Administering Medication Safely In The Domiciliary Care
Administering Medication Safely inthe Domiciliary Care SectorNovember 2018Joint East Riding of Yorkshire Council and NHS EastRiding of Yorkshire Clinical Commissioning Group Policy
AuthorshipJackie Lyon Medicines Clinical AdvisorApproved ByService Redesign and Commissioning CommitteeEast Riding of Yorkshire Clinical CommissioningGroupReview DateJune 2021Equality Impact AnalysisNo ImpactSustainability Impact AnalysisPositive impact – reduced wastageTarget AudienceHealth and Social CareDocument Reference NumberERY-CCG-55Version Number1The on-line version is the only version that is maintained. Any printed copies should,therefore, be viewed as ‘uncontrolled’ and as such may not necessarily contain the latestupdates and amendments.Administering Medication Safely in the Domiciliary Care Sector Policy [June 2018]2
AMENDMENTSAmendments to the policy may be issued from time to time. A new amendment history will beissued with each change.NewIssued Nature of AmendmentApproved Date onVersionbyby & Date InternetNumberAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]3
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CONTENTSSECTION 1 - POLICYPageINTRODUCTION8ENGAGEMENT8SCOPE9POLICY PURPOSE AND AIMS9DEFINITIONS9ROLES AND RESPONSIBILITIESService UserEast Riding Of Yorkshire Council Adult Services (CMT)East Riding Of Yorkshire Council Business Management AndCommissioning UnitDomiciliary Care Agency (Including Community Support Services)Domiciliary DCWs (Community Support Service And DCWs)General Practitioners(GPs)Dispensers (Including Community, Hospital And GP Dispensaries)Nursing Personnel10IMPLEMENTATION15TRAINING & AWARENESS15MONITORING & AUDIT16POLICY REVIEW16REFERENCES16ASSOCIATED DOCUMENTATION16IMPACT ANALYSESEqualitySustainability16BRIBERY ACT 201017Administering Medication Safely in the Domiciliary Care Sector Policy [June 2018]111111121314145
SECTION 2 - PROCEDURESASSESSMENTPROCESSMental Capacity and Best Interests Decision MakingAssessment Outcomes18191919PROVIDERS SUPPORT PLANTYPES OF SUPPORTGeneral Support for assisted self-medicationAdministration of MedicationAdministration of Medication by specialised techniques2020202021COVERT ADMINISTRATION22SECURE STORAGE22SUPPORT FOR PRESCRIBED MEDICATIONSSTORAGE IN THE SERVICE USER’S HOME22-252425CONTROLLED DRUGSSUPPORT FOR SELF CARE (NON -PRESCRIBED OR OVER THE COUNTERMEDICATION)ADMINISTERING AND RECORDING MEDICATIONCAPACITY AND MEDICINES ADMINISTRATIONDOMICILIARY MEDICATION ADMINISTRATION RECORD (domMAR)ADMINISTRATION PROCEDUREWhen required medication (PRN)Splitting/crushing of solid dosage formsLeaving out medication to take at a later 0DISPOSAL OF MEDICATION31-32HOSPITAL APPOINMENTS, ADMISSION AND DISCHARGEOUTPATIENT APPOINTMENTHOSPITAL ADMISSIONHOSPITAL DISCHARGE33-34333333TRAINING DOMICILIARY CARE WORKERS TO SAFELY ADMINISTERMEDICATIONERRORS AND UNTOWARD INCIDENTSTHE STATUTORY REQUIREMENTS FOR REPORTING MEDICATIONERRORSAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]3435-36356
REPORTING ADVERSE DRUG REACTIONS37MEDICATION FOR ADMINISTRATION BY HEATH CARE PROFESSIONALS(HCP)APPENDICIES37Medications Risk Assessment (including FULLERS tool) For Domiciliary CareProvidersDomMAR Request FormGuidance for handwriting a Medication Administration Record ChartManagement Of Patients Prescribed AnticoagulantsMedication Management in Independent Supported Living SchemesInhaled Medication in Domiciliary CareExample Incident Report FormAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]7
SECTION 1 - POLICYINTRODUCTION1.1.1The administration of medicines is a regulated activity under the Health and SocialCareAct 2008 (regulated activities) Regulations 2014. This policy should be used inconjunctionwith CQC guidance for providers on meeting the regulations (February ault/files/20150210 guidance for providers on meeting the regulations final 01.pdf1.2“Managing medicines for adults receiving social care in the community” (NG67,March 2017), a guideline published by National Institute for Health and CareExcellence (NICE), provides recommendations on helping people who have socialcare at home to manage their medicines. The advice is for people who providecare and support, such as Domiciliary DCWs, GPs, pharmacists and socialworkers, but it also contains important advice that people need to know about ifthey receive social care at home and might need support to use or look after theirmedicines.1.3The joint East Riding of Yorkshire Council (ERYC) and East Riding of YorkshireClinical Commissioning Group (ERY CCG)policy on Administering MedicationSafely in the Domiciliary Care Sector has been reviewed and updated to takeaccount of recommendations made in the NICE guideline22.1ENGAGEMENTThis policy has been developed with input from the following stakeholders: Adult Services East Riding of Yorkshire Council Business Management and Commissioning Unit East Riding of YorkshireCouncil Domiciliary Care Agencies Jackie Lyon Medicines Clinical Advisor East Riding of Yorkshire ClinicalCommissioning Group Julie Curran Medicines Optimisation Pharmacist North of EnglandCommissioning Support Antonio Ramirez Senior Principal Pharmacist (Interface) Hull and EastYorkshire Hospitals Trust The Humberside Group of Local Medical Committees Humber Local Pharmaceutical Committee (LPC) known as CommunityPharmacy HumberAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]8
