a formal assessment. The initial part of the formal assessment is carried out by community pharmacists/dispensing practice who will determine the level of support a person needs with medicines. All referrals should be made to the community pharmacist (chemist)/dispensing practice in the first instance. Referral should be made by either using a referral form (see Appendix 1) or by telephone to discuss with the community pharmacist all relevant information, including:

Person’s name, address, date of birth Details of problem(s) with medicines identified Any other relevant information (eg, about support person currently receives)

A record of the referral should be kept by the person making the referral and the person receiving it. Assessments can also take place for hospital in-patients. Care should be taken to ensure an accurate picture of the person’s ability to cope in his/her own home is available: in many cases, it will be more appropriate to undertake an interim assessment and for a follow-up assessment to take place once the person is back in their own home. 4.2 Formal assessment Initial assessment for all patients Community pharmacists (sometimes referred to as “chemists”) or dispensing GP (if no community pharmacy in the geographical location) will assess people’s needs initially. This aligns with community pharmacists’ existing role in assessing people’s medicines compliance needs before providing a compliance aid such as a monitored dosage system. This is described by the NHS Highland Policy on the Use of MDS in NHS Highland. In order to streamline the process, a universal compliance needs assessment is used for both the Care at Home needs assessment (this assessment) and the Compliance Aids assessment. The universal compliance needs assessment is provided in Appendix 2: it can either be used electronically or printed and filled in by hand. If the outcome of the assessment is the assisted level of support, the pharmacist/dispensing GP will make recommendations on the types of support required. If the outcome of the assessment is the managed level of support, the community pharmacist will make a referral to the GP practice for two additional parts to the assessment (see below). Part 2 assessment for managed support Following the initial assessment by the community pharmacist, a referral will be made to the

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person’s GP practice for two further parts of the assessment. Responsibility is divided between the primary care clinical pharmacist/prescribing support pharmacist and the person’s GP. The pharmacists involved in these assessments work across a number of GP practices to support prescribing/medicines management. Their wider jobs differ between the operational units and this is reflected in their job titles: primary care clinical pharmacists in North & West Highland and prescribing support pharmacists in South & Mid Highland. In order to support the referral process, community pharmacists will be informed of the contact details for their local primary care clinical pharmacists/prescribing support pharmacists. These assessments should take place within two weeks of a referral being made by the community pharmacist to the GP practice (in exceptional circumstances, eg, sick leave, it may take longer). It involves two parts: (i) Polypharmacy review and medicines assessment – primary care clinical pharmacist/

prescribing support pharmacist

Part of the assessment for managed support is a medication review. This is to ensure that the medicines being entered on the MAR chart (an essential component of managed support) are accurate and appropriate. This part of the assessment should be carried out by the primary care clinical pharmacist/prescribing support pharmacist who usually works with the GP practice. An NHS Highland polypharmacy review should be conducted. This involves: A) Assessing each prescribed medicine to determine:

1. That each medicine has a current and valid indication. 2. That there is no duplication of therapy. 3. That the patient is taking the medicine. 4. What the desired clinical outcome of each medicine is. 5. The consequences of stopping the medicine. 6. An estimate of the time necessary to realise the desired clinical outcome of a medicine,

particularly for secondary prevention strategies. 7. An estimation of the risk:benefit ratio of the medicine, taking into consideration the

number needed to treat versus the number needed to harm data. B) For medicines to be continued, considering:

1. Is the medicine being prescribed in a form most appropriate to the needs of the patient? 2. Is the medicine being prescribed in the least burdensome dosage regimen? Has the

dose been optimised? 3. Is a more cost-effective alternative available and suitable for the patient?

In addition, the pharmacist should ensure that the medicines are in the best format for administration by a carer (considering frequency of visits, synchronising quantities etc). This assessment is supported by the form in Appendix 3. (ii) Certificate of Incapacity – GP

In order to receive managed support, people must have a Certificate of Incapacity (under section 47 of the Adults with Incapacity Scotland Act 2000) in place. This certificate need only relate to their incapacity to make decisions about their medicines: it is possible for a person to retain capacity with respect to other aspects of their medical treatment but have a Certificate of Incapacity specifically for medicines. Since doctors are the only profession that can sign a Certificate of Incapacity in relation to the general treatment of a patient (ie, not a specialist aspect of care), this aspect of the assessment of people for Care at Home managed support will be made by GPs (or hospital doctor if the person is in hospital). The completed certificate should be retained by the GP practice and a copy sent to the Care at Home service to be retained in the Service User





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Pack. Further information is provided in the form in Appendix 3. Assessment in hospital Assessments can take place for hospital in-patients. Such assessments are often essential to enable a safe discharge following a change in a person’s functioning. However, hospital in-patients can be acutely unwell and therefore it is difficult to get an accurate picture of a person’s ability to cope with medicines in the longer term in his/her own home. Therefore, it may be more appropriate to undertake an interim assessment and refer the person to a community pharmacist for a follow-up assessment. This ties in with the Care at Home service’s process of reviewing people within four weeks of discharge from hospital. An interim assessment form is provided in Appendix 4. Interim arrangements in primary care Although assessments in primary care should usually follow the standard approach described above, it is recognised that sometimes an interim arrangement will need to be put in place. For example, a person may be waiting for a care package to start and therefore the Care at Home service cannot support the person for a few weeks. In these circumstances, it would be appropriate for the community pharmacist to consider whether any interim arrangements may be useful. An example would be providing a monitored dosage system that a family member or friend could use to administer medicines until a Care at Home managed support package could start. Health professional support For assessment of health professional input, the person should be referred to the relevant health professional (usually a community nurse). A list of health professional input tasks is given in section 7. The person may additionally require managed support for other medicines from a Care at Home worker in which case a managed support assessment should be completed. 4.3 Outcome of initial assessment Once the initial assessment has been completed, the assessor (community pharmacist) must complete the Medicines Needs Assessment Report form (see Appendix 5) or otherwise provide the information stated on the form in writing (eg, by email/by phone/in person). The form ideally should be filled in electronically and a copy should be emailed (or printed and posted) to the following people, as appropriate:

NHS Highland Health and Social Care Co-ordinator (if Care at Home support is required) Person’s GP (if a managed support assessment is required and for information) Primary care clinical pharmacist/prescribing support pharmacist who works with the

person’s GP practice (if a managed support assessment is required) Community nursing team (if health professional input is required)

Consent for information sharing should be gained as part of the assessment (as stated on assessment form). In addition, the person assessed should be given an information leaflet providing information about medicines, compliance aids and Care at Home support. The Health and Social Care Co-ordinator in each District is the single point of access for arranging services. The Health and Social Care Co-ordinator will provide a copy of the Medicines Needs Assessment Form to the Care at Home Officer who will organise the Care at Home support. It is not the community pharmacist’s or GP practice’s responsibility to arrange care: any queries





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relating to the delivery of services should be directed to the Health and Social Care Co-ordinator. On receipt of a Medicines Needs Assessment Report form, the following actions are required:

Care at Home service (from the Health and Social Care Co-ordinator): place a copy of the report in person’s Service User Pack kept in their home and a copy in the Service User’s office file. The service agreement should be added to Care First. This ensures all staff are aware of the support required. In addition, the medication record that is part of the Service User Pack should be completed with the information from the assessment.

GP practice: flag the patient’s record in GP system (eg, Vision) to state the level of support required. Ensure this entry is picked up in the Key Information Summary.

Community nursing: place copy in community nursing record. Community pharmacists should also flag the patient’s record in the pharmacy computer system to state the level of support required. 4.4 Review People should be reviewed at least annually by the community pharmacist (or dispensing doctor) to ensure the level of support is still appropriate. Reviews should be carried out earlier if anyone involved in the person’s care is concerned that the person needs a different level of support, for example, if the person stopped taking medicines, was experiencing side effects or there was a change in the person’s health/symptoms.





