Legislation and Proper Administration of Drugs

1.1

Legislation
The medicines Act (1986) – This act governs the manufacture and supply of medicines. The act also defines the categories of medicines, those that can only be supplied with a prescription, those that must be supplied by a pharmacist but do not need a prescription and those that can be brought on generally.

The Misuse of Drugs Act (1971) - The main purpose of the act is to prevent the misuse of controlled drugs. It puts in place the law that allows the production, supply and possession of Controlled drugs.

The Misuse of Drugs (Safe Custody) Regulations (1973) - This act regulates how controlled drugs are stored. The Requirements change depending on the premises where the drugs are being stored.

The Handling of medicines in Social Care (2007) - This is published by the RPSGB and is very useful document covering all aspects of medication in a social care setting.

Health and Safety at work Act (1974) - The Act provides legal framework to promote, stimulate and encourage high standards of health and safety in the work place. Everyone has a duty to comply with this Act.

Health and Social Care Act (2008) - Provides standards that have to be met by those providing care.

Data Protection Act 1998 - When handling personal information about individuals you have a number of legal obligations to protect that information under the data protection act.

Control of Substances Hazardous to Health Regulations (COSHH) - The COSHH Regulations impose a number of obligations on employers the object which is to promote safe working with potentially hazardous chemicals. Guidelines from the Royal Pharmaceutical Society of Great Britain (RPSGB) is the regulatory body for pharmacists and provides guidelines and information.

The National Institute for Health and Clinical Excellence (NICE) - Was established as special Health Authority in April 1999 the role of NICE is to provide guidance, set quality standards and manage a national database to improve people’s health also to prevent and treat ill health.

The British National Formulary (BNF) - The BNF provides UK healthcare professionals with authoritative and practical information on the use of medicines.

The Commission on Human Medicines (CHM) - The Commission is regulatory body for medicines and healthcare products.

The Care Quality Commission (CQC) - The CQC regulate all organizations that provide care, they provide standards for organizations to adhere to. The regulation that is relevant to medication is Management of medicines regulation 13.

Organisational policy on medication - All organisations involved in the administration of medication has policies and procedures for the safe handling of medicines. The policy will cover Prescribing, dispensing, administration, storage and disposal. The medication policy is based on Acts of Parliament, Regulations and guidelines, Care Plans of the service user that state their needs and medication they are using.

2.1

Name: Analgesics (Paracetamol)
Effects: Analgesics are used to relieve pain such as headaches.
Potential side effects: If taken over long periods of time potential side effects could include irritation of the stomach, liver damage and sleep disturbances.

Name: Antibiotics (Amoxicillin)
Effects: Antibiotics are used to treat infections caused by bacteria.
Potential side effects: Diarrhoea, nausea and vomiting. Some people get a fungal infection such as thrush.

Name: Antidepressant (Cipramil)
Effects: Antidepressant work by changing the chemical balance in the brain and that can in turn change the psychological state of mind.
Potential side effects: Blurred vision, dizziness, drowsiness, increased appetite, restless, shaking or trembling, difficulty in sleeping and decreased libido.

Name: Anticoagulants (Warfarin)
Effects: Anticoagulants are used to prevent blood clotting.
Potential side effects: Risk of excessive bleeding (Hemorrhage) passing blood in urine, faeces, severe bruising, prolonged nose bleed.

Name: Antihistamines (Piriton)
Effects: Antihistamines are used to treat the symptoms of allergic reaction.
Potential side effects: drowsiness, impaired thinking, dry mouth, dizziness, constipation, blurred vision and an inability to fully empty bladder.

2.2

For certain medications it is important that other checks are made before and after administering for example, blood sugar should be checked before administering insulin.
An individual’s pulse must also be taken before administering medication for heart irregularities such as dioxin.

2.3

Common adverse reactions to medication can include:

Nausea
Vomiting
Diarrhoea
Constipation
Headache
Fever
Dry mouth
Skin rash

Swelling to lips or face potential signs of anaphylactic shock other signs are swelling of the hands, face and body, Redding of the skin, sweating, blotches, faintness and difficulties in breathing this needs urgent action as it can be fatal. Reactions usually occur within an hour of taking the medication rarely it can develop a few weeks after and may cause damage to the kidney or Liver.

If individuals have any reactions to the medicines then organisational Policies and procedures should be followed.

Inform my manager, deputy or on call.
Phone the doctors, Pharmacist to seek advice.
If the reaction is serious, then call for an ambulance.
The individual would be observe and monitor and the medication stopped.
It’s important that all information in the individual care plans, daily reports and MAR is recorded and kept up to date.

2.4

Oral - This is the most common method for the administration of medication that is taken via the mouth. This can be in forms of tablets, capsules and liquids. If a service user finds it difficult to swallow tablet or capsule medication is also available in liquids, suspensions and syrups.

Inhalation - The medicines used in Inhalation with an inhaler which are used for individuals who have respiratory condition as these deliver the medication directly to the lungs..

Topical - Topical medication comes in the form of creams and gels and is applied directly to the skin.

Intra-aural - Medication administered to the ear, when there is a medical condition in the ear medicine may be delivered by instillation. This is when drops are delivered in a controlled way so the fluid stays within the area.

Intra-ocular - Medication administered to the eye. This is normally in the form of drops or ointments.