3.3.13.2SCOPEThis Policy applies to all stakeholders involved in the safe administration ofmedicines to the residents of East Riding of Yorkshire. This includes DomiciliaryCare Providers, General Practitioner (GP) practices and Dispensers (CommunityPharmacies, Dispensing Practices, Acute and Mental Health Providers) who areinvolved in any aspect of medicine management in the delivery of care packagescommissioned by East Riding of Yorkshire Council (ERYC). This Policy does notapply to non-commissioned packages of care i.e. people funding their own care orreceiving personal budgets (unless these are commissioned by the Council).This policy applies to medicines prescribed for the service user and medicalappliances that are administered in the same way as medicines.3.3This policy cannot cover every possible situation that may arise. Where care staffhave any doubt about the action to take, the duty manager, a Health CareProfessional(HCP), and the person or a nominated person (e.g. next of kin),should always be consulted.4.4.1.POLICY PURPOSE & AIMSTo enable, promote and maximise service users’ independence safely. It isimportant that responsibility for managing a service user’s medicines is not takenaway from them unless an assessment indicates a need.4.2.To give clear guidance to HCPs and Domiciliary Care Agencies (DCA)commissioned to provide medicine support for adults receiving domiciliary careservices.4.3To ensure unified procedures are undertaken where medication is administered toERYC residents4.4To meet all legal requirements and the Good Practice Standards prescribed by theCare Quality Commission (CQC) and other relevant agencies.4.5To meet the recommendations published by NICE NG 67 “Managing medicinesfor adults receiving social care in the community”5DEFINITIONSAdministration of medicines One, all, or a combination of the DCA doing the following: deciding which medicine(s) have to be taken or applied and when this shouldbe done being responsible for selecting the medicines giving a person medicines to swallow, apply or inhale, where the personreceiving them does not have the capacity to know what the medicine is for oridentify it giving medicines (even at the request of the person receiving care) where adegree of skill is required to exercised by the DCW to ensure it is given in the correct wayCMTEast Riding of Yorkshire Council Adult ServicesCPCommunity PharmacistCQCCare Quality CommissionDCADomiciliary Care AgencyAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]9
DCWdomMARERYCERYCCGGPHCPNICEDomiciliary care workerDomiciliary Medication Administration RecordEast Riding of Yorkshire CouncilEast Riding of Yorkshire Clinical Commissioning GroupGeneral PractitionerHealth care professional, defined as a member of the medical, dental,pharmacy and nursing professions and any other persons who in thecourse of their professional activities may administer, prescribe,purchase, recommend or supply a medicineNational Institute of Health and Care Excellence6ROLES / RESPONSIBILITIES / DUTIESGOOD COMMUNICATION BETWEEN ALL STAKEHOLDERS IS KEY TO ENSURING POLICYIMPLEMENTATION, PROVISION OF HIGH QUALITY PATIENT CARE AND MINIMISED RISK6.16.1.1SERVICE USERThe level of responsibility for medication assumed by an individual service user willdepend on their ability to manage this aspect of their life.6.1.2The Medication Risk Assessment for Domiciliary Care Providers, which includesthe Fullers Self-Medication Risk Assessment tool, (Appendix 1) will identify thelevel of assistance required.6.1.3If assistance with medication is required then the service user must provide DCAwith access to the prescription, medicine and other relevant information and, ifthey have capacity, consent must be given to assist with medication.6.1.4If support is required for ordering repeat medications, and the DCA has beenidentified as giving that support, then consideration should be given to allow thecare agency to order medication on-line from the service user’s GP. This wouldrequire the