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Administering medicines in home care agencies

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  • Organisations we regulate

NICE released guidance in March 2017 on managing medicines for adults in community settings.

These are some of the key points from the guidance relating to administration of medicines.

Administration

Care workers should only administer medicines when this is clearly documented in the care plan. The care workers must be trained and competent to do so. The prescriber's directions must be clear, specific and unambiguous.

Leaving out doses

Doses must only be left out for a person to take later, if it has been agreed with them, and a risk assessment has taken place. This information should be recorded in the care plan and an appropriate record should be made on a medication administration record.

Time sensitive medicines

Time sensitive medicines are those that need to be given or taken at a specific time. A delay in receiving the dose or omission of the dose may lead to serious patient harm.

Common examples include

  • insulin injections
  • medicines for Parkinson’s disease
  • medicines that contain paracetamol
  • medicines that need to be given before or after food

Care workers should be able to prioritise visits to meet the needs of people who need support for time-sensitive medicines.

Medicines administration records (MARs)

Care workers should record each time they provide medicine support. The record should include who administered the medicine and whether a medicine was taken or declined.

Medicines support is any support that enables a person to manage their medicines. In practical terms, this covers:

  • prompting or reminding people to take their medicines
  • helping people remove medicines from packaging
  • administering some or all of a person’s medicines

There is no need to keep records when the person is managing their medicines themselves.

NICE recommends that printed MARs should be used where possible. These should include:

  • the name of the person
  • the name, formulation and strength of the medicine(s)
  • how often or the time the medicine should be taken
  • how the medicine is taken or used (route of administration)
  • the name of the person’s GP practice
  • any stop or review date
  • any additional information, such as specific instructions for giving a medicine. Examples might include medicines to be taken with food (such as ibuprofen) or without food (such as some antibiotics)

Home care workers must record the medicine support given to a person. This must be for each individual medicine on every occasion in line with Regulation 17. The record can look different to a standard MAR. But it should be a clear record of all support provided, for which medicines.

Where medicines are recorded as ‘dosette’ or blister pack, keep an accurate record of the medicines contained in the blister pack. Keep this with the administration record.

When medicines change, the old list will need to be dated and kept. This helps to check the support provided for each medicine even if it was several months before.

Only make handwritten changes if you are competent to do so. If the medicine changes mid-cycle, make a new entry to make it clear when the dose changed. Handwritten records and changes should be covered in the medicines policy.

Controlled drugs

The medicines belong to the person and are being stored in their own home. There is no need to keep a register of controlled drugs. Also, there is no need for double witness signatures for administration or support.

Specialised administration

This will be determined by the home care agency’s policy and usually requires additional training.

Delegated tasks

In some circumstances, healthcare professionals may delegate certain tasks to home care workers. These tasks have traditionally been seen as nursing tasks. Staff will usually need extra training and competency checks before undertaking these tasks. The home care agency should have enough trained staff to allow continuity of care.

Examples of these include:

  • injections
  • medicines administered via a feeding tube, for example percutaneous endoscopic gastrostomy

Healthcare professionals should only delegate these tasks to a home care worker when:

  • the person receiving medicines support gives consent
  • responsibilities of each person are agreed and recorded

The delegating healthcare professional must assess that the care worker is competent and trained. The healthcare professional remains responsible for ensuring the care worker can safely and effectively administer the medicine. Providers should have policies in place to support these processes.

Last updated:
13 July 2018

 


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