Archive for December, 2007

Prompting Vs Administration of medicines…..

December 17, 2007

j0178847.jpgA topic close to many of our hearts if we are in the business of caring for people who take or use any form of medication. It’s a mine field isn’t it? If you or your care staff were administering medicines to your service users – you would want to ensure that they were fully trained and competent to do so wouldn’t you? Me too.

Supporting people in taking their medication is all a bit scary. What if you get it wrong? The results could be disastrous and therefore many agencies prefer to think they are acting on the safe side by not getting involved in medicines administration at all.

As a result care organisations are still not training their carers in this vitally important area of care. Why? Because they are under the misperception that because they only prompt the administration of medicines, and do not (in their eyes) administer it, they therefore do not need to go to the trouble or expense of training their team.

BUT – did you know that in the eyes of the law Administration means to both personally administer AND to prompt the administration of medicines?

Therefore, if you are prompting medication you are actually administering it, there is no difference in the eyes of the law. The same checks need to be in place, the same record keeping needs to be completed, the same level of knowledge is required to fully support the client – even if you only prompt from a monitored dosage system. The monitored dosage system must be prepared by the pharmacy or a dispensing doctor for you to legally prompt or administer from it and whilst they have a responsibility to ensure that it leaves the pharmacy with the correct medication inside, you still have the responsibility to ensure that the right person gets the right dose of the right medicines by the right route at the right time.

So – if you are supporting service users who use medication you must ensure that you give your care workers the best possible training, relevant to your sector of care, that meets CSCI and Skills for Care requirements in order to safe guard your clients, your care workers and your business.

For further information about administration vs prompting or training requirements contact Tracey Dowe at Momentum People Ltd on 01793 700929 or email


Secondary Dispensing – Still an Issue in Care

December 13, 2007


This is an issue that I came across recently whilst delivering training in medicines management to a domiciliary care.  I was surprised to hear how much it still happens out there and feel that it’s an area that needs to be highlighted and discussed – put out in the open if you like.

What is secondary dispensing?

Let me give you an example.

You have service users who visit a day centre and will be there for there lunch time medication. The medication is dispensed by the pharmacy into a monitored dosage system which you feel is a bit big for the service user to take to the day care centre with him or her so you take out the lunch time doses and put them into an envelope with their name on it for him/her to take with them.


You have a service user who goes home occasionally for the weekend. You don’t want to send the whole cassette with their medication in with them, perhaps you’re not sure it will be returned when they come back, so you put the weekend medication in to another container with their name on it and brief instructions as to when they should be taken.

What’s wrong with that you might say?

The issue is that you are not qualified to dispense medication. You are giving out medicines that are not labelled properly or legally and the medication is not identifiable in any way. It also does not give the service user proper dose instructions or warning instructions or safe storage instructions. By giving someone medication in this way you are taking responsibility for it, if some thing goes wrong you are liable because you acted outside of the law.

So that’s all very well you say – but what is the solution? How do you ensure that the service user gets the medication at the day centre or during home visits?

There are two possible solutions. The first is to send the service user with the medication in the original pack, be that the boxes and bottles dispensed by the pharmacy or the monitored dosage box (e.g. nomad tray, blister pack, dosette).
If your policies do not allow this to happen at present, then in order to operate with in the law perhaps it is time to review those policies.

The second option is to speak with the GP practice and the pharmacy to arrange to have the doses needed for outside your care dispensed in to separate containers that the service user can take with them. The medication must be dispensed by either a pharmacy or a dispensing doctor though, not by your staff.

But we’ve been doing this for years you cry! Yes…I know but it doesn’t make it right.

But our inspectors have never said anything about it you tell me……yes…..but perhaps as knowledgeable as they are they are in legislation and guidelines they are not experts in medicines and do not know that what you’re doing is not legal. When something goes wrong ignorance will not be a defence so better to put things right as soon as possible rather than hoe it will be ok and continue to break the law.

For further information or any questions about this or any other medication issues please contact


Medicication Administration Records

December 5, 2007


Medication administration records have been widely used in residential care for many years but not so regularly in domiciliary care until quite recently. It’s great to see that they are being used much more widely now in home care and I look forward to the day where they are used in every agency I visit or train.


Why? Because they are essential to good medicines management and to provide you with evidence of medicines support or administration. They are your back up should anything be challenged. They are your way of ensuring that you meet the responsibility that you have under the law of ensuring that the 5 checks are made:-


Right patient

Right medicine

Right dose

Right route

Right time


CSCI have published a guidance document that addresses medicines administration record sheets – what information should be recorded and how they should be used. However, in practice it would appear that very few organisations are aware of this guidance and/or how to interpret it and as a result I see a wide variety of different interpretations. My concern is that the vast majority of record sheets either do not contain the required information and/or they are not being completed appropriately by the agency staff. This may be that the agency staff have not received proper training on how to use the forms, it might be that forms need to be reviewed or it might be that the agency policy is out of date or in need of review by an expert. When any of these scenarios apply – it leaves the agency wide open to litigation should an error occur that is not documented properly.


So let’s clear up some myths shall we!


It is the responsibility of the agency to provide medication administration records for their care workers to use.

The form should contain:-

The name and address of the service user

Date started

Medication details including name, strength and dose of medication

Time given/prompted/observed

Signature of care worker

Code for Administration or prompting or observing


It’s worth pointing out here that the medication details must be given for each individual medicine. It is not sufficient to simply put “Contents of Nomad” or “Dosette box” .  Whilst it is the responsibility of the pharmacy to ensure that the correct medication is dispensed – you are responsible for making your own checks – you cannot abdicate this responsibility and therefore you need to know that what is in the compliance aid is what is being given to the service user. Now you may not know which tablet or capsule is which – however you should know that the names on the box match the names on the chart (which have been checked against the prescription details) and that there are the correct number of tablets or capsules there to be given.


 It might also be useful to have space for the name of the GP, any allergies, and comments.


For further advice and information about medicine Administration records or if you have any questions please contact