Archive for the ‘covert’ Category

Essential Standards Outcome 9 pt 6

January 24, 2012

9g Where people who use services receive support with their medicines, the provider has:
●● Additional clear procedures followed in practice, monitored and reviewed for medicines handling that include obtaining, administration, monitoring and disposal. Wherever they are required these procedures include:
— how clinical trials are carried out in line with relevant laws, current guidelines and ethics committee approval
— sharing concerns about medicines handling.

Here you will required to have written procedure for all aspects of medicines management that include how to order medicines, how to receive them into the service including the records that need to be kept too. Detailed procedures for your team to follow with regards to administering medication in line with the National Minimum Standards and the RPSGB Safe Handling of Medicines in Social Care documents which detail the levels of support and administration that can be provided by a carer.

You will need to have procedures and appropriate records that show that you monitor both the administration of medication by your staff and that you monitor self-administration by clients to ensure that it is still appropriate.

When disposing of medicines always return the m to the pharmacy for safe disposal and ensure that appropriate records are kept, unless you are a nursing home, then you must make your own arrangements for safe disposal via a licensed waste carrier service. In both cases, if a resident dies in your care you must retain the medication for at least 7 days in case it is requested by a coroner.

All policies and procedures should be reviewed regularly to ensure that you keep abreast of changes n legislation or local policy. Do yours show a date last reviewed and/or next review date on them?

●● Established arrangements for obtaining pharmaceutical information by a
person who understands the care, treatment or support that is provided
by the service.
Ideally this would be an expert in medicines such as your local pharmacist, PCT pharmacist or GP practice pharmacist. Alternatively this may be an appropriate health professional such as a GP or Specialist Nurse or other health care professional.

9g People who use services receive care, treatment and support that:

●● Ensures medicines required for resuscitation or other medical emergencies
are accessible in tamper evident packaging that allows them to be
administered as quickly as possible.

Next time we’re exploring Outcomes 9i and 9j – the final of the outcomes for medication.

Essential Standards Outcome 9 pt 5

January 17, 2012

9e People who use services detained under the Mental Health act 1983

●●  Receive medicines that are duly authorised and administered in line with the Mental Health act 1983 Code of Practice.


9f People who use services receive care, treatment and support that:

  • follows clear procedures in practice, which are monitored and reviewed and that explain how staff may be permitted to administer homely remedies.

Homely remedies are those medicines that can be purchased by the client or a relative over the counter from a pharmacy, general store of health food shop. Guidance says that carers may support clients with over the counter medicines in the course of their care. And after all, who are we to take away their choice o use these things?

If our care teams are to support our clients with this group of medicines there are certain criteria that need to be met and it is these criteria that you need to be clear on and give clear guidance in your procedures and training for.

If the client purchases the medication themselves (or a relative buys it on their behalf) they should let the care agency know, especially if they require assistance with it from a member of the care team. The care organisation then has a responsibility to check with a pharmacist that that medication is appropriate and safe for that client to take with any other medicines they take and the medical conditions that they have. They should make a record of this conversation and the outcome.  The medication belongs to the client and would be kept by the client (in their room in a lockable cupboard or drawer in a care home) and a record of the administration made on the medication administration record.

I n a care home (residential or nursing) you may choose to buy over the counter remedies to keep in stock in case a resident needs something for a minor aliment such as pain relief, indigestion, sore throat, a cough mixture, a laxative etc. In this instance you must keep these medicines locked away centrally in a separate place to the prescribed medication. You must have authorised in advance by the GP which over the counter medicine can be taken by which resident.

You must also have for each over the counter medicine that you choose to keep, a record of the recommended dose i.e. How much can be taken or used at one time?
How long should you wait before it is taken or used again? Is there a set number of doses allowed with in a set time e.g. no more than 8 in 24 hours? How long do you continue to use that medication if the resident is not getting any better before you refer to the GP? What each medicine is to be administered for and in what circumstance may it be administered?

Once again, these medicines if given or used must be recorded on the medicines administration record at the time of administration.

Next time we’re exploring Outcomes 9g and 9h so watch this space!

Essential Standards Outcome 9 pt 4

January 10, 2012

Promotes Rights and Choices

9D People who use services benefit from a service that:

●● Ensures that wherever possible, information is available for people about the medicines they are taking, including the risks.
Here you will need to think about how you get that information from reliable sources and deliver the information to the client in a way that they can best understand. This includes information about prescribed medicines and over the counter medicines where appropriate. http://www.BNF.org is a great source of information but will probably be too technical for clients. Ask the pharmacist for Patient Information Leaflets where possible a good medicines book that has been written for the public that puts it more in layman’s terms – jargon free.

●● Ensures information is available for people about medicines advisable for
them to take for their health and wellbeing and also to prevent ill health.
Do you have information available to provide to clients to enable them to be proactive in becoming more healthy and staying healthy. This information may be for supplements, vitamins, minerals, homeopathic or herbal medicines for foods that promote health and well being.

●● Ensures there is access for staff to up-to-date legislation and guidance
related to medicines handling.
Training and continuing professional development and or competency assessment is key to this point. Training that meets the requirements for the CQC, Skills for Care and Essential Standards. Ensuring that staff are aware of and have access to not only your own medication policies but to the actual legislation and guidance documents as well. Do your policies and procedures actually reflect legislation and guidance or would now be a good time to review them to make sure that they do?

