medication and prescription 1

1. Medication groups and their use
1. Antibiotics
They are used to treat bacterial infections, some can be used to treat a wide range of infections (broad spectrum antibiotics) and some only in specific infections (narrow spectrum antibiotics).

2. Analgesics
They are used to relieve pain, to control pain and/or might help to reduce temperature
3. Antihistamines
They are used to treat allergic reactions caused by other medicines, insects, stings, toiletries etc.
4.Antacids
They are used to treat symptoms of indigestion and discomfort associated with it i.e. heartburn, bloating etc.

5.Anticoagulatns
They are sued to prevent forming blood clots which can lead to heart attack, stroke, deep vein thrombosis, pulmonary embolism etc.

6. Psychotropic medicines
They are used to treat, mental illness i.e. schizophrenia, depression, anxiety etc. by controlling symptoms of the disease. Psychotropic medicines do not cure mental illnesses but work by alleviating symptoms of mental illness.

7. Diuretics
They are used to maintain optimum fluids retention in the body by, for example, removing excess water (fluids).
8. Laxatives
They help with constipation by stimulating bowel muscles or/and softening the content of the bowel. Therefore they are used to relieve constipation and clear the bowel.
9. Hormones
They are used to regulate natural bodily functions which were disrupted by factors such as illness , ageing, certain health conditions , stress etc.
10. Cytotoxic medicines
They are used in treating some types of cancer. Very aggressive drugs which along with killing cancer cells , will also damage healthy cells.
2. Routes of administration
Oral
Oral route of administration means , that medicines are given by mouth and absorbed whilst in the stomach or bowel. Oral types of medicines have often form of tablets, capsules, liquids, dispersible tablets and powders, sometimes gels. Some of the medication might be taken with meals, before or after, and some on empty stomach using large amount of water. MAR sheet or leaflet/doctors instruction will provide information how and when to take particular medication. Oral medication should be always taken whilst standing or sitting upright, in order to avoid choking.

Buccal
Administered by mouth as a tablets and have to placed between top gum and the cheek until dissolved. The tablet should not be chewed, sucked or swallowed but dissolved but dissolved itself whilst still in the mouth.
Sublingual
Administered by mouth ,by placing tablet or spray under tongue. Nitrates which are used to treat angina are often administered in that way.
Inhaled
Administered via airways ,directly to the lungs. It allows to administer smaller doses and avoid major side effects. Inhaled medicines are usually used to treat respiratory conditions and administered using inhalers or nebulisers.

Intra-nasal
Administered through nose. They have often form of drops, creams, sprays or vapours and administered by placing medication into the nostril and breathing in. Head should be tipped forward during this procedure. Creams should be applied onto the inner wall of nostrils.
Intra –ocural
These medicines come in the form of drops or ointment and are administered into the eyes. It is very important to store the medications in the right temperature, check the date on the bottles and use separate bottles for left and right eye. When administering this type of medicines, it is advised to pull gently lower eyelid, administer medication and wink afterwards.
Intra-aural
Administered through ears, by placing medication into ears. Head should be tilted when administering medication, which usually comes in a form of drops. Excess amount should be wiped by using a swab. Similar precautions as with inter-ocular medications, have to be applied, such as using separate bottles to each ear, checking dates and date when bottles were open, hand wash before and after administration.

Topical
This route applies to medications administered by outer surface of skin. Topical medicines have often form of suspension, liquids, sprays, lotions, gels, soaps, shampoos etc. They have to be applied by using gloves and on a clean, dry skin. Bottles, tubes etc. when opened, have to be dated and stored accordingly.

Rectal
This route applies to medicines administered into rectum and usually come in the form of suppositories, enemas, ointments and creams. The medication is absorbed directly from rectum which allows to avoid major side effects. However administration of this type of medication is unpleasant and often embarrassing for service user, therefore person who administers the medication should approach the procedure in a sensitive manner and respect privacy, and dignity of person receiving the medication. High standards of hygiene is also required.
In order to administer the medication, service user should lie on the left side with knees drawn up towards their chest. Some lubricate might be used to ease the administration and service user has to agree to receive the medication.

