We are often asked about how to support with medication which can often be difficult to manage. Support with taking medication is important to enable a Service User to continue living at home. Gardiner’s preference in respect of how to support with medication, is always to support Service Users to retain control over their own medication wherever possible.
What help can Care Workers provide with medication?
How to support with medication? If you struggle to open a bottle, pop a blister, or perhaps apply cream, you can maintain responsibility for your own medication by giving instructions that Care Workers will follow. The instructions you give must be in line with the instructions on the medication packaging.
For those who sometimes forget to take medication, we can remind you to do so. Or we can assume full responsibility for administering your medication.
Care Workers can only assist with medication that is in the original pharmacist-filled container. We can’t help with tablets left out or containers that have been filled by a family member. Medication must be given in the form supplied (capsules mustn’t be opened nor tablets crushed).
Medication should not be left out to be given or taken at a later time, this is not something that our staff are allowed to do.
Care Workers must be present and observe whether medication has been taken. They need to that the right medication is given to the right person, in the right dose, by the right route and at the right time. They must always seek consent from Service User and respect their right to refuse medication.
How to arrange support with medication
Prior to commencing care, a Care Manager or Senior Care Worker will meet with the Service User to discuss, agree what support they require with medication. The agreed level of help will be documented in the Service User’s care records – on the PASSsystem summary. Assistance with medication given by Gardiner’s staff must always be in accordance with that agreed and documented level of help.
The level of support required may change over time and will be considered at every care review, or sooner if necessary. Any concern that a Service User may not be managing their medication will be reported to the Care Manager. The Care Manager will review the situation in consultation with the Service User and others.
Any change in the agreed level of medication support will be updated without delay on the PASSsystem summary and communicated to the team.
Nomad (Monitored Dosage System)
Wherever possible, medication should be in a pharmacist filled Nomad pack.
A Nomad pack or a Monitored Dosage System is a method of dispensing medication. Pharmacists organise your medication into a special tray. The tray has a number of compartments, which are very easy to open, that have days of the week and time of the day labelled on them. This makes it far easier to keep track of what medication to take and when. It can replace lots of individual tablet boxes and blister packs.
Gardiner’s staff are not allowed to support with medication from a dosette box. A dosette box is a container that has been filled by the client themselves, or perhaps a family member rather than a pharmcist.
Recording support with medication
All help provided with medication, including the outcome must be recorded in PASSsystem which creates an electronic MAR in the Service Users’s digital record. Cleints, and relative if they have been given permission, will be able to access those records via the openPASS app or website.
Bottles of liquid medication, including eye/ear drops, may have a time limit on how long they can be used after opening. The first Care Worker to open the new bottle should write the date of opening in pen on the pharmacy label, avoiding writing over the printed instructions. They should write the ‘Use by’ date on the label according to the manufacturer’s or pharmacy label instructions.
Managing a new medication
If a new prescribed medication has been delivered, the Care Worker should write the date started on the label. They should then take a photo of the pharmacy label and email it to firstname.lastname@example.org. They will also call the Care Manager or On Call to tell them so that it can be added to PASSsystem before the next administration.
‘As required’ (PRN) medication
Some medication is prescribed to be taken ‘As required’ rather than regularly. Clear instructions on the medication label should identify the reason it may be taken (e.g. for pain, for sickness, for constipation). If the information on the pharmacy label is insufficient, the medication should not be given and this must be reported immediately to the Gardiner’s Care Manager and the pharmacy
On PASSsystem, the specific task for that medication will be ticked to indicate that it is PRN. The Protocol for when the medication should be given is detailed in the notes to the medication task. If a Service User is to be given an ‘As required’ (PRN) medication, the Care Worker must confirm that the circumstances detailed on the packaging instructions and on the PASSsystem task for the PRN medication are met.
The Care Worker must read the notes of the previous care duties on PASSsystem to check the minimum time has elapsed since the last dose and the maximum dose in 24 hours would not be exceeded. If in any doubt, they must contact the Care Manager/On Call to check before giving.
The Care Worker must complete the medication task on PASSsystem recording the actual dose given, the time given and the reason why it was given which must match the reasons specified from the Protocol within the notes to the PASSsystem medication task. For medications such as cream, the Care Worker must document where the cream has been applied and the time.
Some Service Users may have medication for use in an emergency, when they may be unable to give clear instructions or administer it themselves. This information will be documented on the PASSsystem summary. It must be included as a PRN medication task within the PASSsystem care plan.
All medication incidents should be reported to the office promptly so they can be recorded and investigated. It is important to always be open and transparent. Any incidents concerning medication should be reported to the Care Manager at the time and documented on the PASSsystem duty being completed. This includes errors, omissions, reactions to medication or being unable to give medication.
Over the counter medication
Medication that does not need to be prescribed or sold in the presence of a pharmacist is called over-the-counter medication. Care must be taken as over-the-counter medication can interact adversely with other medications. They can interfere with the effectiveness of a drug or cause unintended side effects. For example, taking aspirin with the anticoagulant Warfarin can increase the risk of bleeding.
