Part 1 - Skills for Care

Report
HSC 3047: Part 1
Support the use of medication in social care settings:
Legislation, classification and responsibilities
Sheena Helyer 12.2012
BA.RGN.DN. PGCE. Nurse Prescriber.
Photos supplied by: gename.fieldofscience.com, allcareprofessionals.com
Learning outcomes for HSC 3047
1. Understand the legislative framework for the use of
medication in social care settings.
2. Know about common types of medication and their use.
3. Understand roles and responsibilities in the use of
medication in social care.
4. Understand techniques for administering medication.
5. Receive, store and dispose of medication supplies safely.
6. Know how to promote the rights of the individual when
managing medication.
7. Support the use of medication.
8. Record and report on the use of medication.
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What is a medicinal product ?
The EC defines a medicinal product as:
1. Any substance or combination of substances presented as
having properties for treating or preventing disease in
human beings.
2. Any substance or combination of substances which may be
used in or administered to human beings either with a view
to restoring, correcting or modifying physiological functions
by exerting a pharmacological, immunological or metabolic
action, or make a medical diagnosis.
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Why is it necessary to have acts of parliament and
regulations concerning medication?
• So that you know exactly what you are taking.
• So that medication is given to the appropriate people in the correct
amounts.
• To try to prevent people from taking medicine which is harmful to
them.
• To control infectious diseases amongst the whole population.
• To preserve principles such as ‘consent’ and free will.
• To protect the vulnerable.
• To try to minimise unpleasant/ dangerous side effects.
• To protect health care staff and pharmacy staff.
• To encourage research and manufacture of new medicine.
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Agencies with responsibilities for medicine use
• Medicines and Healthcare Products Regulatory Agency
MHRA
A government agency responsible for ensuring that medicine and medical devices
work and are acceptably safe. They send out alerts to people within health and
social care to warn them of possible dangers or equipment which has be recalled.
• Royal Pharmaceutical Society of Great Britain Inspectorate RPS
Inspection of all professional aspects of registered retail pharmacists.
• Care Quality Commission
CQC
This organisation sets minimum standards for care delivery. Outcome 9 sets out
the expected standards for medication use. The CQC gathers information about
care providers and inspects them to see if the standards are being met.
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Name of legislation
Medicines Act 1968
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Content of legislation
• This act regulates the
manufacture, supply, sale and
import of medicines and
medicinal products.
• Only authorised practitioners
may prescribe: GPs, dentists,
some nurses and pharmacists.
• The act divides medicinal
products into 3 categories:– Prescription only
– Pharmacy
– General sales list
(POM)
(P)
(GSL)
Prescription only medicine
POM:
• These medicines can only be legally acquired
with a valid prescription from a GP, a dentist
or other independent prescriber.
• Independent prescribers are health
professionals who have undertaken extra
training in order to prescribe and will have
their own prescription pads.
• Many GP surgeries employ nurse
practitioners who can physically examine
patients and prescribe from a limited
formulary e.g. antibiotics for a UTI or chest
infection.
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Photos supplied by: pulsetoday.co.uk
Pharmacy medicine
P:
Pharmacists are very knowledgeable about
medicines and are able to diagnose certain
medical problems. They are able to
recommend and sell certain medicines which
are not generally available over the counter.
They will also ask questions to check that
the medicine does not interact with other
medicines, to minimise side effects and to
check that they are not given to people with
specific health problems or conditions.
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Photos supplied by: NHS photo library
General Sales List
GSL:
• These medicines are considered by the MHRA to be safe
enough to be sold from a shop or supermarket.
• Sometimes the pack size and strength is lower than those
available as P or POM medication.
Photos supplied by: dc.de
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Legislation
Misuse of Drugs Act 1971
Photos supplied by: medicines.org.uk
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Content of legislation
• This law controls the use of
potentially dangerous or
highly addictive drugs. These
drugs are defined as
‘controlled drugs’.
• It states how they should be
stored, recorded and
administered.
• Controlled drugs are divided
into classes A,B and C and
specified penalties are given
for illegal possession or
supply.
