Medicine- the law

The black triangle Drugs

-They are brand new drugs on the market, that have been made in the last 5 years.

-They are medicines and vaccines that are under intensive monitoring due to being new, a biosimilar, a new combination, or used in a new patient population.

The yellow card system

-A program used to collect and monitor safety concerns, including suspected adverse drug reactions (ADRs), defective medicines, and medical device incidents.

-If patients experience any side effects from the black triangle medication, its needs to be reported.

Delegation of medicines

-The process where a registered, licensed healthcare professional (such as a doctor, pharmacist, or nurse) authorizes another qualified colleague or support worker to administer or supply medication on their behalf

-The nurse must therefore ensure that the person to whom they are delegating has sufficient training, competence and experience for the required administration task.

-Clear procedure for communication must be available at all times for answering queries, or escalation of concerns of unregistered staff.

Assessing levels of support

There are three levels patient might fall into:

Self-medication (Level one)

Assessed as mentally competent and physically able to undertake medication process and may require occasional verbal reminders.

Physically assisted self medication (Level two)

Assessed as mentally competent to undertake medication process but not physically able to do so and therefore needs assistance to facilitate the process.

Complete medicines management (Level three)

Assessed as not mentally competent to undertake medication process and therefore needs support to undertake the process.

Commencement of care and support needs

-Supporting people to manage their medication is an essential part of enabling them to participate in their own care.

-In order to remain independent, some people may need assistance to take their prescribed medication as part of their care package (e.g. using blister pack).

-Blister pack can be used to keep a patient independent but Can be difficult if having to change medication.

Storage of medication

-If medication status is managed - All medication is to be kept in locked container, drawer or cabinet.

-If the individual is self-managing or assisted, safe storage advice should be provided.

-Medication cannot be administered from monitored dosage systems filled by carers or family members.

-Some medication cannot be dispensed into a monitored dosage system e.g. as required medication, medications that may react or deteriorate once out of there foil covering and liquids and suspensions

-Monitored dosage systems cannot always be supported by community pharmacies.

Creating a safe working environment

-Staff must not allow themselves to become distracted or take on any other tasks until all medication has been given.

-In the event of an emergency where there is a need to stop giving medication before the process is complete,  the medication must be locked away and the interruption recorded

-Always give medication one patient at a time and medication should never be left unattended.

Administration

-Gain consent to administer the medication – if the patient lacks capacity medication can only be given if this is clearly documented in the support plan.

-Crushing medication in order to make swallowing easier is not permitted except on the instructions of the Pharmacist, and alternatives should be discussed with the prescriber and pharmacist.

-Medication should usually be given with half a glass of water (N.B. do not give medication with milk or hot drinks. Because other fluids and food can interfere with medication absorption or cause a reaction).

-•Liquid medications must not be mixed together - give separately.

Record Administration

-The service specific documentation (e.g. MARs / evaluation notes) must be completed and signed for as the drug is given.

-Records must be completed in black ink.

-Any recording errors must simply be crossed out with a single line; initialed, with date and time documented.

-•When a course of treatment is ended or discontinued, for any reason other than death, all unused medicines must be returned to the pharmacy

Refusal to take medication

If a patient refuses medication:

-They should be encouraged to do so and, the medication should be offered again on a few more occasions and the consequences of non-compliance explained.

-If they continue to refuse, this should be recorded, and the incident reported and escalation to manager.

-Medical advice needs to be sought for the regular and consistent refusal of medication so medication can be reviewed

Omitted or delayed medication

-Time critical medication should be administered as close to the time as possible.

-Failure to give theses medicines at the prescribed time could cause severe harm to the patient. (Parkinsons meds/Opiods, you could get a relapse of symptoms if not given in a timely manner)

-The reason for omission or delay should be documented on the notes, discussed with the medic, and reported on the system.

Types of time critical medications

-Parenteral doses of anti-infective medication (e.g. IV antibiotics)

-Insulins

-Regular Parkinson’s medication

-Regular opioid analgesia

-Anticoagulation

-Anti-epileptic medication

Transcribing

Is the act of making an exact written copy of details from an original prescription or medication record onto another document, typically a Medication Administration Record (MAR) chart, to ensure accurate administration by a health professional. (Copying the prescription over)

-Transcribing cannot include any changes to the medication, for example the timing of, or titration of dose, as this becomes prescribing.

Medication errors and adverse reactions

If a health professional gives out the wrong medication or the patient takes the wrong medication, medical advice must be sought immediately.

Medication errors and adverse reactions pt2

If a medication error happens:

-Try to retrieve the medication if possible

-Observe the patient for any ill effects and record the patient’s vital signs as appropriate.

-Follow any specific instructions/advice given by the doctor

-Inform the patient and/or carer of the error and action taken

-Document the incident and the action taken in the patient’s clinical records

-Follow the Trust medication error protocol and report incident via Datix system within 24 hours.

It is very important to report all incidents relating to medication in order we learn lessons and improve systems, procedures and controls.

Medication Administration

-Drug

-Dose

-Time

-Person

-Refuse

-Route