2. System Training Lloydspharmacy
Brief introduction to yourself and your commitment to ensure that the service we provide delivers against the needs of the Customer and their service users.

3. of the handling Medicines in Social Care”
Introduction
“Principal 3
of the handling Medicines in Social Care”
“Care Staff who help people with their medicines are competent”
Today’s training session is to introduce you to or refresh your understanding of the procedures and processes of our system and how these reflect the requirements of the 8 Principles from the “Handling of Medicines in Social Care” document.
Introduce the pack that’s been left and a heads up on the contents therein – we’ll cover these off in greater detail throughout the training and there’ll be plenty opportunity for you to ask questions!!
The pack for the care home will include:
Medication Cycle Planner
Pharmacy contact list
Mid Cycle Ready Reckoner
Allergy Declaration
Consumables Request sheet
Lloydspharmacy “Changes” fax template
Lloydspharmacy “Urgency” fax template
Blister Divider Colour Coding poster
Hints and Tips for use of the MAR Sheet
PRN Protocol Proforma
CD Schedules 2,3,4
Fridge Items

4. Deliveries Green Bags & Tote Boxes Seals Delivery Slip Sign Day
Designated Area
Explain how it will come, green bags, and totes etc, security tagged.
Explain that they will be asked to sign for it.
Demonstrate the delivery slip
Demonstrate bags and security seals.
Discuss Delivery Day
Designated Places

5. Fridge lines Low Temp Items examples Fridge Delivery slip Log
Items low temp
PIL
You need to know which medicines need to be kept cool.
Q: Can you give me any examples
A: Liquid antibiotics, anti fungal creams, antibiotic eye drops and insulin
Q: Where can you find the information that will tell you whether the medicines need to be in a fridge?
A: The PIL’s that is supplied with a medicine will state whether the medicines needs to be kept in a fridge.
Q: Do you have a separate secure fridge, OK, Can you tell me what temperature it should be and how often it should be checked?
A: 2-8 degrees & daily
Q: why?
A: To demonstrate fridge has remained within recommended operating boundaries.
Q: It’s recommended that the fridge needs to be defrosted.....?
A: Weekly
Q: If no separate fridge is available or if your only existing fridge breaks down - you should have separate provision made - what are these provisions?
A: locked metal container, labelled medication, and stored in the food fridge, e.g., petty cash box etc. It is recommended that this metal container is stored inside a plastic box to maintain temperature.Storage.Cabinet or Trolley.
Q: If using a trolley, how should it be fixed when not in use?
A: it must be fixed to wall using clamp when not in use.
Show photos of what good looks like with externals separated from internals and shelf labelled

6. Discuss maximum temp medicines should be stored at 25 degrees.
THE TEMPERATURE OF THE MEDICINE REFRIGERATOR SHOULD BE MONITERED DAILY WHEN IT IS IN USE. AND RECORDED.
A Maximum/Minimum thermometer is recommended for this
The care service should have a written procedure of action to take if the Temperature is outside the normal range ---usually between 2 and 8 degrees Celsius
If a fridge breaks down, it is important to identify the fault quickly, otherwise medicines may be wasted
Clean and defrost the fridge regularly
IF YOU ARE HOLDING THE SUPPLIES OF THE FLU VACCINE, IT IS IMPORTANT TO KEEP THEM IN THE MEDICINE REFRIDGERATOR.
Discuss maximum temp medicines should be stored at 25 degrees.
I was asked in a previous session whether or not regularly administered items that are stored in a fridge require to be immediately put back there or whether they can stay on the trolley for the day – I’d say – check with the Pharmacist if in doubt.
In Residential care, there should be a separate, secure fridge that is only used for medicines that require cold storage.
A separate fridge may not be necessary in a small home unless there is a constant need to refrigerate medicines that a resident takes regularly, for example INSULIN
Fridge lines –;. Show them the fridge line delivery sheet.....

