1. Sheena Helyer 12.2012 BA.RGN.DN. PGCE. Nurse Prescriber.
HSC 3047: Part 1 Support the use of medication in social care settings: Legislation, classification and responsibilities
Sheena Helyer
BA.RGN.DN. PGCE. Nurse Prescriber.
Photos supplied by: gename.fieldofscience.com, allcareprofessionals.com

2. Learning outcomes for HSC 3047
Understand the legislative framework for the use of medication in social care settings.
Know about common types of medication and their use.
Understand roles and responsibilities in the use of medication in social care.
Understand techniques for administering medication.
Receive, store and dispose of medication supplies safely.
Know how to promote the rights of the individual when managing medication.
Support the use of medication.
Record and report on the use of medication.
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3. What is a medicinal product ?
The EC defines a medicinal product as:
Any substance or combination of substances presented as having properties for treating or preventing disease in human beings.
Any substance or combination of substances which may be used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or make a medical diagnosis.
Use the flip chart to gather the students thoughts on ‘What is a medicinal product?’
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4. Why is it necessary to have acts of parliament and regulations concerning medication?
So that you know exactly what you are taking.
So that medication is given to the appropriate people in the correct amounts.
To try to prevent people from taking medicine which is harmful to them.
To control infectious diseases amongst the whole population.
To preserve principles such as ‘consent’ and free will.
To protect the vulnerable.
To try to minimise unpleasant/ dangerous side effects.
To protect health care staff and pharmacy staff.
To encourage research and manufacture of new medicine.
Encourage the students to think of things in pairs and then contribute to making a list on the flip chart. They may come up with some ideas
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5. Agencies with responsibilities for medicine use
Medicines and Healthcare Products Regulatory Agency MHRA
A government agency responsible for ensuring that medicine and medical devices work and are acceptably safe. They send out alerts to people within health and social care to warn them of possible dangers or equipment which has be recalled.
Royal Pharmaceutical Society of Great Britain Inspectorate RPS
Inspection of all professional aspects of registered retail pharmacists.
Care Quality Commission CQC
This organisation sets minimum standards for care delivery. Outcome 9 sets out the expected standards for medication use. The CQC gathers information about care providers and inspects them to see if the standards are being met.
Learners could be given a copy of outcome 9: management of medicines to read in their own time….also the web site addresses for MHRA, RPS and CQC to research their roles and responsibilities: mhra.gov.uk
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6. Name of legislation Content of legislation
Medicines Act 1968
This act regulates the manufacture, supply, sale and import of medicines and medicinal products.
Only authorised practitioners may prescribe: GPs, dentists, some nurses and pharmacists.
The act divides medicinal products into 3 categories:-
Prescription only (POM)
Pharmacy (P)
General sales list (GSL)
The trainer should print off all the slides : Name of legislation/content of legislation(slides 6,10,13,14,15,16,17,18) Cut them in half. Mix them up and then give a set to small groups of learners to match the pairs.
Photos supplied by: thecourier.co.uk
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7. Prescription only medicine
POM:
These medicines can only be legally acquired with a valid prescription from a GP, a dentist or other independent prescriber.
Independent prescribers are health professionals who have undertaken extra training in order to prescribe and will have their own prescription pads.
Many GP surgeries employ nurse practitioners who can physically examine patients and prescribe from a limited formulary e.g. antibiotics for a UTI or chest infection.
Photos supplied by: pulsetoday.co.uk
Ask the students about the kinds of medicines they have used in each category POM, P and GSL.
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8. Pharmacy medicine P:
Pharmacists are very knowledgeable about medicines and are able to diagnose certain medical problems. They are able to recommend and sell certain medicines which are not generally available over the counter. They will also ask questions to check that the medicine does not interact with other medicines, to minimise side effects and to check that they are not given to people with specific health problems or conditions.
Photos supplied by: NHS photo library
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9. General Sales List GSL:
These medicines are considered by the MHRA to be safe enough to be sold from a shop or supermarket.
Sometimes the pack size and strength is lower than those available as P or POM medication.
Photos supplied by: dc.de
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10. Legislation Content of legislation
This law controls the use of potentially dangerous or highly addictive drugs. These drugs are defined as ‘controlled drugs’.