Vaginal
Are administered by inserting into vagina and often used in vaginal infections. They usually come in the form of pessaries, ointments, creams and gels. When administering the medication, the same precautions has to be taken as with rectal administration. Service user should to lie on their back, with bend knees and legs slightly apart. Use of PPE in both, rectal and vaginal administration, is imperative.
Transdermal
This medicines comes in a form of a patch which is placed on the surface of the skin. The patch will need replacing, depends on the particular medication. The patch has to be applied on a dry, clean and unbroken skin. The person who is administering the patch is required to wear gloves. Also, it is a good practice to date the patch, so it is easier to record when it is due to be replaced. When replacing the patch, the new one should be always placed on the different part of skin, if used to treat chronic illness. Patch should not be cut. Sometimes the patch can irritate skin but it is usually mild and improves after a while. Patches are often used to treat chronic pain or in hormonal imbalances/contraception etc.

Percutaneous Endoscopic Gastrostomy (PEG)
This route of administering medicines is used in patients who, due to varied health conditions, required surgical insertion of PEG tube directly to the stomach. The medicines administered come often in a form of liquids or suspension. They cannot be administered in a form of a tablet, because it would have blocked the tube, therefore they have to be dissolved in a water before they are given to the patient. Person who is administering medication to patients with a PEG has to undertake additional training in PEG management.
Subcutaneous
This route of administering medicines requires injection just below the skin, into the fatty tissue. This technique of administration requires staff to undergo additional training. This route of administration is often used with insulin.

3. Legal classification of medication
1. General Sales List
This type of medicines can be bought in a supermarket and, according to Commission on Human Medicines, is safe to be sold without supervision of pharmacist or doctor. However, the medication have to be sold from lockable premises and in original packaging with instruction how to use them.
Some stronger variants of GSL might be classified as POMs or P medicines.
2. Pharmacy
P medication can be bought without prescription but under supervision of registered pharmacist. The reason for that is, the medicines might cause strong side effects, interact with other medicines or might not be suitable in certain health condition etc. Pharmacist might ask some questions in order to establish whether the medicine is suitable for a client.
3. Prescription Only Medication (POM)
As the name states, these medication can be only obtained with prescription due to their serious impact on a health, side effects or possible abuse. Authorised practitioners who can prescribe this type of medication include doctors and dentist or nurses, pharmacists, midwives who completed independent practitioner training.
Some POMs fall into category of controlled drugs i.e. morphine, methadone and pethidine
4. Controlled Drugs (CD)
CD are very strong medication, therefore there are special legislative requirements in place regarding their supply, storage and administration. Legal classification has been introduced in order to minimise the risk of abuse/misuse of those medication.

4. Why additional legislative requirements for controlled drugs
Control drugs are open to misuse and abuse, and can be very dangerous .They must be stored in metal cabinet which complies with Misuse of Drugs Regulations Act 1973. CD register must be bound with numbered pages and administration must be recorded by two people, one administering ,and one to witness. This has to be recorder
On a MAR sheet as well.
5. Key points of the following legislation
The Human Medicines Regulations 2012
Regulates manufacturing, distribution, import, sale and supply of medicines which are intended for human use. The Regulations consolidate over 200 pieces of legislation relating to medicines.
Misuse of Drugs Act 1971
This controls medicines that may cause harm if taken. These are called Controlled Drugs. The main purpose of this act is to prevent the misuse of Controlled Drugs.
The Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007
This specifies how controlled drugs are stored and is referred to in the Standards for care homes. Controlled drugs must be kept in controlled drugs cabinet that complies with these regulations. This legislation controls record keeping of clinical information for the individuals who are looked after.
The Control of Substances Hazardous to Health Regulations 2002
This requires all employers to take all reasonable measures to protect their employees from any potentially dangerous substances or materials that they come in to contact with whilst at work. One of the most common hazards to be found in the workplace is the use, handling and the storage of hazardous substances including medicines. COSHH was introduced to help guide employers on how to safely control the use of hazardous substances and to reduce the risk that may potentially cause harm.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010
This piece of legislation comprises of standards which any registered provider of adult health and social care has to implement and follow. Care Quality Commission established 28 regulations which relate to quality and safety of care delivered to vulnerable people. Regulation13 and outcome 9 apply to safety and quality of medication management.
6. How the following guidelines relate to safe handling of medication
A The Royal Pharmaceutical Society’s guidelines ‘The Handling of Medicines in Social Care’
This document contain guidelines for anyone involved in health and social care and who is involved in medicines’ management. RSP is the professional body for pharmacists in England, Scotland and Wales.