service user to allow third party access to their patient record6.26.2.1EAST RIDING OF YORKSHIRE COUNCIL ADULT SERVICES (CMT)Adult services worker undertakes Adult Assessment in accordance with The CareAct 2014. If support with medication is identified as part of the assessmentprocess, Adult services worker to undertake the Medication Risk Assessment andFullers assessment (or agreed risk assessment).6.2.2Use this risk assessment to identify what support with medication the service userneeds. The score should guide the decision to the support required. It is importantthat responsibility for managing medicines is NOT taken away from the serviceuser unless the assessment indicates a need. Independence in taking medicationshould be supported where possible6.2.3Identify the appropriate type of support (defined in section 2 – 1.1.7) and recordsthis in the support plan.6.2.4Liaise with health care professionals as appropriate to confirm medicationrequirements, any allergies, special storage or administration details etc.Administering Medication Safely in the Domiciliary Care Sector Policy [June 2018]10
6.2.5Completes a domMAR Request Form and sends this to the GP, communitypharmacy and/or dispensing practice commissioned by ERY CCG to provide theMedicines Record Chart for Carers service (Service specification B1)6.2.6If a service user has been assessed as lacking the mental capacity to makedecisions around their care and support needs, then decisions need to be made inthe persons best interests. If the person does not have a legal representative (e.g.Lasting Power of Attorney, Health and Welfare Deputy) who is able to make healthand welfare decisions on their behalf, the Adult Services worker must ensure thatthe person has an advocate or other appropriate person to support them. The bestinterest decision around taking/ administering medication is made by a health careprofessional (e.g. GP) and must follow the statutory principles in the MentalCapacity Act (2005) Code of Practice.6.2.7CMT continues to hold responsibility for ensuring that care and support reviewsare conducted whenever there is a significant change in the service user’scircumstances. Where there is no change reviews must take place every 12months.6.3.EAST RIDING OF YORKSHIRE COUNCIL BUSINESS MANAGEMENT ANDCOMMISSIONING UNIT6.3.1.Ensures that regular audits are carried out to ensure that DCA are complying withthis policy6.3.2.Ensure regular checks are made to ensure that Domiciliary Care Agencies employonly DCWs with appropriate training if involved with medication support and thatrecords are up-to-date for this training and associated competency assessmentshave been completed6.3.3.Ensures that the agreed and documented level of assistance is provided to theservice user on a day to day basis.6.4.6.4.1.DOMICILIARY CARE AGENCY (INCLUDING COMMUNITY SUPPORTSERVICES)Ensures that this Policy is implemented in their service.6.4.2.Facilitates training for DCAs by ensuring that the DCA follows a recognisedtraining , which ideally should be the Train the Trainer package for domiciliarycare, in accordance with this policy and associated Standard OperatingProcedures(SOPs)6.4.3.Maintains records of staff training and competencies for the safe administration ofmedication.6.4.4.Provides the agreed and documented level of assistance to the service user on aday to day basis.6.4.5.Ensures that medication is administered from the original pharmacy filled containerand that this is recorded on a domMAR by trained and competent staffAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]11
6.4.6.Ensures that, if a medication is prescribed mid cycle, this is (in order of preferenceand risk):1) Ideally, added to the existing domMAR or2) A second domMAR is obtained or3) Where the above is not possible, for example Out of Hours when the pharmacyis closed, the DCA directs the carer to handwrite a temporary domMAR chart,ensuring that the carer follows the agreed process (see Appendix 3 )6.4.7.Ensures that DCWs are able to prioritise their visits for people who need supportwith time-sensitive medicines (7 R’s)6.4.8.Has robust processes in place for handling urgent changes to a service user’smedicines from a prescriber, received preferably via NHS Mail, (safe-haven fax orverbally in an emergency), including : Recording details of the requested change (including who requested thechange, date and time of request and who received the request Ensuring that a second member of staff is present to verifytranscription/transfer of information the requestAnd where instructions are given verbally Reading back the information that has been recorded to the prescriberrequesting the change to confirm it is correct (including spelling of