7. THE STORAGE OF MEDICINES NEEDS TO BE IN THE RIGHT PLACE
Q: Can you give me some examples of places that are NOT suitable for storing medicines?
A: Filing cabinets; Kitchens; Bathrooms; Toilets; Windowsills or areas next to heaters are not the right place
these places are to damp or to warm (or both) or unhygienic for storing meds.
If the temp is more than 25 degrees C, its too hot
Q: The designated place for storing medicines must be what?
A: secure and only those staff who handle meds should have access.
It is also good practice to make sure that:
Nothing else is stored in a medicine cupboard.
The medicine cupboard should not be used as a safe for valuables and should not be used as a food cupboard.
The only reason to open the medicine cupboard should be to get access to medicines.
Q: If using a trolley how MUST it be fixed when not in use?
A: it must be fixed to wall using a clamp

8. Delivery Of C.D.s Delivery slip Misuse of Drugs 2001 Storage
Record Keeping
Administration
C.D.Register Ballance
MAR sheet
2 people
Misuse of Drugs Act 2001.
Controlled drugs - can be very potent, addictive or abused, therefore very strict legislation surrounding its prescribing dispensing storage and use.
This are set out in the Misuse of Drugs Act 2001.
Q: Can you give me some examples of a C.D.?
A: Morphine, temazepam, Fentayl patches,
Q: Do they know of any special things that they need to do with controlled drugs?
A: storage, record keeping and administration process
When we deliver a controlled drug it comes with a separate delivery slip and it must be checked and signed by the appointed person in the home.
Q: After checking, what should happen next?
A: it should be locked away securely in the C.D. cabinet.
Q: What is acceptable storage?
A: The C.D. cabinet must be:
a separate cabinet
securely fixed to a main brick wall, not a partition wall
it can be within a locked cabinet on a secure wall

9. How many people are need to be present when administrating a C.D.?
Controlled Drugs
How many people are need to be present when administrating a C.D.?
At time of checking off the C.D. the MAR chart needs to be checked off for this and fridge line that has been delivered.
Controlled drugs are not allowed to be stored on a mobile trolley.
If CD is in blister pack the pack must be stored in CD cabinet. If it’s a BUPA Home the Duo Cassette is used.
Q: Next the C.D. must be recorded in a controlled drugs register; Can you give me some examples what this register must look like?
hard bound book, with numbered pages so that none can be removed.
Separate page must be used for each service user and for each type of controlled drug.
This book should be completed in black, indelible ink, and
upon receipt the date and the amount should be entered in the left hand column.
Column, serial number can be left blank, this is an order number please do not use.
This item also needs to be checked and signed against the MAR sheet.
At this point do they know how many people need to be present when administrating a C.D.?(2 people)
The C.D. register needs to be completed after administration to record date, time, how much was given and the remaining stock balance and both staff should sign full signatures.
The C.D .register should hold an accurate balance as to what stock is present in the home, if any item has been dropped, returned, destroyed, an entry has to be made to reflect this. (This is legally the only type of medication that requires 2 people to be present for administration purposes.)

10. On the screen you have the Lloydspharmacy Unit Blister System which is the preferred system of the Care Commission, as it is easier to see the medication because there is only the one tablet per card this is the 28 days supply.
Introduce the Hoop and Blister pack here
You would have one card per tablet
[Pink] Morning
[Yellow] Early Afternoon
[Orange] Late Afternoon and
[Blue] Night time.
What will be on the blister – label at top – what details need to be on the label
What’s inside it - we can have more than one drug in each blister if, for example the Px has numerous drugs at breakfast.
Pill pop to pop drugs out – demonstrate – Pack to Pop to Pot
Labels for the back – “At a Glance” – Can pop drug back in and re-seal. Reminder to update carers notes on the back of MAR sheet.
Empty hoop collected by pharmacy to be filled for next cycle
Can also introduce Pots at this stage – disposable ones for time of infection – different sizes.
Again, everything here is listed on the “Consumables List”

11. Dispensed Label Information
What are the 10 pieces of information that should be included on a label of a dispensed item
What are the 10 pieces of information that should be included on a label of a dispensed item
Pharmacy Name
Name of drug
Strength of drug
Form of drug
Quantity
Dose
Warnings
Name of person
Date of dispensing of drug
Keep out of reach of children
Explain that it is a legal requirement all medication dispensed by a pharmacy must have a label attached to it and this label should contain the following: Pharmacy details Quantity Name of the drug, strength and forename of the service user Date of dispensing, Advisory /cautions/warnings. Keep out of the reach of children. Recommended practice that all items such as sip feeds – Fort sip etc should each have an individual label on each carton. Discuss as directed not an acceptable instruction and should be referred back to prescriber.