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4.5 Flowchart summarising assessment process

Person has problem(s) with medicines. Identification of need by: Care at Home staff, community nurse, GP, community pharmacist (list not exclusive)

Refer to community pharmacist who completes compliance needs assessment

No formal support

Assisted support

Managed support Health professional input

Pharmacist provides advice to improve

compliance

Care at Home service records outcome on patient’s home record

(Service User pack), Care First record and other as appropriate

GP practice to flag patient’s record

(Vision and KIS) with support level

Community pharmacy to flag patient’s record

with support level

Complete medicines needs assessment report form and send copy to:

Health & Social Care Co-ordinator, GP, pharmacist

Managed support - refer to GP practice:

(i) Primary care/prescribing support pharmacist does medication review

(ii) GP does capacity assessment

Refer to appropriate

health professional (eg, nurse)

Assessor to provide person with an information leaflet about medicines management

and the Care at Home service

Health professional (eg, nurse) record

on eg, nursing record





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5 ASSISTED SUPPORT People who need Care at Home assisted support retain responsibility for the management of their medicines. This is the defining difference between assisted and managed support: in assisted support, the person has the capacity to make decisions about medicines but lacks the physical capability to self-manage. In managed support, the person does not have the capacity to make decisions about medicines. Assisted support can only be provided by Care at Home staff who have received appropriate training (see section 11 on training). 5.1 Types of support The type of support provided will depend on the individual person’s needs. Within the assisted level of support, the Care at Home worker’s role is to provide assistance, not take any decision-making responsibility. The types of support that are included in assisted support are:

Ordering and collecting repeat prescriptions from GP practices. The person must be able to tell the Care at Home worker what medicines need to be ordered.

Collecting medicines from a pharmacy/dispensing practice and delivering to the person but only when there is no other means to support this, eg, a family member who can help or a pharmacy providing a delivery service.

Reading labels on medicines.

Prompting people to take medicines.

Under the person’s direction: opening medicines packaging (such as medicines bottles) and removing tablets/capsules from blister strips or pharmacy-dispensed compliance aids. Then giving the medicine to the person to take (rather than administering it). If a person needs the medicine to be placed into the mouth, this can only be done if there is a clear instruction from the person and it is stated in the Service User’s pack: the person must always retain control. Any observed variations from this practice or concerns about it should be reported by the Care at Home worker to his/her line manager and recorded in the team communication record.

Measuring liquids, when the person can instruct the Care at Home worker on how much to measure.

Assisting with the application of a prescribed medicine (eg, a cream, eye drop, ear drop or nasal spray) where the person can instruct the Care at Home worker on the application of the medicine but cannot physically apply it him/herself. This must be agreed with the Care at Home officer because application of some medicines is not included in this level of support (because they require specialist/nursing skills or because they involve intimate application). Therefore, Care at Home workers can only apply medicines listed in the service user’s file by the Care at Home officer. If a person requests assistance with applying non-prescribed medicine (eg, a purchased cream), this must be confirmed as safe by the Care at Home officer (eg, by checking with a community pharmacist) and recorded in the service user file before assistance is provided. The Care at Home worker must be trained in how to apply medicines.

Returning unwanted medicines to a pharmacy for safe disposal.

Purchasing over the counter medicines at the request of the person. Purchases should only normally be made at the person’s regular pharmacy where the person’s repeat medicines are dispensed, and always be checked by the person’s regular pharmacist, to ensure any purchases are safe (eg, checking for interactions against the person’s pharmacy medication record). In remote areas without a pharmacy, advice should be sought from the person’s GP before purchasing medicines from a retail outlet (eg, a village shop).





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Care at Home staff should take a means of identification (eg, badge or letter) for use at the GP practice or pharmacy when ordering or collecting prescriptions/medicines. The person retains responsibility for his/her medicines. This includes ensuring the correct medicines have been ordered, requesting medicines are collected, deciding which medicines should be taken and when they should be taken, and storing medicines safely. 5.2 Record keeping The support that an individual person needs must be listed in the Service User Pack kept in the person’s home. This must detail the exact tasks required and must be signed by the patient/person holding Power of Attorney to form a contract (see Appendix 6). It is particularly important that specific details relating to any assistance with medicines taking are specified (for example: person needs medicine to be removed from packaging and placed into hand to be taken). Additional tasks must not be undertaken without referring to a Care at Home officer. The Service User Pack should include a record of the medicines the person is taking, for example the repeat prescription slip that is usually provided when a repeat medicine is ordered from a GP practice. Although the Care at Home service is not responsible for making decisions about the person’s medicines, the Care at Home worker should be aware of the medicines the person is prescribed. This helps in the worker’s general duty of care towards the person, for example, noticing if the person is not taking medicines or having problems with medicines such as side effects. The Care at Home worker should record the support provided each time. This should be recorded as follows:

Ordering and collection of medicines: list the names of drugs ordered/collected in the team communication record

Prompting to take medicines: in the team communication record Opening medicines packaging: in the team communication record Assistance in applying a medicine: record details on specific medicines use assistance form

(see Appendix 7). Briefly note in team communication record that assistance has been provided but record the details on the medicines use assistance form (eg, “assistance provided, see assistance form”).

Returning medicines to a pharmacy: on a medicines disposal form (see Appendix 8). The record must be specific. For example: “Prompted person to take their medicines at 9am.” However, there is no need to record which medicines were prompted or ordered within assisted support because the person is responsible for decisions about his/her (including which medicines need to be ordered). When more than one Care at Home worker is involved in a person’s care, they should all check the team communication record and forms in the Service User Pack before carrying out any tasks. This ensures tasks are not repeated unnecessarily. 5.3 Monitored dosage systems Monitored dosage systems – sometimes referred to as Dosette boxes or blister packs – are a form of medicines compliance aid. Some people receiving assisted support may have a monitored dosage system. A pharmacist or dispensing GP will have assessed a person for suitability for a monitored dosage system as part of the medicines needs assessment. Care at Home workers must only assist people with monitored dosage systems that have been





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prepared by a pharmacy or dispensing practice. They must never assist a person with a box that has been prepared by a family member, friend or the person themselves (this should be communicated with family members/friends when appropriate). In addition, Care at Home workers must never fill a box. The reason for this restriction is because there are a number of safety concerns with the preparation of these boxes:

Not all medicines are appropriate for use in a monitored dosage system. For example, liquids or medicines that are sensitive to moisture.

The effectiveness of a medicine is no longer guaranteed under the product licence when it is removed from its original packaging. This makes the medicine “unlicensed” and means that all involved in its prescribing, dispensing and administration assume a greater responsibility for the person’s response to the medicine than if it had been supplied in its original packaging.

Only professionals with appropriate training can safely dispense a monitored dosage system.

Monitored dosage systems may be useful in the following situations:

A person has difficulty accessing medication from original packaging (but note that MDS may present similar difficulties)

A person has difficulty following a medication regime due to factors such as: o Complexity of the regime as a result of the number of medicines to be taken and/or

the frequency that medicines have to be taken o Sight impairment o Confusion o Some situations of forgetfulness o Learning difficulties

Monitored dosage systems are inappropriate when:

They are being provided solely for the benefit of a formal/employed carer. People are no longer capable of making decisions about medicines (ie, assessed as

requiring managed support). People display intentional non-adherence to medicines or poor motivation. People have difficulty opening a monitored dosage system because of mechanical

difficulties or cognitive impairment. People have frequent changes of medicines.

Further details are available in the “Policy on the use of monitored dosage systems in NHS Highland” (see: Policy on the Use of MDS in NHS Highland). 5.4 New technology – telecare systems Telecare is another form of “prompting” offered by the Care at Home service. It involves a monitored dosage system with an audible alarm that prompts the person to take medicines. Community pharmacists should assess whether a telecare system is an appropriate form of support: this should cover the concerns described above for all monitored dosage systems, plus considering whether the person could cope with a telecare system (ie, being able to turn the system over to stop the alarm and then remove the medicines). If a person is identified as suitable for a telecare system, s/he should be referred to the Care at Home service to arrange this. 5.5 Raising concerns If the Care at Home worker suspects that a person is not taking his/her medicines as prescribed, this should initially be discussed with the person. If the problems cannot be addressed, then the Care at Home worker should raise the concern with a Care at Home officer. The Care at Home officer should consider referring the person to their community pharmacist for a re-assessment.

