Working in a care home, or indeed in any domiciliary care role will require you to understand the principles of medication management. While the focus of any care role is on the patient, you are also responsible for the care of others in their locale. The onus ultimately is on you and mistakes with medicine can be fatal. This article looks at medication management and explains how the management of any prescribed or over the counter medicine is an important aspect of the job.
Patients are in care because they require a level of support. This support may be in the form of physical support, such as moving a patient or it may be emotional support. In health and social care, it is important to remember at all times that no two patients are the same – some may have mobility issues, some chronic illnesses and others may need help with simple tasks that others take for granted.
The same applies to the management of medicines. Every patient has a different requirement. Whether that means giving the patient medication occasionally to treat a minor illness or multiple pills every day to treat a chronic medical condition, it is important to handle those prescriptions the right way.
Medication prescribed by a doctor, to aid the patients’ health can be dangerous or even deadly in the wrong hands. Safe dispensing, the correct dosage and secure storage are all important aspects of medication management when dealing with patient care. The wrong dose can be harmful, missed doses can cause side effects or stop the medicine from working, and the administration of incorrect drugs can be fatal. As a carer, it is your duty to ensure you understand the patients’ needs and administer the correct drug and the correct dose at the correct time.
Medication management is broken down into five main areas:
Storage of medicine
As a care worker, it is your responsibility to store patients’ medicines safely, where children, pets and curious teenagers cannot get at them. In a care home, this isn’t a major problem as there will be designated areas for medication storage but in the case of domiciliary work, where you visit the patient’s home it is something you must take into account. You may also need to consider the patient if they have a mental illness or suffer from any kind of dementia. Patients with dementia often get confused easily and may try to take medication at incorrect times.
The most common types of medicine are in tablet or pill form. Patients with complicated medical needs may require multiple medicines to be administered at different times of the day. For home care workers it may be useful to speak to the patient’s local pharmacist to see if they can provide what is known as a dosette (or dosett) boxes. Dosette boxes are storage containers with small compartments that clearly show which tablets need to be taken on which day. Some are more advanced and allow pills to be spread out across a day and others can be securely locked to ensure only the carer can access them.
If the patient lives at home, medicine should be kept in place in the patient’s home, ideally a locked cupboard or drawer. This is extremely important if children live or visit the property. Attention needs to be paid also to the conditions in which the medicine is stored. Heat, air, light and moisture can damage medicine. Therefore, medicines should always be stored in a cool, dry place.
Ideal conditions for medicine storage in the patient’s home include:
- A purpose-made medicine storage box
- A dresser drawer
- A kitchen cabinet (providing it is away from the oven/sink or any other hot appliances)
- On a shelf (as long as it is out of reach of children)
- In a closet
Most people make the mistake of storing medicine in a bathroom cabinet. However, the heat and moisture from a shower, bath and sink can damage the medicine. Medicines damaged in this way can become less potent or may go bad before the expiration date.
Capsules and pills are easily damaged by moisture and heat. Aspirin, for example, breaks down into a vinegar and salicylic acid that can irritate the patient’s stomach. Ideally, keep them in their original container.
Medicine bottles sometimes contain a cotton ball when first purchased. The cotton ball pulls moisture into the bottle – ideally remove this when first opened.
Remember to keep children safe. Always store medicine out of reach and sight of children ideally in a cabinet with a child safety latch or tamper-proof lock.
Dispensing Medication Management
Care home providers should determine the best internal system for the supply of medicines to patients based on the individual’s health and care needs. The aim where possible should be to encourage as much independence for the patient in all aspects of their care, including dispensing medicine. Some patients may be more than capable of taking their medicine, but it may be the policy of the care home to ensure staff members dispense each dose.
A risk assessment will need to be completed prior to dispensing any medicine to ensure that the patient receives the correct medication in the correct dosage at the right times. The risk assessment should also address risks to staff as well as the patient. As mentioned earlier, dossette boxes are a useful way of dispensing medication that has been prepared at an earlier date.
Dispensing includes the preparation and transfer of medication to the end patient. Any assessments must include the steps taken not only to ensure proper use but also confirming the pharmaceutical and therapeutic suitability of the medication for its intended use. Anyone responsible for the dispensing of medicine after consent must check that the product is acceptable for use. This includes examining pills and medicines for out of date products and organising replacements in advance. The quality of the medicine also needs to be examined ensuring that it is suitable for immediate use.
Key indicators of out of date or damaged medicine include:
- Medicines that have changed colour, texture or smell
- Pills that stick together
- Pills that are harder or softer than normal
- Pills or tablets that are cracked or chipped
Administration of Medicine
The route of administration of medicine depends entirely on the requirement. Routes of administration are generally classified by the location on the body the medicine is applied to. Common methods include oral, local (creams or lotions), inhalation and parenteral.
Parenteral administration includes intravenous, intramuscular, subcutaneous and intradermal administration. Some of these can be applied by a patient, or care worker, while others require administration by specialists. Examples of parenteral administration may include injections and catheterisation.
Disposal Medication Management
It is important to safely dispose of medicines when they are finished or out of date. When caring for a patient at home, old prescription medications should not be thrown away or flushed down the toilet. Discarding old prescription bottles amongst regular household waste could mean they end up in the wrong hands, harming people instead of helping them. Flushing old pills down the toilet could contaminate the water supply or environment.
Care homes will have procedures in place for the correct disposal of medication. Typically marked as clinical waste, care home providers should have a process for the prompt disposal of:
- expired medicines (including controlled drugs)
- unwanted medicines (including medicines of any patient / resident who has died / left)
- medicines that exceed requirements
Medicines for disposal should be stored securely in a tamper-proof container within a locked or out of reach cupboard until they are collected or returned to the pharmacy.
Proper disposal starts with careful tracking of medications taken. If a patient takes drugs daily to control a chronic medical condition, it is important to store these medications properly, where no one but those authorised can access them.
Whether medications are kept in a locked cabinet or a secret drawer, controlling access is critical. Carers should be acutely aware that any visitor, bored teenager of small child can may stumble upon and misuse them. By keeping careful track of your medications, you can help to prevent this unauthorised, and potentially dangerous, use.
Documentation, confidentiality and record-keeping
The final aspect of medication management is just as important to efficient patient care as the administration of any medicine. Care home providers should keep records of risk assessments, procedures and a list of all medicines on-site – for both use and disposal. Records should include possible side-effects and tie in with overall standard operating procedures in the event of an emergency. Times of dispensing, dosage amount and other relevant notes for each patient need to be kept up to date to ensure risk is minimised. Any failure to follow correct practices can result in incidents that are harmful to the patient.
Home carers should monitor on-site medication and ensure that similar procedures are in place to check suitability for use and accuracy.
Care home providers should ensure that their process for self-administration of any controlled drugs includes information about:
- individual risk assessment
- obtaining or ordering controlled drugs
- supplying controlled drugs
- storing controlled drugs
- recording supply of controlled drugs to residents
- reminding residents to take their medicines (including controlled drugs)
- disposal of unwanted controlled drugs
Care home providers and staff should consider including the following 6 R’s of administration in their medication management process:
- right resident
- right medicine
- right route
- right dose
- right time
- resident’s right to refuse
At TutorCare we offer a wide range of courses relating to medication management. These include the advanced medication awareness, care planning and record-keeping and the safe handling of medications.