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Right medicine, right dose, right time
Watch the video to learn more about right medicine, right dose, right time while administering medicines.
This presentation is going to take you through the final Rs of medicine administration, right medicine, right dose, right time. There are many steps that are taken before a medicine can be administered to a resident, a member of the care team will order the medication, the description will be generated by the surgery, the prescription is then received by the dispensary and clinical and accuracy checks are made before the medicine is delivered to a care facility. When these medicines arrive in the care setting they are then checked against the medicines that were ordered to ensure that all the medicines are there. Despite all these checks that happen, mistakes can still occurred albeit rarely.
Therefore it is important that you check the medicine before you administer it to the resident. If medicines are supplied in original containers, you need to check the medicine name against the name on the box, the dispenser label and the MAR. When medicines are supplied in blisters (MDS), you need to check that the medicine name on the MAR and the blister label or backing sheet to check that they are the same. With so many different medicines manufacturers, the appearance of medicines can vary significantly. For example, amlodipine 5 mg tablets can be small, oval, grey tablets or small, round white tablets. The patient information leaflet that is supplied with a medicine often contains a description of the medication.
If you are really unsure you can always check with the pharmacy or dispensing doctor that made the medicine supply. Many residents in care homes will take several different types of medicines. It is important that are giving the right medicine at the right time. Before administration, you should check the dose on the MAR are and the dispensed product. Sometimes a dose may have been changed since you last administered a medicine to a resident, so you need to ensure you are administering the correct dose. Administration of tablets are fairly straightforward; you can easily count/ see 1,2 or 3 tablets to administer them. Occasionally there will be an instruction to take half a tablet.
If these tablets are supplied in blisters (MDS) then they will already be halved for you, but if it is in an original pack, you will need to have them. Often tablets will be scored, which means they have a line down the middle, making them easier to half. Tablet cutters are available to purchase if you need to cut tablets regularly. Speak to your manager if you feel your setting would benefit from having a tablet cutter. Liquids are formulations which require a bit more care when measuring doses, so there is a short video to watch to demonstrate how this should be done.
Liquid doses will be written in millilitres or an expression of the number of 5 ml spoonfuls, or sometimes even as a number of drops. The amount of topical preparation required at each application will vary depending where on the body it will be used. Having clarified that we have the right medicine and the right dose we need to consider if it is the right time. The times a medicine should be administered would be documented on the MAR they should say breakfast, lunch, teatime and bedtime or something similar. Your care setting have defined time for breakfast etc and it is important to clarify what these are. In addition to these general timings, some medicines have most specific timing requirements.
For example, some medicines are better absorbed on an empty stomach so need to be taken 30-60 minutes before food. Others can cause irritation to the stomach, so need to be taken with food whilst others can interact with calcium or zinc so must be given 2 hours apart. ‘When required’ medicines do not need to be taken regularly but when the resident reports symptoms ‘when required’ medicines include painkillers, laxatives, sleeping tablets, indigestion, remedies and medicines for agitation. For residents who experience regular pain or constipation, these medicines will be prescribed. But for patients who experience these symptoms infrequently, they may require homely remedies. A homely remedy is another name for a non prescription medicine that is available over the counter in community pharmacies.
They can be used in a care home (with and without nursing) for the short-term management of minor, self-limiting conditions, eg headache, cough, constipation. The decision to administer may be taken by the care worker without necessarily consulting the general practitioner. Homely remedies should be purchased for general use by the home, and should not be labelled for individual residents. Remedies may be brought in by the relatives of a resident and they should be kept separate for the use of that resident only and not used as stock. Homely remedies should be stored in a locked medicine cupboard separate from the rest of the prescribed medication.
When a homely remedy is given it should be administered as per the instructions on the box or bottle. Homely remedies should only be administered by staff with appropriate medication training. Care must be taken to ensure that any home remedies given are suitable for the resident and do not interact with their prescribed medication. If there is any doubt about the suitability of the medication, then the care staff must contact the community pharmacist responsible for the home’s medicine supply, or the GP. If symptoms persist for longer than 48 hours contact the GP surgery for advice. The administration of all homely remedies needs to be recorded on the resident’s medication administration record (MAR). Expiry dates of the home remedies should be checked regularly.
If homely remedies are used in your care setting then a written policy must be in place. So we’ve looked at the last Rs of Medicine administration. But what if the right medicine isn’t the right medicine? As the care worker administering medicines you are the most appropriate person to help the prescriber decide if the medicine prescribed is the right medicine for your resident. The prescriber will assess if there is a clinical need for the medication, but you and your fellow care workers can help to monitor the medicine, and of course, will be the ones administering it.