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6 MANAGED SUPPORT People who need Care at Home managed support are unable to manage their own medicine(s) and do not have the capacity to make decisions about medicine(s). Therefore, the Care at Home worker is responsible for making these decisions and ensuring the person receives medicines as prescribed. Managed support can only be provided by Care at Home staff who have had appropriate training (see section on training). 6.1 Types of support The type of support provided will depend on the individual person’s needs. It is possible that a person requires managed support for only some of his/her medicines. For example, a person may be capable of managing an inhaler for relieving shortness of breath so this may be a self-managed medicine. But the same person cannot manage any of his/her tablets so, for these medicines, managed support is required. The types of support that are included in managed support are:

Ordering and collecting repeat prescriptions from GP practices. The decision to order the medicines is made by the Care at Home worker and should only be the medicines listed on the person’s medication chart.

Collecting medicines from a pharmacy/dispensing practice and delivering to the person’s home. Although many pharmacies offer a delivery service, this may not be appropriate for someone requiring managed support (ie, not able to take responsibilities for own medicines).

Administering medicines. This involves the Care at Home worker identifying the medicine that needs to be administered from the person’s medication administration record (MAR) chart, selecting the correct medicine from its original packaging and administering the medicine to the person.

Applying medicines (eg, a cream, eye drop, ear drop or nasal spray) when listed on the MAR chart. Any administration must be agreed with the Care at Home officer because some medicines require specialist skill to apply or involve intimate application and therefore are not included in managed support.

Returning unwanted medicines to a pharmacy/dispensing practice for safe disposal. Care at Home staff should take a means of identification (eg, badge or letter) for use at the GP practice or pharmacy when ordering or collecting prescriptions/medicines. 6.2 Record keeping The support that an individual person needs must be listed in the Service User Pack kept in the person’s home (see Appendix 6). This must detail the exact tasks required. This list forms the contract for the service delivered and must be signed by the person or, if incapable, a representative (eg, with Power of Attorney). For all managed support tasks, a Certificate of Incapacity (see section 4.2) must be in place: Care at Home workers cannot administer medicines without this certificate. Additional tasks must not be undertaken without referring to a Care at Home officer. The Service User Pack should include a MAR chart provided by the person’s community pharmacy/dispensing GP (see Appendix 9/10). Medicines can only be administered using this chart (see section 6.3).





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The Care at Home worker should record the support provided each time. This should be recorded as follows:

Ordering and collection of medicines: the names of medicines ordered/collected should be recorded in the team communication record

Administration of medicines: record on the MAR chart (see Appendix 9-10) Returning medicines to a pharmacy: on a specific medicines disposal form (see Appendix

8) When more than one Care at Home worker is involved in a person’s care, they should all check the daily communication record and forms in the Service User Pack before carrying out any tasks. This ensures tasks are not repeated unnecessarily. 6.3 Medication administration record (MAR) chart Administration of medicines within the managed support service requires an accurate MAR chart. It is the responsibility of the person’s community pharmacist to produce the MAR chart. In geographical areas with no community pharmacy, it is the responsibility of dispensing practices to produce MAR charts. Community pharmacies should produce MAR charts from their pharmacy computer system. An example of a pharmacy system-generated MAR charts is provided in Appendix 9. They must state the name of the pharmacy/dispensing practice. If a dispensing doctor/pharmacy’s computer system does not have the functionality to produce a MAR chart, it can instead produce a medication chart using a template Word document provided in Appendix 10. If this Word template is used, dispensing practices should computer-generate rather than hand-write the chart to ensure clarity. Retaining a saved copy of the Word document for each person receiving managed support means that charts can be updated easily and printed each time medicines are dispensed. Once a person has been assessed as needing managed support, the assessing primary care clinical pharmacist/prescribing support pharmacist should send a copy of the person’s prescribed medicines to the person’s community pharmacy for entry onto a MAR chart. It is vitally important that MAR charts are kept up to date. Every time the community pharmacy/dispensing practice dispenses repeat medicines for a person receiving managed support, a new MAR chart should be provided with the medicines. Charts must be dated with the date on which they were produced. A copy of all charts issued should be retained by the community pharmacy/dispensing practice: old copies should be appropriately annotated to identify them as out of date. Completed charts should be removed by the Care at Home service and retained by the Care at Home Officer. The possibility of community pharmacists/dispensing practices uploading the person’s current MAR chart into SCI-store is currently being explored. This would enable MAR charts to be downloaded by GPs, hospital teams and Care at Home officers (with appropriate permissions/passwords) to improve information sharing about the medicines the person is currently receiving (eg, on admission to hospital). This is still under review (October 2014). Changes to MAR charts When a change to a person’s medicines is made (eg, a dose adjustment, stopping or starting a medicine), a new MAR chart must be produced. Care at Home staff cannot administer medicines that are not listed on the chart or at different doses to those specified on the MAR chart. It is the responsibility of the prescriber changing the medicine to ensure that the community pharmacist has been alerted to the change so that the pharmacist can produce a new MAR chart.





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This could involve issuing a new prescription to the community pharmacist or, if a medicine has been stopped and needs to be removed from the MAR chart, contacting the pharmacy by phone or email. It is the community pharmacist’s responsibility to update the MAR chart and provide it to the carer by the time the next dose of medicine is due. If this is not possible, an emergency procedures form must be filled out (see section on emergency procedures). Alternatively, if the change is at a home visit, the prescriber can amend the person’s existing MAR chart by hand and sign/date the change. A new printed chart will be provided at the next dispensing of repeat medicines on receipt of the updated prescription by the community pharmacy/dispensing GP. When a new chart is provided, the Care at Home worker should ensure that the old chart is removed. If neither of these options is possible (for example, the consultation takes place out of hours away from the person’s home) then the emergency procedure should be followed (see section on emergency procedures). Emergency changes to MAR charts The following emergency procedure covers situations when an updated MAR chart cannot be provided for up to 72 hours. It enables the Care at Home worker to administer medicines during those 72 hours until a new MAR chart can be provided. The emergency procedure requires an “emergency procedures form” (see Appendix 11) to be filled out. The form has spaces to provide all the information required about the new/amended medicine. Adding other forms of notes (eg, post-it notes) is not permitted. The emergency procedures form can be filled out by either the prescriber (if the prescriber is at the person’s home) or by the Care at Homer worker acting on the written instruction of the prescriber. The prescriber can provide the written instructions on paper or by email. This instruction should state the details of a medicine started, amended or stopped (including name, strength, dose, timing, duration of treatment, indication). This written instruction may take the form of a prescription if a new prescription is issued. If a written instruction is not possible, the emergency procedures form can be used by the Care at Home worker to record any verbal instructions to change medicines. Verbal communication (eg, by telephone) carries a greater risk of error than written communication and therefore verbal communication should only be used in exceptional circumstances. Verbal requests cannot be made for Controlled Drugs: it is the prescriber’s responsibility to ensure that verbal requests are not made for Controlled Drugs. If a prescriber makes a verbal request to change or add a medicine, the Care at Home worker should:

Fill out the information on the emergency procedures form (eg, prescriber details, date and time of request, medication details). See form in Appendix 11 for full details.

Read back the information given to confirm it is correct, including spelling out the name of the medicine to be administered.

Ensure that the medicine strength, dose, number of units and time of administration has been recorded.

The emergency procedures form should be dated and signed by the person completing the form, stating the name of the prescriber. If that person is a Care at Home worker taking a verbal request (see above), then the prescriber who has requested the change should confirm this instruction in writing within 72 hours (eg, by email). The person’s community pharmacy should also be informed by the Care at Home officer/worker so that arrangements can be made for the pharmacy to supply an updated MAR chart. In the interim period until the written instruction is supplied, the old MAR chart can be amended by the Care at Home worker and kept with a copy of the emergency procedures form detailing the change. The Care at Home worker must ensure that the emergency procedures form is removed once an updated MAR chart is obtained.