It states how they should be stored, recorded and administered.
Controlled drugs are divided into classes A,B and C and specified penalties are given for illegal possession or supply.
Misuse of Drugs Act 1971
It is against the law to supply anyone with CDs or to possess them unless you are acting on behalf of someone who has a legal prescription for them.In addition any professional person would lose their registration if they broke the law. Care staff would be disciplined and lose their job.
Photos supplied by: medicines.org.uk
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11. Drug types Drug Penalty for supply Penalty for possession Class A:
Diamorphine (heroine), cocaine, MDMA, LSD, methamphetamine, strong opiates
Up to seven years or unlimited fine or both
Up to life in prison or fine or both
Class B:
Amphetamine, barbiturates, cannabis, less potent opiates
Up to five years or unlimited fine or both
Up to 14 years or fine or both
Class C:
Benzodiazepines, ketamine, steroids and GHB
Up to two years or unlimited fine or both
Easy access to controlled drugs can be a temptation….What would you do if you suspected that a colleague was falsifying records and stealing controlled drugs? The trainer could discuss the cases of Rachel Baker the care home manager in Glastonbury who took residents CDs to feed her habit and Simon Wade: a paramedic in Bristol who falsified records to steal CDs
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12. Legislation Content of legislation
Misuse of Drug Regulations 1973
Controls the storage of CDs in pharmacies and care homes
All care homes must keep their schedule 2 and 3 controlled drugs in a locked cupboard which can only be unlocked by an authorised person
This does not apply to a person’s own home
It is good practice to keep records which enable staff to audit the number of controlled drugs within the home
Photos supplied by: harvarddapa.org
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13. Legislation Content of legislation
The Control of Substances Hazardous to health Regulations 1999 COSHH
Employers must take all reasonable measures to protect their employees from any potentially harmful substance that they may come in contact with whilst at work
Personal protective equipment must be provided
For example…steroid creams could be damaging to a carer’s skin unless gloves are worn . Giving eye drops to a person with an eye infection could allow for transmission of infection.
Photos supplied by: tradekorea.com
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14. Legislation Content of legislation
Misuse of drugs regulations 2001
Controlled drugs are divided into 5 schedules depending on their medicinal benefit/potential for harm
Schedule 1 drugs have no recognised medicinal use and have the highest level of control
The legislation specifies who can produce, possess and supply these drugs and how they should be stored administered and destroyed
It gives permission for the person’s representative to administer, collect or return schedule 2,3 and 4 drugs to a person in the community in accordance with the doctor/dentist’s directions
The main category of controlled medicine which care staff will encounter in people’s homes are opiates used for pain relief
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15. Legislation Content of legislation
This defines household and industrial waste and includes medicines which are no longer required.
Householders and residential care homes may return their waste medicines to the pharmacy for disposal or destruction. They should not be flushed down the toilet.
Hazardous Waste Regulations 2005
If a service user dies, the family should be advised to return the meds to the pharmacy. If there is no family this could be undertaken by the home care worker if his/her manager agrees . If there are controlled drugs, the carer should carry ID and gain a receipt from the pharmacy.
Photos supplied by: weblogs.baltimore.com
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16. Legislation Content of legislation
An individual is assumed to have capacity to make decisions about their medicine
A lack of capacity must be clearly demonstrated
People with capacity should be allowed to make unwise decisions
If an individual lacks capacity then staff must act in the person’s ‘best interest’
The least restrictive option must be chosen
The Mental Capacity Act 2005
Give the learners some practical examples of how this might apply to their role e.g. a service user has full capacity and decides that she no longer wishes to take iron tablets for her anaemia because it has a bad effect on her bowel movements.
Staff may be able to take over full control of a service user’s medication if there is clear evidence that the person has dementia and there has a best interest meeting involving the family and health professionals to discuss the best way to meet this person’s needs
Photos supplied by: inhomecaretodaytona.com
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17. Legislation Content of legislation
This act strengthened the monitoring arrangements for controlled drugs following the Shipman enquiry.