Drug types
Drug
Penalty for supply
Penalty for
possession
Class A:
Diamorphine (heroine),
cocaine, MDMA, LSD,
methamphetamine,
strong opiates
Up to seven years or
unlimited fine or both
Up to life in prison or
fine or both
Class B:
Amphetamine,
barbiturates, cannabis,
less potent opiates
Up to five years or
unlimited fine or both
Up to 14 years or fine
or both
Class C:
Benzodiazepines,
ketamine, steroids and
GHB
Up to two years or
unlimited fine or both
Up to 14 years or fine
or both
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Legislation
Content of legislation
Misuse of Drug Regulations
1973
• Controls the storage of CDs
in pharmacies and care homes
• All care homes must keep
their schedule 2 and 3
controlled drugs in a locked
cupboard which can only be
unlocked by an authorised
person
• This does not apply to a
person’s own home
Photos supplied by: harvarddapa.org
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Legislation
Content of legislation
The Control of Substances
Hazardous to health
Regulations 1999 COSHH
• Employers must take all
reasonable measures to
protect their employees from
any potentially harmful
substance that they may come
in contact with whilst at work
• Personal protective
equipment must be provided
Photos supplied by: tradekorea.com
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Legislation
Misuse of drugs
regulations 2001
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Content of legislation
• Controlled drugs are divided into 5
schedules depending on their medicinal
benefit/potential for harm
• Schedule 1 drugs have no recognised
medicinal use and have the highest level
of control
• The legislation specifies who can
produce, possess and supply these drugs
and how they should be stored
administered and destroyed
• It gives permission for the person’s
representative to administer, collect or
return schedule 2,3 and 4 drugs to a
person in the community in accordance
with the doctor/dentist’s directions
Legislation
Content of legislation
Hazardous Waste
Regulations 2005
• This defines household and
industrial waste and includes
medicines which are no
longer required.
• Householders and residential
care homes may return their
waste medicines to the
pharmacy for disposal or
destruction. They should not
be flushed down the toilet.
Photos supplied by: weblogs.baltimore.com
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Legislation
The Mental Capacity Act
2005
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Content of legislation
• An individual is assumed to have
capacity to make decisions about
their medicine
• A lack of capacity must be clearly
demonstrated
• People with capacity should be
allowed to make unwise
decisions
• If an individual lacks capacity
then staff must act in the
person’s ‘best interest’
• The least restrictive option must
be chosen
Legislation
The Health Act 2006
Accountable Officer
Photos supplied by: gatesheadccg.nhs.uk
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Content of legislation
• This act strengthened the
monitoring arrangements for
controlled drugs following the
Shipman enquiry.
• Healthcare organisations need to
appoint an accountable officer to
oversee management of CDs
• All healthcare organisations
involved with CDs have a duty to
collaborate
• The police may enter any
premises to inspect stocks and
records of CDs
The Medication Policy
It is important that all staff administering medication
are familiar with the organisation’s medication policy.
The policy must comply with the law but will also
outline:• The roles and responsibilities of different people within the
organisation regarding medication administration
• The necessary training required to undertake the task
• Authorised and prohibited procedures
• Action to take in case of error or unexpected circumstances
• Local procedures regarding receipt, storage and disposal of
medication
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What about homeopathic, herbal remedies and
vitamins?
• Many people buy homeopathic and herbal remedies and take
them alongside their prescribed medication.
• These remedies are not so strictly controlled but may still
interact with the prescribed medicine and cause side effects
• It is advisable for the GP’s advice to be sought and care staff
should not give any remedies to service users without GP
authorisation
Photos supplied by: atoneonline.com, guardian.co.uk
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What is the difference between a ‘brand’ name
and a ‘generic’ name ?
• The generic name is the official
medical name for the active substance.
It is chosen by the Nomenclature
Committee of the British Pharmacopoeia.
• The brand name is chosen
by the manufacturer. The aim is
To have a name which is easily
recognised and remembered so
more is sold
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Photos supplied by: poundland.co.uk, medicine.co.uk
morningsidepharmacy.co.uk
Categories of medication
How many categories of medication can you think of?
• Analgesia
Antibiotics
• Sleeping tablets
• Anti-anxiety drugs
• Anti-depressant
Diuretics
Cardiovascular drugs
Anti-hypertensive drugs
•
•
•
•
Lipid-lowering drugs
Anti-coagulants
Antacids
Laxatives
Anti-convulsant
Anti-psychotic drugs
Anti-parkinson’s drugs
Anti-emetic drugs
• Drugs for asthma
• Anti-histamine
Anti-inflammatory
Steroids
• Cytotoxic
Drugs for diabetes
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Latin terms
In the past many latin terms were used by doctors and
pharmacists when giving instructions about medicine.
These days all written instructions must be in english but
occassionally you may hear the following :• STAT
statim
Immediately
• PRN
pro re nata
As required
• QDS
quarter die sumendum
4 times a day
• TDS
• BD
• PO
ter die sumendum
bis die
per os
3 times a day
2 times a day
by mouth
• PR
per rectum
by rectum
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What is the role of the Prescriber?