Workplace policies
These are in place in order to define responsibilities of anyone involved in administration of medicines as well as to protect interest of staff and service users. Workplace policies have to be complaisant with CQC guidelines.

7. Consequences if not working in line with legislation for:
Yourself
If I am not working in line with policies and procedure in my workplace, it means that I am breaching my terms and conditions of employment. Therefore I might be subject to disciplinary procedure and eventually, dismissal from my job.
Service users
If I do not follow guidelines, service users might be given wrong medication, wrong dose, no medication at all etc. The consequences of that might be fatal for the service users. They might for example deteriorate or even pass away.
Employer
If I do not comply with legislation and guidelines, my employer might face closure of the care organisation, fine, imprisonment or even prosecution.

8. My role in handling medications
Administration of medicines is a part of my job role. I have undertaken adequate training already and in-house practical training. When administering medicines I am proceeding in-line with my workplace policies and procedures, and under Health and Safety at Work Act 1974. I make sure that my knowledge regarding administration of medicine is up to date and that I know my own limitations in that area. I have to know what medications are used for particular service user and what is their purpose, dosage, side effects, contra-indications and precautions. I administer medications only to the service user to whom they were prescribed and take into account the individual’s preferences regarding the process of administration. When in doubt I always seek advice and help from professionals i.e. pharmacist, doctor, manager etc.
The golden rule when administering medicines is that the correct medication has to be given in the right dose and time, to the correct person ,using the right route of administration.
9. Role of the key people involved in the process of:
Prescribing medications
The role of prescriber is to assess health condition of an individual and to prescribe an adequate medication according to guidelines by the National Institute for Clinical Excellence. The prescriber has to make sure that the medications will not cause any allergic reactions and is not contra-indicated. They should also explain to the service user why they are prescribed this particular medication, how to take it, what dosage and when. The prescriber has to make sure that the prescription written is valid i.e. written or printed on a secure prescription form, with serial number and anti-counterfeiting features, with prescriber’s signature.
The person who is authorised to prescribe medications is usually GP, dentist or specialist doctors. Nurse or pharmacist can also prescribe medicines after undergoing additional training.

Dispensing medication
The person dispensing medication is a pharmacist. Their role is to check prescription whether it is accurate and valid. Prescription has to be authorised by GP , independent or supplementary prescriber in order medication to be dispensed. Pharmacist has to give information regarding the medication and supply devices/containers which allow the service user to take the medication. Pharmacist is also responsible for supplying information regarding medication storage, any special requirements, recording and reporting requirements.

Obtaining and receiving medication
The manager is usually the key person responsible for obtaining and receiving medication. However there might be ‘designated person’ appointed to order and receive medicines. Person who is dealing with this aspect of medicines’ management has to be fully trained and competent in handling medication. Also, they are the only person who deals with prescription orders and any issues which may have arisen.
The key person has to be familiar and up to date with legislation regarding medicines administration, health and safety regulations regarding medication storage, preparation and disposal as well as, to be responsible for record keeping.
Whilst ‘designated person’ provides support with ordering and receiving of medications, ultimately the manager is responsible for checking whether the received medications correspond to the order and whether the order was correct in a first place.

Administering medication

I have already completed basic training in administration of medicines and I administer medication to the residents on a regular basis.
I follow policies and procedures when giving out medication, including health and safety, infection control, confidentiality, dignity and equality regulations. My responsibility is to administer the right medicines to the right service user, at the right time, in the correct dose, through the right route. Therefore, I am directly responsible for residents’ health and life.
Equally important is to be able to maintain good relationships with service users, so they trust me enough to take medicines, I give to them.

10. Limitations when administering medicines
I am permitted to:
I am allowed to administer medication, including controlled drugs through all routes except vagina, rectal, subcutaneous and PEG. I have to strictly follow instructions regarding time, dosage and route of administration medicines. I have to record every medicine given in MAR sheet and in case of PRN and controlled drugs, accordingly records on separate sheet and DDA record book. I am permitted to book in any received medication and counter sign them. I can liaise with pharmacy ,GP or any prescriber when in doubt regarding administration of medicines.