Healthcare organisations need to appoint an accountable officer to oversee management of CDs
All healthcare organisations involved with CDs have a duty to collaborate
The police may enter any premises to inspect stocks and records of CDs
The Health Act 2006
Accountable Officer
The trainer could review the facts about Harold Shipman and how the system for controlling opiates at the time, allowed him to get away with his crimes for so long. Controls need to be tight enough to identify malpractice at a very early stage and all staff handling CDs must remain vigilant.
Photos supplied by: gatesheadccg.nhs.uk
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18. The Medication Policy
It is important that all staff administering medication are familiar with the organisation’s medication policy.
The policy must comply with the law but will also outline:-
The roles and responsibilities of different people within the organisation regarding medication administration
The necessary training required to undertake the task
Authorised and prohibited procedures
Action to take in case of error or unexpected circumstances
Local procedures regarding receipt, storage and disposal of medication
Ask the learners to outline what information they would find in the medication policy of their organisation. Strongly advise them to read their policy if they have not already done so…
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19. What about homeopathic, herbal remedies and vitamins?
Many people buy homeopathic and herbal remedies and take them alongside their prescribed medication.
These remedies are not so strictly controlled but may still interact with the prescribed medicine and cause side effects
It is advisable for the GP’s advice to be sought and care staff should not give any remedies to service users without GP authorisation
It must be made clear to the learners that care staff are only able to give homeopathic, herbal remedies and vitamins to service users if the GP has authorised this because they can cause problems. St John’s Wort interacts with many medicines including the contraceptive pill, anti depressants and warfarin. Chamomile and Feverfew may cause allergies and Ginko biloba has caused stomache upsets and headaches.
Photos supplied by: atoneonline.com, guardian.co.uk
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20. What is the difference between a ‘brand’ name and a ‘generic’ name ?
The generic name is the official
medical name for the active substance.
It is chosen by the Nomenclature
Committee of the British Pharmacopoeia.
The brand name is chosen
by the manufacturer. The aim is
To have a name which is easily
recognised and remembered so
more is sold
Ask the learners which is the generic name and which the brand name. Learners could be asked to look in a BNF, Mims or other medicine book to see the difference between brand and generic names. They may know the brand and generic names of tablets they have been prescribed themselves. Discuss how people can take paraccetamol over doses if they do not realise that lots of cold remedies contain paracetamol.
Photos supplied by: poundland.co.uk, medicine.co.uk morningsidepharmacy.co.uk
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21. Categories of medication
How many categories of medication can you think of?
Analgesia Antibiotics
Sleeping tablets Diuretics
Anti-anxiety drugs Cardiovascular drugs
Anti-depressant Anti-hypertensive drugs
Anti-convulsant Lipid-lowering drugs
Anti-psychotic drugs Anti-coagulants
Anti-parkinson’s drugs Antacids
Anti-emetic drugs Laxatives
Drugs for asthma Anti-inflammatory
Anti-histamine Steroids
Cytotoxic Drugs for diabetes
Ask the learners to work in pairs and write down as many different categories of medicine that they can think of in 2 minutes….feed back results before revealing above list.
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22. Latin terms
In the past many latin terms were used by doctors and pharmacists when giving instructions about medicine.
These days all written instructions must be in english but occassionally you may hear the following :-
STAT statim Immediately
PRN pro re nata As required
QDS quarter die sumendum 4 times a day
TDS ter die sumendum 3 times a day
BD bis die 2 times a day
PO per os by mouth
PR per rectum by rectum
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23. What is the role of the Prescriber?
The prescriber should select suitable medicine according to the National Institute for Clinical Excellence(NICE) guidelines.
The prescriber must check that there are no known allergies to the medicine, no interactions with existing medication and no contraindications.
The prescription must include the following :-
The patient’s name and address
The drug name and strength
When to take the drug
How much to dispense
The prescriber’s signature
The prescriber’s address
Ask the learners this question and put response on the flip chart.
Check that all the learners know the meanings of allergy, interactions and contraindications.
Photos supplied by: pharmafile.com
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24. What is the role of the Prescriber?
The prescriber should explain what the drug is for, why it should be taken and any common side effects.
The prescriber should review the need for long term medication at regular intervals
whilst monitoring the person’s
medical condition.