12. GENERIC – Chemical name BRANDED – Manufacturer Who can name some?
Generic v Brand
GENERIC – Chemical name
BRANDED – Manufacturer
Who can name some?
Generic V Branded
GENERIC – is the chemical name
The generic names tend to be quite long difficult to spell and pronounce.
Doctors tend to prescribe by generic name and this gives pharmacy choice over which brand to dispense hence differences in shape colour and size
BRANDED – Manufacturers name
The Branded name is the name a specific manufacturer gives it.
Who can name some?
Talk through some examples e.g. Paracetamol and Panadol, Ibuprofen and Nurofen Amoxicillin and Amoxil
Discuss that can have at least 2 names. The Generic name is the chemical name of the drug- it’s the active ingredient.

13. Reminder Cards
Reminder cards are used for any item of dispensed medication that cannot be placed into bubble packs.
Discuss the 3 main reasons
Size e.g. Adcal D3
Properties such as effervescent tablets, Discuss Epilim as hydroscopic
Creams and Ointments and Liquids
Explain they will be entered on the hoops at the relevant time of day.
Show an example

14. Of Handling Medication In Social Care
Principle 2
Of Handling Medication In Social Care

15. D Destroyed Medication I Information O Ordering Information
R Received medication
A Administration
D Destroyed Medication
I Information
MAR SHEETS
Mar Sheets help care providers meet Principle 2 of Handling Medicines in Social Care Document –“Care Staff know which medicines a person has and the social care service keeps a complete account of medicines.”
MAR sheets create an audit trail, it tells the journey of what happens to the service user’s medication, from the time it enters the home until it’s either administered or destroyed.
From your records anyone should be able to understand what you have done, and to be able to account for all the medicines that you have managed.
Mar sheet can be used in a court of law, must be filled in, in black indelible ink.
Q: What must NEVER be used on a MAR Sheet?
Pencil; Gel pen; Felt pens; Tipex
Q:Do they know how long a MAR sheet should be kept?
A: National standards state 3 years, however as good practice, most inspectors will recommend that they are kept for 7 years as legal action can be taken up to 7 years from the death of a service user.
Hand out copies and talk through the MAR sheet, explain that they are now laser printed rather than the old triple carbon copies to make it more legible and aligned.
Talk through the top part of the MAR sheet, stating that they should have the full name and title, and D.O.B.
If they have any allergies they must be stated on the MAR sheet if there are no allergies that the home are aware of this must be communicated to the pharmacy, and the phrase “None known “will be entered, this field must not be left blank nor the word” NO “be inserted as this could be challenged.
Talk through the start date, and explain that the MAR sheet is for 4 weeks not a calendar month. Explain on the left hand side how the drugs are listed and the drug times.
MAR sheet audit trail, 5 elements,
Received – Administration – Destruction – Information - Ordering.
Booking meds in, they need to log all meds that have entered the home confirming the entry with their initials and the date.
O Ordering Information

16. Administration Principal 4
Of Safe Handling of Medications in Social Care
Five Rights
Administration to Principle 4 of Safe Handling of Medicines In Social Care states that “Medicines are given safely and correctly and care staffs preserve the dignity and privacy of the individuals when they give medicine them".
The Medicines Act 1968 state that anyone can administer a medicine to a third party as long as it’s in accordance with the prescribers directions. Once they have been checked and booked in they are ready to administer.
Administration is a single person process; therefore, one person must complete all of the following tasks,
Checking,
Dispensing (popping out)
Offering (to the service user) Witnessing Recording If they do have a policy of 2 persons administering meds, one should be for observation only.
Discuss the full process including 5 rights –Person, Drug, Dose, Time, and Route. Discuss and demonstrate the” No touch “Method of Pack to Pot to Person Checks What type of Liquid should be offered – Water explain hot drinks can react so can milk or fruit juices and give examples e.g. certain antibiotics will react with milk Remind them Upright position and awake