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Emergency procedure forms are kept in the Care at Home Service User pack, at Primary Care Emergency Centres and in hospital pharmacies. If a Care at Home worker is told by the person or a family member/other carer that a medicine has been changed and there has been no change to the MAR chart or an emergency procedures form, or if the Care at Home worker thinks the MAR chart is wrong for any other reason, then the person’s community pharmacy should be contacted. 6.4 Administration of medicines Medicines can only be administered by Care at Home workers exactly as stated on the person’s MAR chart (see section on MAR charts). This chart should be retained in the Service User Pack. The following procedure should be followed on every occasion that medicine is administered:

1. Check the name on the medicine container is that of the person. 2. Check the following details on the medicine label against the person’s medication chart:

The name and strength of the medicine. The time of administration. The dose to be administered. Any other specific instructions, such as timing of administration in relation to meals.

If a specific time is required, this should be stated clearly so that care can be arranged around these times.

3. It is good practice to check that the drug details on the box itself (ie, in addition to the dispensing medicine label) matches the medicine label. This will have been checked by the community pharmacy/dispensing practice that dispensed the medicine.

4. If there is any discrepancy between the chart and the medicine label, or if the Care at Home worker is unsure about any aspect of giving the medicines, the Care at Home worker should contact a Care at Home Officer or person’s primary care professional (pharmacist or GP, or NHS 24 if out of hours).

5. Check the expiry date of the medicine. If no expiry date is available, check that the medicine is within six months of date of dispensing.

6. Check the person’s medication administration record to ensure the medicine has not already been given. Where appropriate, double check with the person that he/she have not already received the medicine.

The Care at Home worker should then ask the person if he/she wants to take his/her medicines. If the answer is yes, the Care at Home worker should:

1. Explain the procedure to the person to ensure he/she knows what to expect and what to do. 2. Ensure good hygiene by washing hands before and after administering medicines and by

keeping everything as clean as possible. 3. Help the person into a comfortable upright position. 4. In order to avoid handling the medicine, the appropriate numbers of tablets or capsules

should be tipped into the lid of the container and then placed into a clean medicine cup or the person’s hand. In the case of foil wrapped medicines, the appropriate dose can be pressed out or torn out of the wrapping into a clean medicine cup or the person’s hand.

5. The Care at Home worker should encourage the person to take the tablet/capsule with approximately half a tumbler of water to ensure that the medicine is washed down into the person’s stomach.

6. For soluble tablets, the dose should be measured out from its original container as previously described, but it should then be placed in half a tumbler of water and allowed to dissolve before giving to the person to drink. If the person wishes, a cold drink may be taken afterwards.

7. For buccal tablets (ie, tablets from which the medication is absorbed through the lining of





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the mouth) the tablet should be placed high up between the upper lip and the gums to either side of the front teeth, where it will soften and adhere to the gum. For people who wear dentures, the tablet should be placed in any comfortable position between the lip and the gum.

8. For sublingual tablets (ie, tablets to be placed under the tongue) the tablet should be placed under the tongue and left to dissolve.

9. For liquid medicines, first shake the bottle, then measure the appropriate dose into a clean 5ml spoon, medicine measure or oral syringe. When pouring the medicine, tip the bottle with the instruction label facing upwards so that if any of the medicine dribbles down the bottle it will not mark the instruction label. Give the measured dose to the person to take. Unless it is inappropriate for the particular medicine (eg, indigestion remedy, cough linctus), a cold drink may be taken after if the person wishes. Wipe the neck of the bottle and any liquid which may have dribbled down the side of the bottle with a clean tissue prior to replacing the lid.

10. If the person appears to have consumed alcohol, check the label of the medicine to see if there is a warning statement about alcohol. If it is a stated issue, contact the person’s GP or pharmacist for advice (or NHS24 out of hours). Also check the person’s care plan for any planned action/advice.

11. Tablets/capsules should not be split or crushed unless this has been confirmed to be safe with a pharmacist.

12. Complete the person’s medication administration record (MAR) chart. See section below. If a person is being taken out for a day (eg, by a family member) and requires medicines during this time, arrangements should be made with the family and member and the details recorded on the MAR chart. 6.5 Documentation on MAR chart by Care at Home worker

It is the responsibility of the Care at Home worker to record all medicines administered on the MAR chart. The MAR chart must be filled out at the time at which the medicines are administered when administration has taken place. All actions must be recorded including the date and time at which it took place. Any problems encountered with administration must also be recorded on the MAR chart, with additional details on the reverse of the chart if further space is needed. This includes the date, problem, actions taken and the outcome. It is the responsibility of the Care at Home officer to ensure that old MAR charts are removed monthly and stored in the Service User’s file. If a dispensing practice cannot provide a printed MAR chart and a Word medication chart is being used instead, it is the responsibility of the Care at Home officer to supply blank MAR charts to record the medicines being administered. 6.6 When required medicines Some medicines are only required on a “when required” rather than regular basis. Examples include pain killers and laxatives. This presents a particular problem for people assessed as needing managed support given that it is defined as not having the capacity to manage their own medicines. However, some people while not being able to be responsible for their medicines overall may still be able to indicate if they need a “when required” medicine. In these situations, it is more appropriate to allow the prescribing of “when required” medicines than to put such medicines onto a regular prescription.





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Care at Home workers cannot be responsible for deciding whether or not a person needs a “when required” medicine or what dose of a “when required” medicine is needed. Therefore, to ensure safe provision of “when required” medicines, the following guidance is recommended:

If a person is receiving managed support, the GP should consider whether “when required” medicines are appropriate for that individual.

When prescribing a “when required” medicine, the GP must state: the maximum single dose, the dose interval, the maximum number of doses per day/week and the indication/criteria for giving the medicine on the prescription.

When the initial assessment is made for managed support, the primary care clinical pharmacist/prescribing support pharmacist should consider whether any existing “when required” medicines are appropriate to continue. For any that are to be continued, the primary care clinical pharmacist/prescribing support pharmacist should fill out a When Required Medicines form (see Appendix 12) as part of the initial assessment. This form acts as a direct instruction from the prescriber. If the prescribing information is not clear, the pharmacist should seek clarification from the GP.

The Care at Home worker must not give the medicine more frequently or at a higher dose than stated on the form.

The form also states the criteria/indication for the medicine to be given. This may range from “at the patient’s request only” to “when the patient has leg pain”. These criteria must be specific because the Care at Home worker is not responsible for making a decision on whether a medicine is needed or the dose to be given: he or she will follow the criteria stated by the prescriber.

If the primary care clinical/prescribing support pharmacist and/or GP consider it to be appropriate, a single dose of a “when required” medicine can be left with the person to take at a time when the Care at Home worker is not there. If this is appropriate, it must be stated on the form. Any medicines left in this way should be recorded by the Care at Home worker in the team communication record and, at the next visit, the carer should check to see if the medicine has been taken.

At assisted support level, there is no problem with “when required” medicines because the person retains responsibility for making decisions about their medicines. 6.7 Warfarin Warfarin is a medicine that requires particular care to ensure the person receives the right dose at the right time. It is not usually appropriate to be prescribed for people requiring managed support from the Care at Home service. For people receiving managed support who are already prescribed warfarin or who develop an indication for oral anticoagulation, rivaroxaban should be considered as a first line option. For this group of patients who have their medicines administered by a Care at Home worker (which ensures the prescribed dose is administered), rivaroxaban is considered to be a safer option than warfarin because it avoids the need for INR monitoring and dose changes. People should be identified as part of the assessment process for managed support. If a prescriber considers rivaroxaban to be unsuitable and warfarin to be necessary, special arrangements must be made on a case by case basis to ensure safe prescribing of warfarin. This would include a system to ensure the MAR chart is updated with every dose change and also ensure continuous treatment (ie, no doses are missed nor the wrong strength administered): the details of how to achieve this will need to be agreed between the Care at Home worker, pharmacy and practice (this will depend on local arrangements for blood tests, communicating results etc). It should be noted that any complex dosing must be stated clearly on the person’s MAR chart (eg, particular clarity is needed when doses are different on different days of the week).





