Prompting/assisting with/administering medication

General requirements

 8.1    Staff must:

• follow local procedures
• take all practicable precautions to prevent and control the spread of infection
• only assist with or administer medication to the person it was prescribed for or, in the case of an over the counter product, intended for
• understand what the person’s medications are and the reason why they are taking them. This information can be found in the person’s record

8.2    Staff must administer medication only from the original:

• labelled container/packaging provided by the pharmacy. Staff must check with the pharmacist if a label is illegible or has been altered
• packaging as purchased for an over the counter medication and must administer it in accordance with the manufacturer’s instructions

8.3    Staff must not administer: 

• medication from containers packed by the person or family/carers
• any prescribed medication labelled as to be taken ‘as directed’. The pharmacy label must detail exactly how the medication is to be used
• any over the counter remedy to someone who lacks capacity unless this has been agreed by a health professional and recorded in the person’s plan

Pre-administration checks

8.4    Staff must check the MAR and:

• confirm the person’s identity, for example by asking their name or by photograph
• ensure that they have the right medication for the right person
• that the details on the medication label exactly match what is recorded on the MAR, in particular name, strength and dosage instructions
• the sensitivity/allergy box
• that no-one else has already given the person their medication
• whether any as and when required medication has been administered in the previous 24 hours
• the expiry date on the medication container to ensure that it is still in date

8.5    Staff must consult a pharmacist or the prescriber before administering the medication if they identify any discrepancies or have any concerns, for example if the medication looks different from expected or staff are unsure if they should administer an as and when required medication or its effect.

Respecting the person’s wishes and their right to refuse their medication

8.6    We will respect people’s rights to dignity, compassion and privacy when assisting with/administering medication.

8.7    Before unpackaging the medication, staff will explain to the person what they wish to do and check that the person agrees to take their medication. 

8.8    We will not administer medication against the person’s wishes. If they do not wish to take it, staff must record this on the MAR and in a case note. The case note must state the reason for refusal if the person gave a reason and any actions taken.  
 
8.9    Staff will re-offer the medication after a short while. If the person still does not wish to take it, staff will check whether the plan has an instruction about what to do when medication is refused. If not, staff will seek advice from a relevant health professional. 

8.10    Staff will raise concerns about any ongoing refusal with the person’s family / carer or a relevant health professional as appropriate and record all actions taken in the person’s record.

Prompting, assisting with, administering medication/monitoring 

8.11    Staff will prompt people to take their medication as prescribed.
 
8.12    Staff who are assisting with / administering medication will prepare the correct dose and administer the medication as instructed on the label and the MAR. Staff will offer a drink of water for oral medicines.
 
8.13    When the person has taken their medication, staff must update the MAR and sign and date the record. Where the medication is a Schedule 2 controlled drug, staff must also update the controlled drugs register and a second staff member must check that all is correct countersign the MAR and the controlled drugs register. Please see section 15 Controlled Drugs for detail. 
 
8.14    Staff must also update any separate administration records, for example for warfarin or lithium where dosage is dependent on blood tests.
 
8.15    Staff must record any dose that is accidently wasted or spoiled on the MAR and record the reason for wastage.
 
Covert administration

8.16    Covert administration means giving someone medicine in a disguised format without their knowledge, for example in food or drink.  Administering medication in this way can affect how a medication works.

8.17    We will only administer medication covertly to anyone over 16 when:

• we have determined that the person lacks capacity to make decisions about their medication, and
• the health professional prescribing the medicine(s), care home staff and family members or an advocate have made a MCA compliant decision that  administering medication  covertly is in the person’s  best interests and
• the responsible health professional has provided written instructions about how to administer the medication covertly

8.18    We will only administer medication covertly to a child under 16 in accordance with the child’s plan and as agreed with the relevant health professional and the person with parental responsibility.

8.19    We will record the decision in the person’s MAR and plan. We will keep the plan under review to ensure that covert administration is used only for as long as is necessary.

8.20    We will not administer medication covertly to anyone who has capacity to make their own decisions about their medication.