Another risk is medication overlap where products used to treat different problems or with different trade names contain the same active ingredient. Taking both could lead to an overdose of that active ingredient. To reduce the risk it is important to seek pharmacist advice about using over-the-counter medication.
Gardiner’s staff must never suggest to Service Users that they take over-the-counter medication but can suggest that a Service User speaks to their doctor or to a pharmacist.
If a Service User is responsible for their own medication, they can ask a Care Worker to buy them a specific type of over-the-counter medication. The Service User may ask the Care Worker to seek advice from the pharmacist about what over-the-counter medication they recommend. The request and advice given should be documented in the care record. Care Workers can provide physical help to Service Users responsible for their own medication, provided the instructions given by the Service User match the directions on the medication packet.
Where Gardiner’s are responsible for supporting with medication, over the counter medication can only be given where this has been approved by a Care Manager and a relevant task for the medication added to PASSsystem. Before adding the task, the Care Manager must seek advice from a pharmacist or GP in order to satisfy themselves that it is safe and document the advice that has been received.
Wherever possible Service Users or their families/friends should organise obtaining new medication or delivery by the pharmacist to the Service User’s home.
Storage and disposal of medication
Medication should be stored in accordance with the instructions on the packaging and kept in a safe place agreed with the Service User, known to the Care Manager and documented on PASSsystem in the medication task. Occasionally, for the Service User’s safety, following a best interests discussion, medication may be locked away.
Any old or out-of-date medication should be separated from current medication and returned to the pharmacy for safe disposal. Removing the medication in this way reduces the risk that it will be confused with current medication.
Any dropped or refused medication should be put in a labelled envelope and put in a safe place, away from current medication, so that it can be returned to the pharmacy for disposal. Do not put tablets into the household rubbish.
Hiding (Covert) medication
Medication must not be given without the service user’s knowledge if they have the mental capacity to make decisions about their treatment and care.
If the Service User does not have capacity to make decisions about their medicines, a best interests meeting must take place and the outcomes documented and signed by the Gardiner’s decision maker (normally the Care Manager) along with written confirmation from the GP. The prescriber (normally the GP), in discussion with the Care Manager/Care Workers, a pharmacist, and someone who can communicate the views and interests of the person, such as a family member or advocate, should decide whether the medicines can be given covertly in the Service Users best interests. It is important to check whether the service user has made an advance decision (this will be identified at the Initial Assessment).
Prior to every administration, we must assess whether the Service User has the capacity to make the decision about whether or not to take the medication. If they have capacity, they can make the decision. If we assess that they do not at that time have capacity to make that decision we will need to make a decision in their best interest which can be to give medication covertly in line with the GP’s instructions.
Care Workers are permitted to administer prescribed, controlled drugs in the same way as other prescribed medication, according to the pharmacist instructions. Any concerns about usage or safe storage should be reported to the office.
Anticoagulant medication, such as Warfarin, is sometimes prescribed for those who have had or are at high risk of a condition caused by a blood clot such as a stroke, heart attack, deep vein thrombosis, pulmonary embolism (blood clot in lungs).
Warfarin therapy aims to decrease the blood’s tendency to clot, but not stop it clotting completely. Regular blood samples will be sent to the local anticoagulant clinic to check the dose is correct. The dose to be taken will be detailed by the clinic on an INR card which is sent to the Service User. INR or ‘International Normalised Ratio’ is a measure of how long it takes blood to clot.
The Warfarin dose must be taken exactly as directed i.e. at the correct dose stated and at the same time every day before, during or after a meal. Warfarin doses are variable and will be monitored and can regularly change.
Where Gardiner’s are responsible for supporting with Warfarin, the Care Manager will contact the anticoagulant clinic and arrange for them to inform us of the results of these tests and any changes to the dose that are required. The Care Manager will update PASSsystem with any changes and add a message about the change to the Communications section on PASSsystem. Care Workers must be fully confident that they are giving the correct dose. If in any doubt they must contact the Care Manager, or On Call, to request help.
Care Workers need to be aware of the different strength tablets available – 1mg, 3mg, 5mg etc and care must be taken to select the correct dose. Sometimes different doses need to be taken every other day, for example 2mg today, 2.5mg tomorrow, 2mg the next etc. If in doubt, the Care Worker must call the office for guidance.
Anticoagulants decrease the blood’s normal clotting ability. The risk is greater during the first weeks of taking Warfarin and when unwell. Be alert for and report any of the following:
- passing blood in urine or faeces or passing black faeces
- have severe bruising
- nosebleeds lasting more than 10 mins
- have bleeding gums
- cough up blood or have blood in vomit
- Experience unusual headaches
Those taking anticoagulants are at risk of excessive bleeding. Seek urgent medical attention if they have a fall or accident, experience a significant blow to their head, are unable to stop any bleeding, or there are signs of internal bleeding, such as bruising.
Staff training and observations
All staff complete regular medication training. Specialist training may be required for some medication. Senior Care Workers and Care Managers conduct observations of Care Worker to ensure that they follow good practice and our agreed ways of working.