●● Ensures best interest meetings are held with people who know and
understand the person using the services when covert administration of
medicines is being considered, to decide whether this is in the person’s best
interest.
Medication may only be given covertly with certain consent. A team of multidisciplinary health professionals must come together to discuss the individual case and give consent in writing. I highly recommend that a pharmacist is part of this team to ensure that if medication is being given covertly because it is in the best interest of the client and they do not have capacity that that medication is put in to food that is appropriate and that that medication can be crushed if that is the proposal. I have heard some interesting and frightening stories recently of medication being authorised to be given covertly and instruction given by the doctor to put it in a hot drink, or hot food or even medication that needs to be swallowed whole being wrapped in toast! How would you not chew it??? So whilst a doctor is an expert in diagnosis and disease, the majority are not experts in medicines – please keep your clients safe by involving the pharmacist who is an expert in medicines.
I’m sure at some point we will cover covert administration and medicines in food as a separate article – please let me know if this would be useful to you.

Next week we will look at Outcome 9e and 9f – so more good stuff to come!

Consent and Medicines Management

March 6, 2008


Forms Before any support with medication can happen in care the service user must give their consent. In order to give informed consent they must first be given all of the information they require to make a decision about their level of care. It is important that information is shared freely with the service user, this will include providing patient information leaflets to your service users, and if necessary reading and explaining these to them if they are not able to do this themselves.

A service user can agree to treatment and care verbally, in writing or by implying (by co-operating) that they agree. Even though verbal consent or consent by implication would be enough evidence in most cases written consent is always preferable and probably expected in most care agency policies.

Service user consent should be obtained and recorded in the care plan during the care assessment. Both the service user and the assessor should sign and date the document. Written consent stands as a record that discussions have taken place and of the service users choice. however, the service user had the right to refuse consent and may do so at any time during his or her care. This may be detrimental to their care and you must provide them with the information they require to be fully informed I making their decision but if they still refuse to consent then you must respect that decision. You should make a record of the refusal and document what information was given and who else you involved such as your line manager or GP in the service users records.

What you should never do is hide the medication in food or beverages for the service user to take without knowing that it is there. This is covert administration of medicines and is considered to be abuse.

In an emergency situation were treatment is necessary to preserve life and the service user cannot make a decision (for example because they are unconscious), the law allows you to provide treatment without their consent, providing you are sure you are always acting in their best interest.

You should also know that if the service user is an adult, consent from relatives is not sufficient on its own to protect you in the event of a challenge, as nobody has the right to give consent on behalf of another adult unless the service user has passed over the power of attorney to another person. In this case the other person can give their consent for you to administer medication

As you can see gaining consent may not be as straightforward as it first appears. Nonetheless, it is a vital part of caring for people. The reason it is so important is that it is assumed that the service user is the best person to be in control of their care. So any procedure that may affect them can only be given once they have consented to the care and this includes medication.

 

For further information Contact

Tracey Dowe

email training@momentumpeople.co.uk

Tel 01793 700929

http://www.momentumpeople.co.uk

Covert Administration of Medicines

January 7, 2008

j0321104.jpg    Covert administration of medicines has recently hit the news again and in my training I often meet care workers who do not understand what covert administration is and why it is not acceptable. ‘Covert’ administration of medication is disguising the medicine in food, normally by crushing tablets or opening capsules and mixing them with the food to be eaten by the service user and they do not know they are taking it.

Care workers who have not been trained on medicines management will often think they are acting in the best interest of the service use, rationalizing that it is better that the person gets the medication than go with out because they do not want to take it. On the surface it appears a reasonable thing to do to them.

However, by law consent must be obtained from service users before any treatment or care or help with taking their medicines is given to them. Their decision, whether or not to agree to treatment or care has to be based on adequate information so they can make up their own mind what level of support is appropriate for them.

In theory a service user can agree to treatment and care verbally, in writing or by implying (by co-operating) that they agree. Equally a service user may take away that consent in the same way. Even though verbal consent or consent by implication would be enough evidence in my book nothing beats written consent, it’s always preferable and probably expected in most care agency policies.

Such consent should be recorded in the care plan and the service users signature obtained on the care plan during the care assessment. Written consent stands as a record that discussions have taken place and of the service users choice.

In the context of medication you need to be aware of how consent is managed. You are likely to need the service user to sign for their medication administration; this may be done once at the care assessment stage, each week/month as a new medication administration record is used or each

It is important that information is shared freely with the service user, in an accessible way and in appropriate circumstances. This includes providing patient information leaflets to your service users, and if necessary reading and explaining these to them if they are not able to do this themselves.

In an emergency situation were treatment is necessary to preserve life and the service user cannot make a decision (for example because they are unconscious), the law allows you to provide treatment without their consent, providing you are sure you are always acting in their best interest.

You should also know that if the service user is an adult, consent from relatives is not sufficient on its own to protect you in the event of a challenge, as nobody has the right to give consent on behalf of another adult unless the service user has passed over the power of attorney to another person. In this case the other person can give their consent for you to administer medication

Legally, a competent adult service user can either give or refuse support, even if refusal will be to their detriment. However, you must respect the refusal of consent by a service user just as much as you would their consent. You must make sure that service user has been fully informed and, when necessary, involve another member of the health and social care team. You should make sure that a summary of any such discussion and the decision is documented in the service users records.

Consent to support with the administration of medicines means there must never be any ‘covert’ administration of medication e.g. disguising the medicine in food (unless someone is mentally incapacitated and a multi-disciplinary team deems this to be in the service users best interest).

It is important that the principles governing consent are applied just as vigorously to all forms of care with people who are mentally incapacitated as with a competent adult. When a service user is considered incapable of providing consent, or where the wishes of a mentally incapacitated service user appear contrary to the interests of that person, you may need to involve other people close to them, but respect any previous instructions the service user gave. Covert administration is still a last resort and can only be authorized by a multi-disciplinary team of health professionals.

As you can see gaining consent may not be as straightforward as it first appears. Nonetheless, it is a vital part of caring for people. The reason it is so important is that it is assumed that the service user is the best person to be in control of their care. So any procedure that may affect them can only be given once they have consented to the care and this includes medication.