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25. What is the role of the pharmacist?
The pharmacist will check the validity of the prescription and
accurately dispense the medication and legally label the container with:-
The name of the individual
Date of supply
Name and address of the supplier
Name of the medication
Dosage of the medication
Route of administration
Directions for use/frequency
Special instructions, warnings or cautions
Expiry date
Photos supplied by: NHS photo library
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26. What is the role of the pharmacist?
Some will deliver medication to the house bound.
Dispose of medicine brought back from care homes and private homes
Give advice on all aspects of medication
delivery
Supply devices and containers to help
people take their medicine
Photos supplied by: NHS photo library
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27. The role of the community care manager
Ensure the staff are trained properly
Put policies and procedures in place
Provide personal protective
equipment if needed
Assess how the service
user likes to take their medicine
Risk assess the capabilities of the service user to self medicate
Write a plan of care describing the help needed to order, collect, store and administer medication
Keep and store accurate records of care episodes
What role do they expect their manager to play regarding medication administration?
Photos supplied by: NHS photo library
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28. Role of the community carer
To assist with medication according to the plan of care
To only give authorised medication from a labelled container
To give medication respecting the person’s dignity and choice
To give the medication according to the training received
To help to inform and educate the person about their medicine
To be aware of common side effects
To record episodes of care accurately
To report any problems to the manager
Ask if they can they of things they MUST NOT do e.g force a service user to take medicine, take out or add medicine to a compliance aid, change the instructions or dosage.
Photos supplied by: von.ca
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29. Levels of assistance
Care staff must be aware of what level of assistance is required and be trained to administer at the appropriate level:-
General support. Care staff will prompt and remind the service user. They may help to open containers but the service user is predominantly in control of their medicines. Assistance may be given in collecting and returning medicine.
Administration of medicine. Care staff are trained to take full responsibility for correct administration of medicines which can be delivered via a non-invasive route e.g. pills, creams, nasal spray, eye drops, ear drops or inhaled medication.
Administration of medication via specialised techniques. Some care staff may be trained to give medicine rectally, by injection or through a PEG tube. This will NOT be covered in this training package.
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30. Consent to give medication: Person with full mental capacity.
It is an important principle that all people receiving a service should be fully informed and consulted in matters relating to their health and well being and agree to the care provided.
Some care providers will ask the service user to sign a consent form to allow their medication to be administered by care staff.
On each occasion medication should only be given with full consent. This can be implied by positive body language and cooperative behaviour.
If the service user declines or refuses, this choice should be documented.
The manager and/ or GP should be informed.
Ask the learners to describe times when their service users have refused medication. What have they dome about it?
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31. Can medication ever be given to a person without their consent?
If the person has mental capacity the answer is ‘NO’
Sometimes confused people will refuse medication
Is there sufficient evidence that the person is unable to make choices about their medicine? Do they lack mental capacity?
Is the medicine essential ?
Is there a nominated person who has Lasting Power of Attorney to make health and welfare decisions on their behalf?
If not a ‘Best Interest’ meeting should be convened to decide on the best way forward. This must be documented.
Photos supplied by: intellectual disability.info
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32. Crushing and/or disguising medication
If it is decided that medicine should be either crushed or disguised then the GP and pharmacist must be in agreement that this is a safe course of action. Some medicines can act very powerfully if their protective coating is removed.
This is an important decision and must be thoroughly documented.
Without proper decision making and documentation it is totally unacceptable to crush and disguise medicine
The learner should be shown any forms which are used locally to document decisions about crushing and disguising
Photos supplied by: objectsofuse.com, guardian.co.uk
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33. The following outcomes have now been covered:-
Identify legislation that governs the use of medication in social care settings.
Outline the legal classification system for medication.
Explain how and why policies and procedures or agreed ways of working must reflect and incorporate legislative requirements.
Outcome 2
Identify common types of medication
Outcome 3
Describe the roles and responsibilities of those involved in prescribing, dispensing and supporting use of medication.
Explain where responsibilities lie in relation to use or ‘over the counter’ remedies and supplements
Outcome 6
1. Explain the principle of ‘consent’ in the use of medication
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