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6.8 Controlled Drugs Controlled Drugs can be administered by a Care at Home worker within the managed support service. This is because the Misuse of Drugs Regulations state that Controlled Drugs in schedules 2 to 5 can be administered to any patient by any person who is acting in accordance with the directions of a prescriber. In such circumstances, Controlled Drugs should be treated as any other prescribed medicine. 6.9 Refusal to take medicines Care at Home staff must not force a person to take a medicine against his/her will. Care at Home workers can encourage a person to take a medicine, for example by saying “Your medicines are there to help you” but this must not be done in a threatening manner. Under no circumstance should a Care at Home worker attempt to conceal a medicine (eg, in food or drink). This does not affect people for whom a specific request has been made to take a medicine with food (eg, in a spoon of jam in order to address swallowing difficulties, following health professional advice). If specific arrangements are needed, these should be clearly recorded in the person’s Service User Pack. If a person receiving managed support refuses to take his/her medicines, the Care at Home worker should:

Note on the medication administration record that medicines were refused, using the codes listed on the MAR chart.

Inform the Care at Home Officer as soon as possible (who will then contact the appropriate health professional, eg, ask a pharmacist/doctor for advice).

Place the refused medicine in an envelope marked “medicine for destruction” and write the number of tablets added and the date.

Store the envelope safely with the person’s medicines until it can be returned to the pharmacy for safe destruction.

6.10 Medicine sick day rules and dealing with illness In June 2013, NHS Highland started to distribute “medicine sick day rules” cards that highlight medicines that should be stopped when people are ill with sickness/diarrhoea because they can cause dehydration. The medicines included are:

Diuretics: can cause dehydration or make dehydration more likely in an ill patient. ACE inhibitors and angiotension II receptor blockers: in a dehydrated patient, these

medicines may impair renal function which could lead to renal failure. NSAIDs: when given to a dehydrated patient, these medicines may impair renal function

and this could result in renal failure. Metformin: dehydration increases the risk of lactic acidosis, a serious and potentially life-

threatening side effect of metformin. A card will be issued to all patients receiving one of these medicines. If a patient being supported by the Care at Home service is given a card by a pharmacist/GP, the Care at Home worker should place this in the person’s Service User file to ensure that a record is kept of the medicines that should be withheld from a person with sickness/diarrhoea. If a person is receiving assisted support, he or she will decide if a medicine should be temporarily stopped. If a person is receiving managed support, the carer should contact the person’s prescriber who will decide if the medicine should be temporarily stopped. Further information about this initiative is given in the NHS Highland Polypharmacy guideline, and advice is available on individuals from GPs and community pharmacists.





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It should also be noted that if a Care at Home worker notices a significant change in the person’s health/condition, advice should generally be sought from the person’s GP before administering medicines. Particular care should be taken when medicines have been recently started or stopped. 6.11 Involvement of family/informal carers The support that a person requires must be stated in the Service User Pack. In some instances, a family member or other informal carer may be supporting the person for some parts of the day, eg, at nights. If a medicine is due to be given during this time and the family member/informal carer is willing to be responsible for administering this medicine, this must be detailed in the Service User Pack. The record must make it clear which medicines the Care at Home service will administer and which medicines the family member/informal carer will administer. All medicines should be listed on the MAR chart to provide a complete record of medicines the person is taking. Family members/informal carers can be asked to sign the MAR chart when administering a dose of medicine but this would be by voluntary agreement. Care at Home workers should not record administrations on behalf of a family member/informal carer.





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7 HEALTH PROFESSIONAL INPUT The “health professional input” level of support involves administration of medicines that require specialist skills beyond those of a Care Worker’s training. These are typically invasive procedures. If a person is identified as requiring health professional input, he or she should be referred to the local community nursing team. The nursing team is responsible for delivering health professional input. It should be noted that many people who require health professional input for one or two medicines may well be taking other medicines for which they may be assessed as requiring assisted or managed support. The following tasks are always regarded as health professional input level:

Injections Removal of stitches Insertion of catheters Stoma care in the post-operative phase Testing for diabetes Administration of products where the initial needs assessment says a health professional

needs to be involved Administration of medicines which need skilled observations either before or after

administration (eg, taking a pulse), as indicated in the initial needs assessment The following tasks are normally considered health professional input level. In some circumstances these tasks may become managed support providing the Care at Home worker has undergone additional training and a written agreement between the health care professional, Care at Home Officer and person (or representative) is in place for the Care at Home worker to provide them. They include:

Insertion of pessaries Insertion of suppositories or microenemas Changing some types of dressings (eg, simple dry dressings)

A further list of tasks can be provided by Care at Home workers if they have had appropriate training. They may be classed as health professional input level if a Care at Home worker with additional training is not available:

Changing catheter leg bags where this not disturb the catheter Changing colostomy bags PEG (percutaneous gastrostromy) feeding where there is no disturbance to the catheter Administration of medicines via a PEG tube where specific written directions from the

prescriber are available Naso-gastric tube feeding Administration of medicines via a naso-gastric tube where specific written directions from

the prescriber are available





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8 STORAGE AND DISPOSAL OF MEDICINES 8.1 Safe storage of medicines It is generally recommended that medicines should be stored safely and securely, such as out of the reach of children. To ensure the quality of medicines, the following good practice guidance applies:

Medicines should be stored in a cool dry place (ie, not in bathrooms or kitchens) and out of direct sunlight.

Medicines should be stored in their original containers as dispensed from the pharmacy/dispensing practice; they should not be decanted into other containers.

The label of the medicine should be inspected for special storage instructions such as store in the fridge. Medicines stored in the fridge should be placed in a container (eg, plastic box) and kept separate from food and other consumables

All medicines in the person’s home should be stored in one place unless there are special instructions for storage. Creams and ointments should be stored in a separate container from other medicines.

To ensure the safety of the medicine, the following good practice guidance applies:

Medicines should be stored safely to ensure that they cannot be taken inappropriately by the person or any visitors to the house, particularly children. Consideration should be given to locking the medicines away if there is a risk of the person taking medicines inappropriately (eg, cognitive impairment).

Within the Care at Home managed support service, medicines should be stored in a sealed container labelled in a manner to inform relatives/friends not to administer medicines (unless part of the written agreement) without informing the Care at Home Staff and completing the agreed documentation.

The MAR chart should be stored in the person's care plan or alongside the medicines. If a person requires managed support for all medicines, the Care at Home worker should

remove any stocks of medicines no longer being used from the person’s house. This is to avoid any confusion and to ensure the person’s safety. If a person requires a mixed level of support (eg, managed support for one medicine and assisted support for another), then an assessment should be made on an individual basis as to whether medicines should be removed.

8.2 Disposal of medicines Unwanted or out of date medicines should be disposed of by taking them to the person’s regular community pharmacy/dispensing practice for safe disposal. Unwanted medicines should not be flushed down the toilet or put into domestic waste. The pharmacist/GP should consider whether unwanted medicines represent a compliance problem. If so, the pharmacist should take appropriate action to address the problem or contact the person’s GP to discuss the issue. A medicines disposal form should be completed (see Appendix 8). This form should be signed by the pharmacist on receipt of the unwanted medicines. The form should then be kept in the Service User pack. In addition, the Care at Home worker should alert the Care at Home Officer of the unwanted medicines.





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9 HOSPITAL ADMISSION A stay in hospital may result in a change in medication. Therefore, it is vitally important that people receiving Care at Home managed support are identified in hospital so that appropriate arrangements can be put in place for their ongoing care after discharge. 9.1 Admission People requiring managed support must be identified on admission to hospital. A question will be added to the admissions document to remind staff completing the admissions process to check if the person receives managed support. For planned hospital admissions, the Care at Home service should inform the hospital that the person requires managed support at the point of admission. For emergency admissions, the person/and or representative should be asked if the person receives managed support. If the person/representative does not know, this information can be found in the person’s Key Information Summary (KIS). KIS is a new system which is replacing the Emergency Care Summary. KIS includes free text fields which allow the phrase “Care at Home managed support” to be included in the “special patient notes” section. Once a requirement for managed support has been identified, it should be written clearly in the patient’s notes. When a person is admitted to hospital, the Care at Home worker should inform the person’s community pharmacist of the admission so that no further supplies of medicines are made during the admission period. In addition, this will alert the pharmacist to be prepared for a potential change of medicines on discharge. 9.2 Discharge It must be remembered that Care at Home workers can only administer medicines as stated on the MAR chart. Therefore, if someone has had a change in medication during a hospital stay, it is vitally important that the Care at Home worker is informed of this as part of the discharge process. If this does not happen, there is a danger of the wrong medication being administered. The discharge planning process should include a check to see whether a person requires managed support. This should have been identified during admission. If it has not been checked, this information can be found on the person’s Key Information Summary. It is planned for a question to appear in the IDL (immediate discharge letter) so that staff completing the person’s IDL will be prompted to check for managed support status. This change to the IDL should take place in 2015. If a change in medication has happened, this must be communicated via an IDL:

The IDL must be written and all sections authorised before the person is discharged from hospital.