themedicine) Ensuring that a second member of staff is present to verify the informatione.g.by speakerphone6.4.9.Monitors and reviews the service provided via regular audit of domMAR charts6.4.10.Informs the Adult Services Team of any significant change/s that may trigger theneed for a review.6.4.11.Ensures that incidents and ‘near-misses’ are recorded appropriately and used as alearning tool to improve the service. See example of incident reporting formAppendix 86.4.12.Takes responsibility for resolving problems and investigating incidents .Wherenecessary specialist support should be involved in these investigations andlearnings disseminated to all parties.6.4.13.Takes responsibility for reporting to CQC and Safeguarding where appropriate6.5.6.5.1.6.5.2.DOMICILIARY CARE WORKERS (COMMUNITY SUPPORT SERVICE ANDDCWS)DCWs should only assist with medication where they have the required trainingand they are competent to do so. This includes support with opening bottles orpassing inhalers etc.It is the responsibility of DCWs to follow the support plan and administer/recordmedication in line with this Policy using a domMAR chart or handwritten chart asappropriate.Administering Medication Safely in the Domiciliary Care Sector Policy [June 2018]12
6.5.3.If there is any doubt about the capacity of the service user then the DCW shouldNOT administer the medication. The DCW should immediately contact their linemanager for further advice. The person’s GP or appropriate professional should becontacted.6.5.4.DCWs should report any concern to their line manager and document in thesupport plan, ensuring that the concern is logged in the DCA’s incident reportingsystem6.5.5.DCWs should not undertake any duties which fall within the responsibility of theNursing service (e.g. sutures or catheter removal) or Primary medical services.6.5.6.DCWs must not make any clinical decisions or judgments (e.g. increase or changeof dosage) regarding the administration of medication. If there is any change ofcircumstances relating to a service user’s medication, the DCW must report it totheir duty manager or a health professional or a nominated person (e.g. next ofkin).6.6.6.6.1.GENERAL PRACTITIONERS(GPs)GPs have a duty of care for all of their listed patients to provide general health andmedical care or refer for specialist health care or social care.6.6.2.In looking after an individual’s health and wellbeing, the GP or other non-medicalprescriber will prescribe medication to their patient to prevent, treat or relievemedical conditions. It should be noted that individual service users might alsoreceive medication prescribed by specialists who might have been supplied tothem in hospital. Within primary care, other professionals may be involved inprescribing for service users – e.g. Dentists, suitably qualified nurses, pharmacistsor physiotherapists.6.6.3.GPs should record details of the service user’s medicines support and who tocontact about their medicines (the service user and their DCA) in their medicalrecord, when notified that the person is receiving medicines support from a socialcare provider. This information is available on the domMAR request form. Thedetails should be immediately obvious to anyone accessing the patient’s record byadding an alert, reminder or “Pop-up box”. Such support should be Read coded –SystmOne: XaN5J – needs domiciliary care worker to administerEmis Web: 8BML – needs domiciliary care worker to administer6.6.4.Prescribers should communicate any changes to a service user’s medication (e.g.when stopping or starting a medicine) by : Informing the service user and their named contact Providing written instructions of the change or issuing a new prescription Informing the service user’s supplying community pharmacy and DCA.Any changes in medication, where there is a need to avoid delays in treatment oravoid confusion, should be made preferably by NHS mail (safe-haven fax orverbally in an emergency).6.6.5GP Practices should consider identifying at least 2 members of the administrationteam to be responsible for managing the prescription process for domiciliary carepatients requiring domMAR chartsAdministering Medication Safely in the Domiciliary Care Sector Policy [June 2018]13
6.6.5.Provide clear written directions on the prescription to show how each prescribedmedicine should be taken or administered, in
If support with medication is identified as part of the assessment process, Adult services worker to undertake the Medication Risk Assessment and Fullers assessment (or agreed risk assessment). 6.2.2 Use this risk assessment to identify what support with medication the service user needs. The score should
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