Handling of Medication Jane Hancock DipClinPharm BPharm MRPharmS

NEWS HEADLINES Seven in ten care home residents is 'victim of drug error', The Daily Telegraph, October Fears over care home drug errors, BBC News, October Study reveals alarming level of drug errors in care homes, The Guardian, October More than two-thirds of care home residents given the wrong prescription, Daily Mail, October Elderly hit by muddles over drugs, Daily Express, October

Medication errors affect three quarters of care home residents 6 October, 2009

Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people The University of Surrey, in conjunction with the London School of Pharmacy and Leeds School of Pharmacy Qual Saf Health Care 2009;18: doi: /qshc

Study Details 55 Care Homes 256 Service Users Average of 8 items of medication each

Findings 178 (69.5%) of Service Users had one or more errors 57 Service Users had 116 administration errors, including being given the wrong dose of medication or not being given their medication at all

Contributing Factors G.P.s not readily accessible Did not know the service user Lacked information in the homes when prescribing

Contributing Factors Home Staff had high workload Lack of medicine training Interruptions during medicine rounds Lack of team work between Home, Surgery and Pharmacy Inefficient ordering systems Inaccurate medication records Verbal communication

Conclusion from the study "People in care homes are a frail and vulnerable population at particular risk from medication errors, and it is a cause for concern that two-thirds of care home residents in this study were exposed to one or more errors."

How can this be improved?

The five rights of administration Right service user Right medicine Right dose Right time Right route

Types of medicines Systemic Topical

Systemic medicines - One Oral medicines - Solid dose forms - Tablets and capsules - Soluble/dispersible/effervescent tablets - Lozenges - Enteric coated tablets - Sustained release tablets and capsules - Liquid dose forms - Solutions - Syrups - Suspensions -Mixtures -Linctus

Systemic medicines - Two Rectal medicines Injections Medication given via PEG tubes Transdermal Patches

Topical medicines Eye, ear, nasal drops Creams and ointments Inhalers Rectal medicines Vaginal preparations

Applying topical medicines Just as important as oral medicine When opening new tubes or drops etc. always record opening date Unless labelled otherwise the general guidance is: - Jars - discard one month after opening - Tubes - discard three months after opening - Eye drops and eye ointment - discard four weeksafter opening

Giving the medicines - One Be prepared Check the medicine record Find the medicine Measure the dose * Check the label * Measure the dose - Liquids Read at the bottom of the Meniscus *

Giving the medicines - Two Take the medicine to service user Check service user is the correct person Make sure they are in an upright position

Giving the medicines - Three Give the medicine Offer a drink Record immediately what has been given or declined

MARR sheet

Medication Administration Records and Request (MARR) TRACK MEDICATION – EVERY SERVICE USER – RECORD IMMEDIATELY The Home is expected to carry out a minimum of five audits: 1. Quantity received audit 2. Quantity disposed audit 3. Administration audit 4. Ordering audit 5. Information audit Therefore: Medication Containers & Labelling + Reminder Cards + MARR + Returns Book = FULL AUDIT TRAIL

Storage Locked cupboard or trolley Cool, dry room Key security Self medicator’s medicine Fridge temperature Oxygen

Waste Medication Hazardous Waste Regulations 2005 Care Homes classed as domestic waste record and return to Pharmacy Care Homes with Nursing classed as industrial waste collected from home by specialised waste contractor e.g. Cannon, PHS

Controlled Drugs Medicines Act 1968 Misuse of Drugs Act 1971

Requirements of a Controlled Drug Prescription Service User’s name & address Age (if under 12) Name of Medicine Strength Dose Form Quantity (in words and figures) Dose Doctor’s Signature Prescribing Date

Storage of CDs Must comply with Misuse of Drugs (safe custody) regulations Made of steel 5 lever or 6 pin lock Fixed to a solid wall or a wall that has a steel plate mounted behind it Fixed with rag or rawl bolts

Controlled drugs Register

The five rights of administration Right service user Right medicine Right dose Right time Right route

NEWS HEADLINES Seven in ten care home residents is 'victim of drug error', The Daily Telegraph, October Fears over care home drug errors, BBC News, October Study reveals alarming level of drug errors in care homes, The Guardian, October More than two-thirds of care home residents given the wrong prescription, Daily Mail, October Elderly hit by muddles over drugs, Daily Express, October