The IDL must contain the details of all the medicines the person should be taking. Any changes in medicine (ie, details of all medicines started/stopped/amended) should be

recorded on the person’s IDL. A copy of the IDL should be sent to the SCI (Scottish Care Information) store. A copy is

also sent to the person’s GP and given to the person on discharge. The Care at Home service should alert the person’s community pharmacist that the person

has been discharged from hospital. This would usually be done by the Care at Home officer





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as part of the discharge planning process (notifying the pharmacist that a new MAR chart is needed). For shorter admissions, it may be the Care at Home worker who informs the pharmacist (in conjunction with the Care at Home officer).

Community pharmacists can view the IDL in SCI store and use this to amend the person’s MAR chart (chart produced by the pharmacy).

The community pharmacist will then give the Care at Home worker the amended MAR chart.

The community pharmacist’s role is to provide an updated MAR chart on the direction of the hospital prescriber. No medicines can be supplied by the community pharmacist because the IDL does not constitute a prescription: medicines will usually be supplied by the hospital on discharge, or a prescription issued (or arrangements for a prescription to be issued). By updating the MAR chart, the community pharmacist is enabling the medicines prescribed in hospital to be continued until the GP can review the patient’s IDL. If the GP decides to change any medicines, this should be communicated to the community pharmacist so a revised MAR chart can be produced: this would normally happen via the generation of a new prescription. Caldicott Guardian approval has been granted to allow community pharmacists to access the IDLs of patients for whom they provide Care at Home managed support. Community pharmacists can apply to NHS Highland Community Pharmacy Services for a user name and password to use SCI store: they are required to sign a user agreement specifying the access permitted and patient confidentiality requirements before access to SCI store is granted Out of hours discharges Ideally, planned discharges for people requiring managed support will ensure that this group of people are only discharged in normal working hours to allow MAR charts to be produced. If an out of hours discharge is necessary, the Care at Home worker must be supplied with a copy of the IDL which can be used as a written instruction to administer medicines until the person’s community pharmacy is open and can produce an updated MAR chart. An updated MAR chart should be obtained within 72 hours. The IDL should be provided on discharge.





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10 ERRORS AND INCIDENTS If a mistake is made during any aspect of assisting or administering medicines, the Care at Home staff involved should initially contact the Care at Home Officer who will decide on whether advice is needed from appropriate professionals, eg, the person’s GP or community pharmacist. In 2013, the Care at Home service will be able to record incidents on DATIX. In the short term, the existing manual recording system should be used for later recording on DATIX. Out of hours, it may be appropriate to seek advice from NHS24 depending on the nature of the problem.





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11 TRAINING AND EDUCATION All Care at Home staff must receive training in the management of medicines before starting to deliver any medicines-related care. They must adhere to the guidance in this policy and the training provided. Competence must be assessed as part of the training. Training is provided in three parts:

1. General training on the safe administration of medicines (applicable for all care settings) 2. Additional training on specific medicines (see section 11.2 below) 3. Training about delivery of care in the Care at Home setting

Training materials are available from the NHS Highland Practice Development Department. Following the initial training, Care at Home staff should undertake the “Administer medication to individuals” (HSC375) unit of the SVQ level 3 qualification. 11.1 General medicines management training All Care at Home workers must have received NHS Highland-recognised training on the safe administration of medicines and been deemed competent before administering any medicine. Full details of the training are available separately. The main points it covers (list not inclusive) are:

Basic information about the ordering, collection and storage of medicines Practical demonstrations on how to administer medication, including different forms and

types of medicines Disposal of unwanted medicines Common side effects of medicines Potential risk factors Record-keeping/documentation Dealing with problems, errors and incidents Basic information about the medical conditions commonly encountered Numeracy

Care at Home staff will be assessed on their knowledge of the content of these guidelines. Competence to administer medicines will be determined by observation and evaluation. 11.2 Types of medicines that require additional training When a Care at Home worker is involved in assisting a person to use a medicine or administering a medicine, the exact role that the Care at Home worker is expected to carry out must be specified in the Service User Pack. The Care at Home worker must have received appropriate training recognised by NHS Highland and been deemed competent to deliver the care listed in the Service User Pack. Some medicines require additional training. Induction level training (all Care at Home staff) Care at Home workers can assist with the following types of medicines when they have received appropriate NHS Highland-recognised training and been deemed competent:

Tablets and capsules Oral liquids Creams, ointments and lotions Eye drops and ointments Ear drops and ointments Nasal drops and ointments





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Skin patches Inhalation devices Mouthwashes

Advanced level training Care at Home workers can also assist with the following products when they have received appropriate NHS Highland-recognised training and been deemed competent:

Nebulisers Oxygen Changing catheter leg bags when this does not disturb the catheter Changing colostomy bags Changing simple dry dressings PEG (percutaneous gastrostromy) feeding where there is no disturbance to the catheter Administration of medicines via a PEG tube where specific written directions from the

prescriber are available Naso-gastric tube feeding Administration of medicines via a naso-gastric tube where specific written directions from

the prescriber are available Some types of medicines require a greater level of training. These medicines usually require a health care professional’s input and are regarded as the “health professional input” level of support. However, in some circumstances, specific training may be provided to a Care at Home workers to enable them to fulfil this role. Written agreement would also be required from the health care professional, Care at Home Officer and person (or representative) before a Care at Home worker could undertake any of these tasks. They include:

Insertion of pessaries Insertion of suppositories or microenemas Changing simple dressings

The following tasks are regarded as specialist input requiring a health care professional’s input:

Injections Removal of stitches Insertion of catheters Stoma care in post-operative phase Testing for diabetes Administration of products where the initial needs assessment says a health professional

needs to be involved (eg, some cytotoxic drugs) Administration of medicines which need skilled observations either before or after

administration (eg, taking a pulse), as indicated in the initial needs assessment 11.3 Education for NHS staff and contractors Educational support materials will also be made available for the following NHS staff and contractors: community pharmacists, GPs, practice staff, hospital staff and community nurses. Each pack will include a summary of the role of Care at Home workers plus details of the specific role for each professional group.

Appendix: Index of forms

1. Compliance Needs Assessment referral form 2. Compliance Needs Assessment 3. Care at Home managed support assessment (part 2) 4. Interim assessment form 5. Medicines needs assessment report form 6. Care at Home Service User pack specification of agreed tasks (contract) 7. Medicines assistance form 8. Medicines disposal form 9. Example MAR chart generated by pharmacy computer system 10. Paper based managed support medication chart 11. Emergency procedures form 12. When required medicines form

APPENDIX 1: COMPLIANCE NEEDS ASSESSMENT REFERRAL FORM

These are the details a community pharmacist/dispensing GP will require to complete a compliance needs assessment. The form can either be completed by the referrer, or the referral can be made by telephone and the pharmacist/dispensing GP can use this form to record the details. Referrals can be made by: nurses, GPs, hospital staff on discharge, social workers, Care at Home staff or the patient.

Patient name: DOB:

Address:

Telephone: CHI Number:

Lives alone- Yes / No (circle) House bound- Yes / No (circle)

Informal carer input (if applicable):

Relationship to patient: Telephone:

Contact address (if different from above):

Community pharmacy/dispensing practice:

Address:

Telephone number: FAX number:

Care at Home /other professional carer input (if applicable):

Designation: _____

Address:

Telephone: Visit frequency: daily or times per week (circle)

General practitioner:

Address:

Telephone number: FAX number:

Referral details

Patient referred by Contact number Date

Relevant Medical History: circle as appropriate

Stroke, arthritis, high blood pressure, cataract, glaucoma or history of falls/fractures

Other _________________________________________________________________________________

NHS Highland/National Compliance Needs Assessment Package

Multi-agency Referral Form

Current Medication:

If available please attach GP repeat medication slip/print-out and attach to this referral form. Alternatively, complete the table below including non-prescription medicines.

