Sunshine Care Training Sarah Yorwerth & Tara Hollinshead

1. Sunshine Care Training Sarah Yorwerth & Tara Hollinshead Medication

2. MOST IMPORTANT It is an Organisational requirement that you check the Care Plan of every client on every visit

3. There are 8 core principles that apply to any care setting or service that might be involved in the handling and administration of medicines and drugs on behalf of service users.   People who use social care services have freedom of choice in relation to their provider of pharmaceutical care and services including dispensed medicines. Medication is used to cure/prevent disease. Care staff know about medication, and keep records Medication is accessible and disposed of correctly Care staff preserve dignity and privacy. Care staff are competent Stored safely Access to Pharmacy advice

4. Legislation Handling medicines in accordance with all legal requirements and professional guidelines including: Medicines Act 1968 Misuse of Drugs Act 1971 Misuse of Drugs (Safe Custody) Regulations 1973 Safer Management of Controlled Drugs Regulations 2006 Health and Social Care Act 2008; (Regulated Activities) Regulations 2010 Care Quality Commission: Essential Standards of quality and safety March 2010 Controlled Drugs (Supervision of Management and Use) Regulations 2013 Guidelines of the Royal Pharmaceutical Society and other relevant professional guidance (such as the Nursing and Midwifery Council standards).

5. Self Medicating For client’s who are self medicating we DO NOT Need to record anything to do with medication on their report sheets Check the care plan it should read self medicating

6. Level 1: Category 1

7. Level 1: Category 2.

8. Level 2: Category 3.

9. Level 2: Category 3. Permanent/regular medication recorded here. Clear information/direction how medication is given. Any changes to medication must be report to office, a new list will need to be completed and old sent to office. No editing/adaptations to list permitted.

10. List must be reviewed weekly be the keyworker. It must be reported if this is not happening. Any changes must be reported to office and a new sheet completed, implementing the change. Every Delivery of medication should be checked, and signed by the Care Worker present.

11. Level 3: Category 4.

12. What is a drug? A medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.

13. What makes a drug become a medicine? A drug becomes a medicine when it is used in the treatment or prevention of a disease

14. Interlinked areas of law Duty to employer Duty under statutory law Duty under civil law Duty to profession

15. Legal categories of Medicines • GSL – General Sales List, can be bought anywhere, supermarket, garage. Can only be sold in limited quantities. • P – Pharmacy Only Medicines, can be bought from chemist without prescription – but only if pharmacist is in attendance. • POM – Prescription Only Medicines, only supplied on prescription signed by doctor, dentist or registered nurse prescribing practitioners.

16. Controlled drugs – These prescriptions are normally written in the doctor’s own handwriting • Complementary medicines – vitamins etc • Homeopathic medicines – natural products

17. The Journey of a Prescription • Prepared instruction from a doctor to a pharmacist to supply the medicine to the named patient • Care homes often have different mechanisms for obtaining supplies of medicines, usually explained within the individual local policies and procedures • All prescribed medication from the GP will be written on a FP10 prescription form

18. Prescriptions • May be hand written or computer generated. • Usually written for 28 days or multiples of for continuous treatment. • Should be reviewed at least annually, but if taking more than four types of medication, 6 monthly.

19. What should be on the prescription? • Name of patient • Address • Age/date of birth • Name of medicine • Strength/dose of medicine • Quantity to be supplied • Date • Doctor’s name and address • IT MUST BE SIGNED

20. Names of Medication All medicines have two names Generic name chemical composition, e.g. Paracetamol Brand name given by the manufacturer, e.g. Panadol A medicine can have many brand names but will only have one generic name, however sometimes generic medicines made by different manufacturers can look different. Prescriptions will usually be written as the generic name.

21. Abbreviations

23. Routes for Medication.

24. General considerations for storage All medication should be stored correctly in accordance with the practitioner’s instruction and per Risk Assessment. Medication may be locked and have restricted access if it is assessed the Service User could be at risk. Some medications may need to be kept at a lower temperature e.g. Refrigerator. Out of Date medication must be returned the pharmacist.

25. Five R’s

26. Royal College of General Practitioners • Elderly patients must be treated with dignity and respect. They should not be forced to take medication against their will. If they have swallowing difficulties the most suitable preparation of the drug should be used – usually in the liquid form if available. If a person has difficulties, they, or a carer, should contact the prescribing doctor.

27. Consent • All service users have the right of refusal and should consent to the administering of medication. • Have the right to information about the medication being administered. • Service users’ beliefs and views are a key influence on whether , when and how they take their medicines.

28. Crushing medication • This should not be routine practice and as stated above it is preferable to use a product in the way it was licensed to be used. The prescriber should take responsibility for using a medicine in a manner that is outside its licence and should specify the exact directions on the prescription, e.g. “crush, mix with water and administer”. These instructions should be added to the dispensing label. • Altering the form of medicine must only be undertaken under the guidance of an authorised prescriber. • A written direction to crush or disperse tablets or to open capsules should be documented in the patient’s care plan (where care staff are involved in administration.) • A pharmacist or Medicines Information service should be referred to and every effort must be made to ensure Health and Safety guidance is followed.