I am not permitted to:
To stop medication, change dosage, time or route of administration. I am not allowed to give any other medication to service user which has not been prescribed and approved by GP. I am not permitted to deal with prescriptions, order medicines or dispose of unused medicines.

11. When to seek advice
I will seek advice if I am not sure how to administer medicine, I do not know what dosage should be administered, service user is experiencing side effects or allergic reaction or I am not sure whether certain medication can be taken together, at the same time. I might also seek advice if medications seem to be the same but the packaging is different, received medications have different name but dosage and timing remain the same, dosage has changed, dosage and medications are the same but different frequency or service user received completely new medicines and there is no information about any changes.
People who are competent to advise me are my manager, prescriber or pharmacist.

12. Help regarding administration of medicines within my workplace
I can access support and guidelines within my workplace by asking for advice my manager, who is familiar with all medications used and can decide whether I need to seek further help.
Prescriber and pharmacist are the most competent people when it comes to enquiries regarding medicines.
Both can identify whether a particular medication is suitable for service user, recommend substitute or covert medication if necessary. The will also clarify any doubts which can arise during the process of administration of medicines.

13. Five approved sources of information regarding medication
1. Patient Information Leaflet, Summary of Product Characteristics, instructions on the box or Patient Data Safety ,which are provided with the medication
2. Reference such as British National Formulary and Monthly Index of Medical Specialities which can be accessed in written form or online at www.bnf.org and www.emims.net.
3. Service user care plan and MAR chart which give details what medications has been prescribed ,for what condition and how to administer them.
4. Internet can be a great source of information but is not always reliable and credible. When searching information regarding medicines, it is important to look at UK guidance and regulations as different countries will have different formulations, dosage and regulations.
5. Pharmaceutical companies should be able to answer any queries regarding medicines they are selling, therefore they might be helpful in case of any concerns regarding medicines.

14. Info which has to be supplied with any meds
All medicines have to be delivered with Patient Information Leaflet and personalized dosage instructions from the prescriber. According to Medicines and Healthcare products Regulatory Agency (MHRA) all medicines have to be provided with information such as : ingredients (active and bulking); strength, amount which can be taken without risks to health and the recommended amount, unless advised otherwise by prescriber; what is the medicine for, what health conditions ( indications) ; when the medicine cannot be taken i.e. children under certain age, people with certain health condition or using other medication etc.; how the medication should be taken in order to be effective (precautions) i.e. before or after food, whether special monitoring is required in patients with certain health problems etc. ; what side effects can occur whilst taking medication or after completing the course i.e. nausea, tiredness, weight gain, anxiety etc. ; what interactions with other medicines or certain foods can develop and which medications should not be ken at the same time. Patient Information Leaflet has to contain instructions what steps have to be taken in case of overdose or severe side effects.
The leaflet has to be written using simple language which can be understood by patient and anyone who is supporting them and is not necessary a health professional.
Except PIL, which are aimed at patients, companies (manufacturers) are expected to provide, for each medicine, Data Sheet and Summaries of Product Characteristics. These are in depth sheets designed for health professionals and written using more advanced, medical language.
Electronic copies of PILs ,Data Sheet and SPCs are available online at www.emc.medicines.org.uk.
Pharmacist who dispense medications has to ensure that container in which the medication is supplied contains patient’s name, name of the medication, the dosage, frequency of the medication and the route of administration, directions for use, the date of supply and expiry date, special instructions and warnings for administration, name and address of supplier/pharmacy and the wording ‘keep out of reach of children’.

15. Why to seek info from s/u regarding medication and their condition
It is a part of person centred approach to discuss with service user their heath condition, whether it is improving and the medications they are receiving are helping or maybe they are experiencing unpleasant side effects. Service user might have suggestions regarding the form they prefer to take particular medication and they will often know, whether they are allergic to certain ingredients present in the medication. Overall service user is more likely to benefit from medication taken, when they have opportunity to express their concerns, preferences and inform the care staff whether the medication is helping or rather causing damage. Care staff have to constantly monitor service users’ health and well-being including the effects the prescribed medications have on them.