Name of medication Strength Form Dose Times of administration

Reason for assessment: Circle as appropriate

1. Is patient taking their medication as prescribed? Yes No

2. Does the patient understand why they are taking medication? Yes No

3. Patient has difficulty opening bottles/foil pack? Yes No

4. Patient has difficulties with ordering repeat medication? Yes No

5. Patient cannot read labels/ patient information leaflets Yes No

6. Is the patient confused or forgetful? Yes No

7. Other? Yes No

Comments

The pharmacist/dispensing GP assessor will contact patient/carer to arrange an appointment and will inform you of the result of the assessment.

NHS Highland

Compliance Needs Assessment

Section 1: General information

APPENDIX 2: NHS HIGHLAND STANDARD COMPLIANCE NEEDS ASSESSMENT TOOL

This form should be used by community pharmacists or dispensing GPs or hospital pharmacists/doctors when completing a medicines compliance needs assessment. This form is used for assessing people requiring any type of assistance required with medicines (ie, supported self management, Care at Home assisted support or Care at Home managed support).

Patient consent before the assessment: I understand the purpose of the assessment and agree to participate

Patient name Signature Date

Patient name

CHI GP

Patient address Initial assessment Y/N

Review Y/N

Number of regular medicines

Number of times per day medicines are taken

Can this frequency be reduced?

Number of “as required” medicines

Number of “as directed” medicines

Can instructions be added?

Is regimen stable? (eg, are any drugs being titrated?)

Are all drugs suitable for inclusion in an MDS?

Pharmacy/disp prac name Tel:

Assessor’s name Signed Date

Duration of assessment Location of assessment Source of referral MDS provided Y / N

Section 2: Medication details

Yes No Comments

1. Who orders repeat prescriptions?

2. Who collects repeat prescriptions?

3. Does your medication ever run out?

4. Can you tell me what your medication is for?

5. Can you tell me when you take your medicines?

6. Do you ever forget to take your medicines? (circle) Never frequently sometimes

7. Do you ever choose not to take your medicine? (circle)

Never frequently sometimes

8. Does anyone/thing help remind you to your medicines?

9. Can you open child resistant tops?

10. Can you open foil blisters?

11. Can you read the labels/ patient information leaflets?

12. Can you measure liquids? (if appropriate)

13. Can you use inhalers/eye drops? (if appropriate)

14. Can you swallow all of your medication?

Section 4: Compliance aid assessment

Have the following methods of improving compliance been tried?

Yes/no

Simplifying medication regime

Easier packaging

Large font labels

Memory aids (reminder charts, advice, new technology)

Support from carers/relatives

Weekly dispensing

Section 3: Ability to manage medicines

PLEASE NOW FILL OUT THE NEEDS ASSESSMENT REPORT FORM AND SEND TO PERSON’S GP/ NHS HIGHLAND DISTRICT HEALTH & SOCIAL CARE CO-ORDINATOR/CARE AT HOME SERVICE/COMMUNITY PHARMACY (DELETE AS APPROPRIATE)

The compliance assessment shows the patient requires: Tick as appropriate

A simpler medication regime (please be specific on how existing medicines can be simplified)

A memory aid (please specify, eg, reminder charts, advice, new technology)

Easier packaging (please specify, eg, non-click lock bottles)

Large font labels

Weekly dispensing in original packaging

Monitored dosage system

Care at Home assisted support (please tick): Ordering/collection of medicines Prompting to take medicines Assistance to take/use medicines (specify assistance)

Care at Home managed support Refer to GP practice for primary care clinical/prescribing support pharmacist to complete medicines assessment and GP for Adults with incapacity assessment

No further assistance

Community pharmacist/dispensing GP name and signature

Date

Date for follow up

Following a demonstration of an MDS: Yes/no

Do you find it easier to take the tablets out of the MDS than the packets you have now?

Do you know today’s date? Can you identify each dose in the MDS? (eg, ask patient to find Tuesday lunchtime hole)

Do you understand how to take medicines that cannot be put into the MDS?

Section 5: Ability to use an MDS (if appropriate)

Section 6: Community pharmacist/Dispensing GP recommendations

Patient consent after the assessment: I agree with the outcome and the assessment and agree for the outcome to be shared with other agencies (eg, GP, hospital, Care at Home service, carer, care home).


APPENDIX 3: NHS HIGHLAND CARE AT HOME MANAGED SUPPORT ASSESSMENT (PART 2)

Once a community pharmacist has assessed a patient as requiring managed support from the Care at Home service, the patient will be referred to the GP practice for two further assessments. This form supports those assessments: a primary care clinical pharmacist/prescribing support pharmacist will assess the medicines using the person’s medication record at the GP practice and a GP will assess the person’s capacity. Background – levels of support:

Assisted support (was “level 2”): patient requires physical assistance to take medicines. The patient has the capacity to make decisions about medicines although may be forgetful and require prompting.

Managed support (was “level 3”): patient is unable to manage medicines. The patient does not have the capacity to make decisions about medicines.

Health professional input (was “level 4”): the medicines to be administered require an additional (health professional) level of skill.

Patient name/CHI no

Consent Has the patient/representative consented to this assessment and agreed for information to be shared with the Care at Home service and other health professionals?

Yes No

Pharmacist name/signature

1: Primary care clinical pharmacist/prescribing support pharmacist: conduct polypharmacy review

Why? A polypharmacy review is needed to ensure all medicines remain safe and appropriate for the patient. In particular, consider that the patient may not have been taking medicines regularly so check these are safe to be re-started.

Points to consider Comment

Use existing NHS Highland polypharmacy assessment. Agree with GP if changes can be made or how outcomes should be communicated (eg, make recommendations to GP)

2: Primary care clinical pharmacist/prescribing support pharmacist: check medicines are prescribed in best format

Why? These checks are to ensure medicines can be administered safely by a carer.


Are all regular medicines listed on the patient’s repeat prescription?

Does each medicine have a direction for use (not “as directed”)?

Have the quantities of repeat medicines been synchronised for ordering every 28 days?

Can the frequency of medicines administration can be reduced to once or twice a day?

Are any “when required” medicines needed? If so, can the person decide when the medicine is needed or does the carer need special instructions? State on the “when required” medicines form.

Agree with GP if changes can be made or how outcomes should be communicated

3: GP: assessment of capacity (Adults with Incapacity certificate)

Why? For the Care at Home service to manage a patient’s medicines, a Certificate of Incapacity is required. This is specifically for the person’s capacity to make decisions about medicines; it is not an assessment of the patient’s capacity in general.


Does the person already have a Certificate of Incapacity? (under the Adults with Incapacity Scotland Act 2000, section 47)

In relation to the person’s ability to manage their medicines only, would they fit the criteria for a Certificate of Incapacity? For example: Does the person know what their medicines are

and what they are for? (simplistic terms, eg, one for the heart, is acceptable)

Does the person know when to take their medicines?

Does the person know how to take their medicines?

Does the person take their medicines? Note that forgetfulness may be addressed

through prompting (assisted level of support).

If a Certificate is needed, GP should fill out the one-page form (available at: AWI form) stating that the incapacity is: “incapacity to manage medicines”.

PLEASE COMMUNICATE THE OUTCOME OF THIS ASSESSMENT WITH:

NHS Highland District Health & Social care Co-ordinator who will arrange care with the Care at Home service.

Patient’s community pharmacy, so that medicines can be supplied. Please send the pharmacy an updated copy of the patient’s repeat medicines list.

Community nursing team (if health professional support is required). An assessment outcome form is available or please fax/email/phone this information.

http://www.scotland.gov.uk/Resource/Doc/254430/0086221.pdf

Section 1: General information

APPENDIX 4: NHS HIGHLAND COMPLIANCE NEEDS INTERIM ASSESSMENT This form should be used by hospital pharmacists/doctors when completing an interim medicines compliance needs assessment (or occasionally community pharmacists/dispensing GPs). This is to arrange interim support for up to 4 weeks until a full assessment can take place. A date for the full assessment must be specified.