29. Crushing NMC • The NMC gives advice on crushing medication in its Standards for Medicines Management 2010 and says “Medicinal products should not routinely be crushed unless a pharmacist advises that the medication is not compromised by crushing, and crushing has been determined to be within the patient’s best interest.”

30. Covert Administration Staff MUST NOT disguise medication and administer to Service User’s without their knowledge. Only Service User’s detained under section 3 under the Mental Health Act can legally be given medication against their will. With Service User consent, making the medication more palatable by taking it with food or drink is not the same as disguising. This consent must be in writing and confirmed by the Prescriber. Crushing or Covert medication should only take place with written consent from the GP and appropriate recorded on the care plan.

31. Controlled drugs Prompt 9B of CQC Essential Standards state that clear procedures must be in place. Controlled drugs are those that have been agreed as potentially addictive or dangerous thus requires special provisions. The Misuse of Drugs Act 1971 classifieds controlled drugs into 5 schedules. The Controlled Drugs (Supervision of Management and Use) Regulation 2013 came into force with Department of Health and replace previous guidance and regulations.

32. Controlled drugs classification

33. Disposal / Ordering of medication • Medicines belong to the Service User so must be disposed of with prior consent. • Unused tablets must be placed in sealed envelope and returned to pharmacy. • Complete a Disposal form and Pharmacist to sign for. Reasons for Disposal • Service User refused medication • Service User no longer taking medicine • Medicine dropped on the floor • Medicine out of date.

34. Omitted Doses. If you wrongly administer or omit to give a dose of medicine to a Service User in your care, or become aware than an error has been made, you must report to the line manager immediately. The line manager will: • Immediately seek Professional advice. • Enter details onto an issue log. • Inform NOK. • Report to CQC.

35. Types of medications Analgesics - Painkillers • Paracetamol • Aspirin • Co Dydramol • Co Codamol OPIODS (reduce intensity of pain signals to the brain) • Morphine • Diamorphine (heroin) • Pethedine • Fentanyl • Oxycodone

36. Contd Non Steroidal Anti Inflammatory Drugs (NSAIDS) – for pain • Ibuprofen • Naproxen • Diclofenac (Voltarol) NSAIDs are generally prescribed for people who have pain and inflammation - for example, if you have pain in your joints (arthritis) or muscles (back pain). Although cannot be taken for people who have stomach ulcers.

37. Contd Antibiotics – For treatment of Infections • Penicillin • Erythromycin • Trimethoprim • Cephalexin • Amoxycillin • Tetracyclides The main side effects for antibiotics are diahorrea, skin rashes and some penicillin’s can cause anaphylactic shock.

38. Contd Respiratory Drugs • Ventolin • Salbutamol • Atrovent • Prednisolone These are used to open up the breathing tubes.

39. Contd Diuretics These drugs are designed to make the kidneys pass more urine. They are useful in treating high blood pressure, heart failure and severely swollen legs. • Frusemide • Co Amilofruse • Amiloride • Frumil People that take certain diuretics, must increase potassium foods within their diet. Diuretics can cause dizziness.

40. Contd Heart Drugs Used for Atrial fibrillation or heart failure. • Digoxin • Lanoxin Anti Convulsants These are used in the control of Epilepsy • Carbamazepine • Phenytoin • Phenobarbitone • Gabapentin • Midazolam.

41. Contd Anti Depressants These are mood altering drugs that affect brain chemistry to relieve depression • Amitryptilline • Dothiepine • Fluoxetine (Prozac) • Lorazepam • Diazepam

42. Contd Sedatives Reduces brain chemistry thus relieving anxiety, agitation, and /or psychiatric disturbances, and sleeplessness. • Temazepam • Zopiclone • Amitryptilline Anti Coagulants Used for thinning the blood • Warfarin • Heparin • Aspirin

43. Warfarin To prevent and treat the formation of harmful blood clots within the body by thinning the blood and/or dissolving clots. • There will be given an anticoagulant record book; read this carefully and carry it with you at all times. • It is important to have regular blood tests to check the level of warfarin in the blood - these blood tests are very important. • Any changes to diet must be discussed with GP prior. • Avoid drinking cranberry juice whilst taking warfarin. • Only drink alcohol in moderation whilst taking warfarin.

44. Check Therapy (INR) book for correct dosage. • DN/GP will complete this 1-week or 2-weekly. • You MUST check every time before you administer, doses can change within 24 hours. • Select and prepare correct dosages. E.g. 2mg Warfarin (2x1 mg tablets)

45. Contd Anti Hypertension (reduce High Blood Pressure) • Clonidine • Diazoxide • Furosemide • Hydralazine • Minoxidil • Nitroprusside • Lisinopril

46. Contd Cytotoxics -All cytotoxic are anti cancer drugs, the interfere with cell division and can kill tumours. • Anastrozole – antibiotic for cancers • Tamoxifen • Letrozole Working with cytotoxic drugs has also been associated with negative health effects for developing fetuses including higher incidences of spontaneous abortions, congenital malformations, low birth weight, and infertility