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The right resident and the resident’s right to refuse
The right resident and the residents right to refuse. Watch this video to learn more.
This step will take you through the first two Rs of Medicine administration, the right resident and the resident’s right to refuse. So let’s start with the right resident. As a community pharmacist I have heard lots of stories of patients sharing their prescribed medicines with others whom they feel have similar symptoms to themselves so would benefit from the medication. But medicines should only be administered to the person to whom they have been prescribed. In the last step we talked about over-the-counter and herbal medicines and how they should be checked with the resident’s prescribed medicines to ensure that they are compatible.
This is one of the reasons why medicines should only be administered to the person to whom they have been prescribed to avoid potential medicine incompatibilities. Other reasons include that the medicine is not suitable do to a person’s medical condition and that it is not lawful to supply prescription only medicines without a prescription.
When you receive a medicine it should be labelled with the following information: The residents name, name and address of supplying pharmacy, date of dispensing, name and strength of the medicine, dose and frequency; that is the number of tablets/capsules/drops and how often they should be administered (in the morning, twice a day four times a day) and any special instructions; does the medicine need to be kept in the fridge? Does it have to be taken before or after food? If all the information is on the medicine label then you have all the information to be able to safely administer the medicine to the resident.
If you feel there is anything missing or is incorrect, speak to your line manager who can then make further enquiries. Before administering the medicine, you will need to check that the details on the medicinal product label match those details on the medicine administration record chart (also knows as MAR charts or MAR sheets). Having established that the medicine has everything it needs to be administered to the resident, you now need to ensure that it is given to the right resident. Your organisation will have a procedure for the safe administration of medicines; you should have identified this and become familiar with it in the last module. It should outline the process to confirm the identity of residents.
You may know your residents very well, but new and agency staff may be unfamiliar with the residents, so checking identity is very important. Even regular staff can mis-identify residents from time to time, especially if they have similar names. Some medicines administration records allow you to attach a photograph to aid resident identification, it’s very easy to make a mistake. Once when I was working as a pharmacist one of my daily patients came in to collect his medication. I was chatting away with him and handed him his medication. As he walked out to the shop, my dispenser said ‘why did he give that patient the wrong medication?’
I dropped everything and ran after him to retrieve the wrong medication and give him the correct one. So although I was familiar with the patient, I still made an error but now I insist in confirming the patient’s identity even if I see them every day. When administering the medication, the first thing to do is to introduce yourself then ask for the patient’s name and explain that it is time for them to take their medicine. Before administering you will check that the resident’s name is the same as on the MAR chart and the dispense medicine so your three-way
identity check: patient, MAR and medicine. When you have administered the medicine you need to annotate the MAR chart. So, now let’s explore the resident’s right to refuse. Although a medicine has been prescribed for a patient, it doesn’t mean that they are compelled to take it. Care workers and health care professionals need to explore resident’s values and preferences in relation to their health and medicines. Sometimes, the resident’s values and preferences may be different to those of the healthcare professionals. Sometimes, residents can change their mind about taking a medicine so they need to be given the opportunity to review their decision. For example, a patient had a blood test which revealed they had high cholesterol so their GP started them on simvastatin.
Initially the patient had no concerns about taking the medicine but then they read an article in a newspaper saying that simvastatin can cause really nasty side effects and that people should avoid taking it. Whereas the patient was initially happy to take the medicine, now he was afraid of the side effects and didn’t want to take it. In this particular example, I, as a community pharmacist was able to meet with the patient and discuss his concerns and agree on an action plan. Your residents are unique individuals and should be treated with dignity and respect at all times. As already mentioned, the residents have to consent to taking their medicines, and they have the right to refuse their medication.
You could explain the benefits of taking the medication to the resident, but ultimately they have the right to refuse. If a dose is refused, it must be documented on the medicines administration record. There will be times when a patient is unable to consent, for example, if they have a severe mental health condition such as dementia, and they lack capacity to consent to treatment. If you feel that a resident is unable to consent to their treatment, you must contact the GP who will carry out an assessment. Further guidance should be in your settings medicines policy. Covert administration.
Residents who lack the mental capacity to consent to or refuse to a particular treatment will need to be treated using the Mental Capacity Act (2005) when residents are deemed to lack capacity, it may require a covert administration of medicines. Covert administration of medicines is a complex issue, and involves the administration of a medicine disguised in food or drink to a patient who resists it when it is given openly. It involves the fundamental principles of patient autonomy and consent to treatment, which are underpinned by the Human Rights Act 1998. The disguising of medication in food is not to be encouraged. Efforts must be made to obtain the patient’s consent to receive the prescribed medication in the normal way.
In exceptional circumstances, it is recognised that it may be justified in the best interests of the patient. A specific care plan must be in place for any residents who receive medicines covertly. You need to consider reasons why the resident may not be taking the prescribed medication. Do they understand what to do when presented with a tablet or a spoonful of medicine? Do they find the medication impossible? Do they have difficulty swallowing the formulation? Do they lack understanding of what a medication is for? Do they understand what will happen if they don’t take the medication? Attempts should be made to encourage the resident to take the medication by normal means. This may be achieved by giving regular information and clear explanation.
The resident must have every opportunity to understand the need for medical treatment.
Identify and respect the resident’s wishes and beliefs about medication.
You should take time to sit down with residents and relatives to find out what their wishes, preferences and religious beliefs are and when they would like them to be considered.
Care home staff must:
- Always record meetings
- Record instances where residents state they do not wish to take medicines
- Respect, understand and document the resident’s wishes
You should involve the resident and/or those important to them to make shared decisions about medication.
Care home staff must:
- Actively identify the most appropriate relative or person with power of attorney
- Consider other healthcare professionals e.g. GP, pharmacist, carers, nurses and anyone else who may know the resident very well
- Record decisions in care plans and share this with relevant members of the team ensure residents are at the centre of any decision making
Polypharmacy is the prescribing of multiple medicines to one individual. This can be appropriate as older people tend to have multiple conditions. Inappropriate polypharmacy can cause adverse effects.
Medicines optimisation reviews ensure that residents receive medicines which improve their quality of life. The benefits gained from medicines must outweigh the risks.This ensures that medicines don’t interact with each other or with any disease the resident may have.
Watch the video to understand the importance of the first two R’s of safe medication administration.
This information will come in useful for the final steps which tests your understanding. You can come back to, pause or replay the video as you need.
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