The prescriber should select suitable medicine according to
the National Institute for Clinical Excellence(NICE) guidelines.
The prescriber must check that there are no known allergies
to the medicine, no interactions with existing medication and
no contraindications.
The prescription must include the following :• The patient’s name and address
•
•
•
•
The drug name and strength
When to take the drug
How much to dispense
The prescriber’s signature
• The prescriber’s address
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Photos supplied by: pharmafile.com
What is the role of the Prescriber?
• The prescriber should explain what the drug is for, why it
should be taken and any common side effects.
• The prescriber should review the need for long term
medication at regular intervals
whilst monitoring the person’s
medical condition.
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What is the role of the pharmacist?
The pharmacist will check the validity of the prescription and
accurately dispense the medication and legally label the container with:• The name of the individual
• Date of supply
• Name and address of the supplier
• Name of the medication
•
•
•
•
Dosage of the medication
Route of administration
Directions for use/frequency
Special instructions, warnings or cautions
Photos supplied by: NHS photo library
• Expiry date
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What is the role of the pharmacist?
• Some will deliver medication to the house bound.
• Dispose of medicine brought back from care homes and
private homes
• Give advice on all aspects of medication
delivery
• Supply devices and containers to help
people take their medicine
Photos supplied by: NHS photo library
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The role of the community care manager
• Ensure the staff are trained properly
• Put policies and procedures in place
• Provide personal protective
equipment if needed
• Assess how the service
user likes to take their medicine
• Risk assess the capabilities of the service user to self medicate
• Write a plan of care describing the help needed to order,
collect, store and administer medication
• Keep and store accurate records of care episodes
Photos supplied by: NHS photo library
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Role of the community carer
• To assist with medication according to the plan of care
• To only give authorised medication from a labelled container
• To give medication respecting the person’s dignity and choice
• To give the medication according to the training received
• To help to inform and educate the person about their
medicine
• To be aware of common side effects
• To record episodes of care accurately
• To report any problems to the manager
Photos supplied by: von.ca
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Levels of assistance
Care staff must be aware of what level of assistance is required
and be trained to administer at the appropriate level:1. General support. Care staff will prompt and remind the service
user. They may help to open containers but the service user is
predominantly in control of their medicines. Assistance may be given
in collecting and returning medicine.
2. Administration of medicine. Care staff are trained to take full
responsibility for correct administration of medicines which can be
delivered via a non-invasive route e.g. pills, creams, nasal spray, eye
drops, ear drops or inhaled medication.
3. Administration of medication via specialised techniques.
Some care staff may be trained to give medicine rectally, by injection
or through a PEG tube. This will NOT be covered in this training
package.
1.
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Consent to give medication: Person with full
mental capacity.
• It is an important principle that all people receiving a service
should be fully informed and consulted in matters relating to
their health and well being and agree to the care provided.
• Some care providers will ask the service user to sign a
consent form to allow their medication to be administered by
care staff.
• On each occasion medication should only be given with full
consent. This can be implied by positive body language and
cooperative behaviour.
• If the service user declines or refuses, this choice should be
documented.
• The manager and/ or GP should be informed.
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Can medication ever be given to a person without
their consent?
• If the person has mental capacity the answer is ‘NO’
• Sometimes confused people will refuse medication
• Is there sufficient evidence that the person is unable to make
choices about their medicine? Do they lack mental capacity?
Photos supplied by: intellectual
disability.info
• Is the medicine essential ?
• Is there a nominated person who has Lasting Power of
Attorney to make health and welfare decisions on their behalf?
• If not a ‘Best Interest’ meeting should be convened to decide
on the best way forward. This must be documented.
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Crushing and/or disguising medication
• If it is decided that medicine should be either crushed or
disguised then the GP and pharmacist must be in agreement
that this is a safe course of action. Some medicines can act
very powerfully if their protective coating is removed.
• This is an important decision and must be thoroughly
documented.
• Without proper decision making and documentation it is
totally unacceptable to crush and disguise medicine
Photos supplied by: objectsofuse.com,
guardian.co.uk
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The following outcomes have now been covered:-
Outcome 1
1. Identify legislation that governs the use of medication in social care
settings.
2. Outline the legal classification system for medication.
3. Explain how and why policies and procedures or agreed ways of
working must reflect and incorporate legislative requirements.
Outcome 2
1. Identify common types of medication
Outcome 3
1. Describe the roles and responsibilities of those involved in
prescribing, dispensing and supporting use of medication.
2. Explain where responsibilities lie in relation to use or ‘over the
counter’ remedies and supplements
Outcome 6
1. Explain the principle of ‘consent’ in the use of medication
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