Rectal - The administration of rectal medication is an invasive procedure this is usually a small plug (A suppository), this medication is absorbed very quickly into the blood stream. To administer medication via this route, you must have specialised training.

Vaginal - This medication usually comes in the form of a small plug (a pessary). Pessaries are designed to deliver medication for a localized medical problem in the vagina or to deliver medication to organs close by. To administer medication via this route, you must have specialised training.

Intravenous - The administration of a drug or fluid directly into the vein. This is carried out by qualified healthcare personnel doctors, nurse and paramedic. The medication goes directly into a vein and usually over a period of time which ensures a rapid up take of the medicine or fluid.

Injections - medication that is usually delivered by syringe and needle.

Subcutaneous - This is an injection under the skin.

Intramuscular - This is an injection into the muscle. Only given by doctors and appropriately trained registered nurses and paramedics.

3.1

Good hand hygiene is essential when administrating medication to help prevent cross contamination.

Oral - This is medication is taken via the mouth most commonly in the form of tablets, using a non-touch technique these should be administered direct from the NOMAD (blister pack) system used in Breach House. Medication cups and spoons should be used to administer medications. Some tablets must not be crushed as this can change how the medication works.

Inhalation - For those with respiratory difficulties inhalers are used and can be either worked by the individual when they breathe in or set automatically to activate when the individual breathes in which is measured by the doctor prescribing. A spacer can also be used which is a tube between the service users mouth and the inhaler, a measured dose is dispensed into the spacer and the service user inhales the contents of the spacer. Nebulisers can also be used and work differently a liquid is placed into a chamber at the base of a mask, a fine mist of the medication is released into the mask and the service user inhales.

Topical - Topical medication comes in the form of creams and gels and gloves should be worn and instructions should be followed.
Intra-aural - Hands should be washed and gloves should be worn, instructions should be followed. Following administration gloves should be disposed of and hands washed.

Intra-ocular - Hands should be washed and gloves should be worn, instructions should be followed. Following administration gloves should be disposed of and hands washed.

Rectal - Hands should be washed apron and gloves should be worn instructions should be followed gloves and apron should be disposed and hands washed afterwards.

Vaginal: Hands should be washed apron and gloves should be worn instructions should be followed gloves and apron should be disposed and hands washed afterwards.

3.1

Prescription - The Prescription must be dated, show the Name of the Medication, the dose, how frequently it should be taken and by which route. The Prescription must have the name and signature of the person who has prescribed the medicine and their contact details. The Name, address and date of birth of the person the medicine is for.

Medication - Date of dispensing, the name of the medicine prescribed, the dose and frequency of the medicine, the route by which the medicine should be taken, when the medicine should be taken, full name of recipient who the medicine is for. Special instructions, warnings and cautions, Name of the pharmacy, use by date and Keep out of reach of children.

Medical Administration record (MAR) - This is an official record and states all the medication that the service user you support is receiving.
The MAR should included

Name of service user
Date of birth
Known allergies to medicine
Information provided by pharmacist
Name of medication
Dates prescribed
Prescriber
Quantities
Dose
Forms
Routes of administration
Time to be given
Date the medicine received
Date the medication creased and who authorised this
Conditions that may affect medicines being taken

As the MAR chart is a working document it must be signed to record administration of medicine by the member of staff giving the medicine and must show the date when the medicines are administered.

4.2

Certain medications need to be taken at particular times of the day in order to achieve the goal of the medication for example, diuretics are given in the morning so that the person is awake and can access the toilet safely; Zopiclone is given at night to aid sleep (if given in the day, the person might suffer a fall); insulin is given before meals to allow it to work effectively. This is why it’s imperative to clarify the instructions from the prescription to ensure the service user is treated in the correct manor allowing the medication to perform in optimum conditions.

5.3

Anyone who will be administering medication in a care setting must be trained first and in this training you are made aware of the importance of all the laws, legislation, policies and procedures into administering medicine. This training also covers errors in medication as it just as important. All errors in medication should be reported straight away and it is equally important that errors are recorded in the correct manor, factually and legible. Failure to declare an error could be serious for the individual and may lead to litigation against the company and yourself. When there is an error in medication administration it’s important to follow the correct policies and procedures.

Steps to follow.

A person in charge checks the service user who medication error it is.
Seek Medical Advice
Inform the manager
Record error on the individual’s care plan, daily records, health records and MAR sheet
Complete an incident report
Send a report to the individuals GP
Inform individual’s relatives if necessary
Send a report to the regulatory authority (CQC)

5.5

To ensure that the service user is taking their prescribed medication and that their condition does not deteriorate. It is workplace policy to check medication is taken by the service user. If a service user gives their medication to another service user it could result in overdose for the service user for which the medication is not prescribed causing them to feel ill or can be fatal.

5.7

There are different pieces of legislation and guidelines in place regarding the ordering, storage and disposing of medicines, these legislation and guidelines should be stated in policies and procedures. Surplus, unwanted or expired medicines should not be stored in residential care setting as they cannot be used for anyone else.
They should not be placed in house hold waste but in a clinical waste bin. All surpluses, unwanted or expired medicines should be stored safely until they can be returned to or collected by the pharmacy who supplied them who then dispose of them in the correct safe manor.

A record of all medicines leaving the setting should be recorded these should include:

The service user’s name
The name, strength and quantity of medicine
The date the medicine is returned
Signature of person returning the medicine
Signature of the pharmacist receiving the medicine
A receipt should be obtained