17. Right Route
Right Person
Right Time
Right Dose
Right Drug

18. Principle 5 of Safe Handling of Medication In Social Care
Medication Returns
Principle 5
of Safe Handling of Medication In Social Care
Principle 5 In Safe Handling of Medicines in Social Care states that the care provider should make sure that unwanted medicines are disposed of safely.
Introduce “Returns Document” and discuss.
Anything that is not needed needs to be recorded into the returns book, and also onto the MAR sheet. Demonstrate Returns envelope and book.
If the home is a care home it will go back to the pharmacy.
Shelf life if blistered, 56days (8 weeks) on blistered, 3 months, in original packaging, exceptions to the rule, eye drops, 28 day screams/ointments with an active ingredient, 28days.
Discuss PRN Protocols PRN PROTOCOL PROFORMA Who for why When Medication Dose Route. including area of application for creams etc How often (with time scale) Maximum Dose Do you need to contact on call first What to do if doesn’t work How long before contact GP Any other treatments to be tried first Anything to watch out for e.g. side effects/ cautions/ warnings Written By Status GP Signature Date Review Date

19. PRN {when required meds}
Discuss PRN Protocols
PRN PROTOCOL PROFORMA
Who for
Why
When
Medication
Dose
Route. including area of application for creams etc
How often (with time scale)
Maximum Dose
Do you need to contact on call first
What to do if doesn’t work
How long before contact GP
Any other treatments to be tried first
Anything to watch out for e.g. side effects/ cautions/ warnings
Written By
Status
GP Signature
Date
Review Date

20. Deceased Service Users
How long does medication get kept after service user dies?
Q: Ask do they know how long medication should be kept in the home after the death of a service user?
A: (7 days)…..explain why
A corner may request medication to be used in inquest. This request must be made in writing within 7 days of death.

21. Acceptable Changes to the MAR’s
Preferable to have a printed MAR sheet as this reduces the risk of error when transferring information by hand; however there are some exceptions,
1. New resident moves in with their own meds, we cannot issue a MAR sheet, as we have not seen the original prescription
2. Discharged from hospital,
3. Out of hour’s prescription.
We can leave some blank sheets for them to use, these must be counter signed by 2 members of staff to ensure that the info that has been entered is correct.

22. Verbal Orders
Page 50 Handling of Medicines In Social Care gives best practice If the doctor phones through a dose change, they should have a procedure to communicate these changes which should include:
Who took the call,
Time and date of the call,
The name of the person who called
The details of the change.
It is good practice to read back the information to clarify preferably by another member of staff, and also to request written confirmation ASAP.
The amendment should be transferred to the MAR sheet and counter signed by 2 members of staff.

23. The Ordering Process
The bottom copy of the mar sheet goes to the pharmacy, it is your re-ordering tool, so that the branch knows what you have ordered and they have a full understanding of what is going on.
They do not have a crystal ball!
Reordering, on Week 2 at the latest, show cycle planner.
Running out of medicines due to “bad housekeeping is not acceptable” Principle 5 states Medicines should be available when the service user needs them, therefore the care provider should ensure the correct medication is available for service user as otherwise can be deemed as abuse by omission.

25. Principle 2 of Handling of Medication in Social Care
Medicine Information
Principle 2
of Handling of Medication in Social Care
In the document “The Handling of Medicine In Social Care” document -Principle 2 states that care staff should know which medicine a person has. This means what the medicines are, how they should be taking and what conditions they are intended to treat. Principle 7 states that the “Social care service has access to a pharmacist.
Branch - pharmacist.
Branch contact sheet,
BNF
Patient info leaflet.
BMA Guide to meds and drugs.

26. Interims/Cut off times
Explain arrangements, talk through cut off times specific to that home and the process. However good practice to supply original script when driver comes with medication, we cannot accept a faxed script for C.D’s. .

28. Keele University Accredited DLP
Roles Responsibilities and Boundaries
Practical Aspects of Administration of medication
Safe practice in the administration of Medication
Read this screen

29. Why Offer Medication Training?
The Care Commission requests accredited training for care workers
Ensure medication is managed per legislation
Improve overall Care Work skills
Minimise risk/error in medication administration
We offer Medication Training to care workers to safely administer medicines in care homes in accordance with the local health authority.
To a description level of NvQ2 Accredited Training.
And improve overall Care Work skills.