If you identify any issues, they should be raised with your line manager who will then liaise with the appropriate health care professionals to address these issues. During medicine administration, you will be the one who identifies potential
problems: Does the resident have difficulty swallowing? Do they not want to take it because they don’t know why it’s been prescribed or they don’t think it’s working? Or are they worried about adverse effects? An adverse effect can be called a side effect or adverse drug reaction. An adverse drug reaction (also known as an ADR) is an unwanted or harmful reaction which occurs after administration of a medicine. An adverse drug reaction can occur from prescription medicines, herbal medicines or over the counter medicines. As a care worker, you will need to look out for adverse drug reactions and any suspicions should be reported immediately.
Some adverse drug reactions are predictable due to the way that the medicine works in the body, for example getting diarrhea when taking oral antibiotics such as penicillin. However, some adverse reactions can’t be predicted and are quite rare, for example a severe allergic reaction to penicillin. Any adverse drug reactions should be recorded on the resident’s MAR chart. The patient information leaflet that is provided with the medication can give you information about the adverse effects associated with the medicine. You can also contact your local pharmacist for information. So let’s have a look at some of the problems that can occur during administration.
Lost medicines, so this can happen where a tablet gets dropped during a medicines administration and isn’t found or when a resident’s medicine is misplaced. Missed medicines, there could be many reasons why a medicine is missed, one example could be that the resident is asleep during the medication round. Spilt medicines, this would occur during the medicines round, sometimes the care worker can spill the medicines, sometimes it’s the resident. Refusal of medicines, as I mentioned earlier, patients have the right to refuse to take the medicine. If it continues to be a problem you need to inform the manager who can liaise with the appropriate healthcare professionals.
Wrong medicines, I’ve mentioned earlier that there are the rare occasions when the wrong medicine is supplied from the pharmacy. Another unfortunate event is when the wrong medicine is administered. Again these events are rare but should it happen it should be reported to the manager immediately. There should be a procedure to follow in this eventuality. Vomiting after taking medicines, if a resident vomits after taking a medicine, our health care professionals should be contacted to ascertain what to do. The action will vary on the type of medicine, how the resident is feeling and how long it has been since they vomited. Any suspected adverse drug reactions should be documented.
Administering medicines to residents can be a daunting task. You need to ensure that they are administered correctly by referring to several sources such as the residents care plan, MAR chart, medication label and the resident themselves.
As a care worker you must ensure the resident you care for have a regular medicines optimisation review. Care staff must ensure that a review has been conducted which:
- Identifies the dose of medicines which is most effective for the resident
- Identifies the formulation which is acceptable to the resident
- Ensures any changes that have been made is documented in the care plans
- Involves the appropriate healthcare professionals e.g. GP, pharmacist or community geriatrician ensures the involvement of residents in any medicines optimisation review
Ensure an advance care plan, which includes medication, is in place for the resident, with a regular review when their condition changes.
You must ensure that:
- Discussions between the resident, family members and multi-disciplinary team members are enabled
- Within these discussion, advance decision care plans and how these relate to residents medicines are considered
- Any decisions, wishes or preference not to take medication, is recorded in the care plan as part of advanced decisions
- You monitor progress and trigger discussion with the multi-disciplinary team when necessary
Work with other members of the multi- disciplinary team to ensure that the resident’s medication needs are met. As people, have increasingly advanced degenerative conditions they have increasingly complex and more difficult nursing needs. Members of the multi-disciplinary team have unique knowledge and skills which can be used to support the residents
Speech and language therapists: advise where the swallowing difficulty may arise i.e. mouth, throat or oesophagus provide advice on appropriateness of oral feeding
Dieticians: review nutritional status of the resident ensure residents weight is maintained
Dentists: review oral hygiene, appropriateness of dentures
Pharmacists: ensure formulations are appropriate identify the need for medicines to be crushed or altered
Occupational therapists: ensure that eating is a meaningful activity identify the need for adaptations to help with eating
Physiotherapists: identify the appropriate posture for the resident identify if the resident needs aids or help with their posture
Clinicians: ensure that the goals and aims of treatment are still appropriate identify when to involve the relatives ensure an advanced life directive is in place Communication is key, and staff must ensure that care records are shared within the multidisciplinary team and they know how to contact the agencies
Watch the video to get a better understanding of what to consider for these 3 ‘Rs’ 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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