Number of regular medicines

Number of times per day medicines are taken

Can this frequency be reduced?

Number of “as required” medicines

Number of “as directed” medicines

Can instructions be added?

Is regimen stable? (eg, are any drugs being titrated?)

Support level

Points to consider Specify support required

Supported self

Patient has the capacity and capability to self-manage medicines but requires some additional

Patient name

CHI GP

Patient address Review date (must be within 4 weeks)

Pharmacy/practice/hospital name Tel

Assessor’s name Signed Date

Duration of assessment Location of assessment Source of referral MDS provided Y / N

Patient consent before the assessment: I understand the purpose of the assessment and agree to participate


Section 2: Medication details

Section 3: Interim level of support required (for next 4 weeks)

management support for example: Simplifying medication regime Easier packaging Large font labels Memory aids (reminder charts, technology) Support from family/informal carers

(ordering/collecting medicines, opening packages, reading labels)

Weekly dispensing Monitored dosage system

Now either provide support or arrange with patient’s community pharmacist

Assisted support

Patient has the capacity to make decisions about medicines and retains responsibility for managing medicines (although may be forgetful). Requires physical assistance from the Care at Home service to take or use medicines, for example:

Ordering/collecting medicines

Reading labels

Prompting to take medicines

Assistance with opening packaging, measuring liquids, applying medicines

Now refer to District Health and Social Care Co-ordinator

Managed support

Patient does not have the capacity to make decisions about medicines and requires the Care at Home service to manage medicines. This involves:

Administration of medicines from original packs using a MAR chart

Now refer to District Health and Social Care Co-ordinator and contact community pharmacist to arrange MAR chart

Health professional support

Is support needed from the nursing team? Examples include: Injections Removal of stitches Insertion of catheters Stoma care in post-operative phase Testing for diabetes Administering medicines which need skilled

observations before/after administration Insertion of pessaries Insertion of suppositories or microenemas Changing of dressings Changing catheter/colostomy leg bags PEG (percutaneous gastrostromy) feeding

Naso-gastric tube feeding

Administration of medicines via PEG or naso-gastric tube

Seek advice from nurses caring for patient and refer to community nursing team

Patient consent after the assessment: I agree with the outcome and the assessment and agree for the outcome to be shared with other agencies (eg, GP, hospital, Care at Home service, carer, care home).


APPENDIX 5: NHS HIGHLAND MEDICINES NEEDS ASSESSMENT REPORT FORM This form should be used by the community pharmacist or dispensing doctor who has assessed a person for medicines compliance support to communicate the outcome with the NHS Highland District Health & Social Care Co-ordinator (to arrange care with the Care at Home service) and/or the primary care pharmacist/GP practice (to arrange a managed support assessment or for information if appropriate). Alternatively, the information on this form should be communicated by fax/email/phone.

Patient name Patient’s GP

Address

Patient referred for compliance needs assessment by (name and designation)

CHI

Dear (delete) Health & Social Care Co-ordinator/GP/primary care pharmacist/Other_____________ A. I have identified that the above patient referred to me for medicines needs assessment has the following problem(s). This will/ will not require any action from you please indicate if you agree to the proposed action and return to the pharmacy/dispensing practice.

Medicines issue Action taken or proposed action Agreement Y/N

B. I have been unable to identify/resolve the patient’s problems for the following reasons

Assessor details

Practice/pharmacy name: Address: Tel:

Assessor’s name/job title: Signed Date:

For GP/Pharmacy/Care at Home use (Action, File, Patient to attend etc)

PLEASE ENSURE THE FOLLOWING PEOPLE HAVE A COPY OF THIS FORM: GP / PHARMACY / HEALTH & SOCIAL CARE CO-ORDINATOR (IF APPLICABLE)

NHS Highland

Care at Home Needs Assessment Report

APPENDIX 6: CARE AT HOME SERVICE USER PACK SPECIFICATION OF AGREED TASKS (FORMING CONTRACT) Note that this form currently contains the old terminology of “level 1” which is no longer used, “level 2” which is now called “assisted support” and “level 3” which is now “managed support”. This will be updated.

APPENDIX 7: ASSISTANCE WITH MEDICINES USE FORM This form should be filled in by Care at Home workers to record any assistance with applying or using a medicine where the person is receiving the assisted level of support. The Care at Home worker is assisting a person to apply a medicine when the person can instruct the Care at Home worker but cannot physically apply it him/herself. It is vital that the person retains responsibility/capability for his/her medicines to fall within the assisted support criteria.

Patient Name CHI Date of form

Number enter no. on record below

Name of medicine Amount of medicine Frequency of use Assistance required (eg, how medicine should be applied)

1

2

3

Date Month/year

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Morning

Initial

Lunchtime

Initial

Afternoon

Initial

Evening

Initial

Date Month/year

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Morning

Initial

Lunchtime

Initial

Afternoon

Initial

Evening

Initial

APPENDIX 8: MEDICINES DISPOSAL FORM

I give permission for the following medicines to be removed from my house by my Care at Home worker for safe disposal at the local pharmacy:

Name of medicine Strength Form Approximate quantity (exact quantity for Controlled Drugs)

Name of Service user Signature of Service user or representative

Address Date medicines taken to pharmacy

Name of Care at Home worker disposing of medicines Signature of pharmacist/pharmacy staff receiving medicines

APPENDIX 9: EXAMPLE OF MAR CHART PRODUCED BY PHARMACY COMPUTER SYSTEMS

Name Doctor Pharmacy Pt number Address DoB Home

APPENDIX 10: MANAGED SUPPORT MEDICATION CHART This chart should be prepared by dispensing GPs/pharmacies only if a computer-system generated MAR chart is not available. Computer-generated charts (see Appendix 9) are preferred.

CLIENT NAME

CHI NUMBER

DATE

PAGE ..........OF..........

ADVERSE MEDICINE REACTIONS (IF KNOWN) CHART PREPARED BY (PHARMACIST/GP)

Medication Time Dose 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

[type information from dispensing label here]

MORN

NOON

TEA

BED

MORN

NOON

TEA

BED

MORN

NOON

TEA

BED

MORN

NOON

TEA

BED Initial in date box to state medication administered. Or use code: R=refused, S=sleeping, N=nausea, U=unwell, Q=not required, H=hospitalised, O=other

APPENDIX 11: EMERGENCY PROCEDURES FORM

EMERGENCY PROCEDURES FORM

MEDICATION TO BE ADMINISTERED

Code (for MAR chart)

Medication name, form and strength

Number of dose units to be given

Administration times Reason for giving/Special Instructions Breakfast Midday

meal Teatime Bedtime Other

times

X

Y

Z

ADDITIONAL INFORMATION

This form to be kept with and on top of the MAR Chart. It should be removed and retained by the Care at Home Officer when a revised MAR chart is provided

Client Name Address CHI number

Verbal information (if applicable) Received from Designation Date/Time

Form completed by Designation Date

APPENDIX 12: WHEN REQUIRED MEDICINES FORM FOR MANAGED SUPPORT SERVICE This form must be filled out by the primary care clinical pharmacist/prescribing support pharmacist for any “when required” medicines. Care at Home workers cannot be responsible for deciding whether or not a person needs a “when required” medicine: they can only administer “when required” medicines as stated on this form. This form is a direct transcription of the information the prescriber has stated on the prescription, therefore the Care at Home worker is following the prescriber’s direction.

CLIENT NAME

CHI NUMBER

DATE

PAGE ..........OF..........

1: Information about when required medicines that can be administered:

Name of medicine Maximum single dose

Doses per day/ dose interval

Reason for medicine Criteria for medicine to be given Single dose left to take later? Y/N

Name of prescriber Name of pharmacist Date

2: Record of when required medicines administered:

Medication Time Dose 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

[type information from dispensing label from two medicines stated above]

MORN

NOON

TEA

BED

MORN

NOON

TEA

BED Initial in date box to state medication administered.

NHS Highland Care at Home medicines management policy · 2016-12-05 · 6. Care at Home Service...

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Transcript of NHS Highland Care at Home medicines management policy · 2016-12-05 · 6. Care at Home Service...