There are several legislations relevant to the administration of medication in the care home. Although not expected that care staffs have detailed knowledge of the legislations, they do need to be aware of the legal difference between drugs and the legal framework that allows them to handle medicines on behalf of the service user. The Medicines Act 1968 being the umbrella and from this several amendments and legislations have been implemented. The following is a list of legislation that has a direct impact upon the handling of medication within a social care setting.
• The Medicines Act 1968
• The Misuse of Drugs Act 1971
• The Misuse of Drugs (Safe Custody) Regulations 1973 SI 1973 No 798 as amended by Misuse of Drugs Regulations 2001 • The NHS Scotland Pharmaceutical Service (Regulations) 1995 • The Social Work (Scotland) Act 1968 as amended by The Regulation of Care Act 2001 • The Children Act 1989
• The Children’s Act (Scotland) 1995
• The Data Protection Act 1998
• The Care Standards Act 2000
• The Regulation of Care (Scotland) Act 2001
• The Health and Social Care Act 2001
• Adults with Incapacity (Scotland) Act 2000
• Health and Safety at Work Act (1974)
• The Control of Substances Hazardous to health Regulations (1999-COSHH)
• Hazardous Waste Regulations (2005)
• Mental Capacity Act (2005)
• The Access to health records Act (1990)
In the care home, where I work all four of our clients do not self-administer. They have care plans and risk assessments in place making the staff team aware that they are unable to take control of their medication for one reason or another.
About 90% of the clients’ medication is supplied from Boots and is delivered in MDS. The liquids and PRN medication are delivered in original boxes and bottles. When we take delivery of the four weekly supply it usually comes in a zipped bag. The tag is checked in the presence of the courier for security and the delivery note for the courier is signed. Should there be controlled drugs delivered this is checked while the courier is present and a separate delivery note is signed for this. In the medication delivery is new MAR sheets. The top sheets are separated from the yellow and white ones. These are saved for a later date when we need to order repeat prescriptions.
Two members of staff, one medication trained, will check the medication in. Each medication is counted and checked against quantity ordered. The results logged and signed in on the new MAR sheet. As the new medication arrives about ten days prior to us needing them any discrepancies can be addressed prior to needing them.
When administering medication it is always good practice to remember the five ‘rights’ to ensure that this very important job role is done safely.
1. The “right” client – Check identity (we have photo cards in the MAR file) 2. The “right” medicine – Check identity of medicine to client (mostly MDS but definitely check the PRN and regularly check the cartridge in case they have been shuffled around 3. The “right” dose – Check the quantity to be given. Care taken to distinguish between strength and quantity to be given. Client JM often requests different dose so have to check and record on MAR 4. The “right” time – Check time of day for the medicine to be taken. JM has two medications to be taken after food in the evening. These were two that she had previously taken at 20:00 so is now taking after dinner. 5. The “right” route – Check the route by which the medicine is to be administered and follow procedures for that route. I have heard of Canesten Pessary being taken orally.
Although there are care plans in place for all our residents for medication it is within their rights to refuse to take it. People with altered mental capacity may refuse due to their mental state at the medication time. I like to try a few times later, often after I...