Understand legislation, Policy and procedures relevant to administration of medication
1.1 Identify current legislation, guidelines policies and protocols relevant to the administration of medication. The Medicines Act 1968 – It governs the control of medicines for human use and for veterinary use, which includes the manufacture and supply of medicines. The Act defines three categories of medicine:
– Prescription only medicines (POM), which are available only from a pharmacist if prescribed by an appropriate practitioner. – Pharmacy medicines (P), available only from a pharmacist but without a prescription. – General sales list (GSL) medicines which may be bought from any shop without a prescription.
Human Medicines Regulations 2012 – The Regulations set out a comprehensive regime for the authorisation of medicinal products for human use; for the manufacture, import, distribution, and sale and supply of those products; for their labelling and advertising.
The Misuse of Drugs Act 1971 – The act creates three classes of controlled substances, A, B, and C, and ranges of penalties for illegal or unlicensed possession and possession with intent to supply are graded differently within each class.
The Misuse of Drugs (Safe Custody) Regulations 2001 – The Misuse of Drugs Act controls the export, import, supply and possession of dangerous or otherwise harmful drugs. In effect the Act largely renders unlawful all activities in the drugs controlled under the act except provided for under the regulations made under the Act.
Health Act 2006 – An Act to make provision for the prohibition of smoking in certain premises, places and vehicles and for amending the minimum age of persons to whom tobacco may be sold; to make provision in relation to the prevention and control of health care associated infections; to make provision in relation to the management and use of controlled drugs; to make provision in relation to the supervision of certain dealings with medicinal products and the running of pharmacy premises, and about orders under the Medicines Act 1968 and orders amending that Act under the Health Act 1999.
Health and Social Care Act (CQC) 2008/2012 – The Act, the regulations and this guidance are part of a wider regulatory framework that includes regulation of professionals such as nurses, doctors and social workers. The framework is designed to ensure that people who use services are protected and receive the care, treatment and support they need.
The Health and Safety at Work Act – The Health and Safety at Work etc Act 1974 is the primary piece of legislation covering occupational health and safety in Great Britain. The Health and Safety Executive, with local authorities (and other enforcing authorities) is responsible for enforcing the Act and a number of other Acts and Statutory Instruments relevant to the working environment. Understand and know how to change any decisions about examination, care, treatment as in medication and support that has been previously agreed and be confident that their human rights are respected and taken into account accordance with, the consent of service users in relation to the care and treatment provided for them.
Data Protection Act 1998 – The Act’s definition of “personal data” covers any data that can be used to identify a living individual. Individuals can be identified by various means including their name and address, telephone number or Email address. The Act applies only to data which is held, or intended to be held, on or held in a relevant filing system.
Control of Substances Hazardous to Health (COSHH) Regulations 2002 – The occupational use of nanomaterials is regulated under the Control of Substances Hazardous to Health (COSHH). COSHH is the law that requires employers to control substances that are hazardous to health and includes nanomaterials.
The Environmental Protection Act 1990 & The Waste and Contaminated Land Order 1997 place a “Duty of Care” on anyone who produces, collects, treats and disposes of waste. This includes feminine hygiene, clinical, sharps, medicines, dental wastes, confidential waste or other waste to be recycled. The main principles of duty of care are about documenting the transfer of waste and checking up on anyone you transfer waste to (e.g. if they are a registered carrier of waste, if they are taking waste to suitably licensed/permitted sites). You should only use a Contractor who can provide proof of compliance with the legislation.
Hazardous waste regulations 2005
The regulations replaced the Special Waste Regulations 1996 in England and fully meet the requirements of the Hazardous Waste Directive. The Regulations remove the current need to pre-notify the Environment Agency before hazardous waste can be moved off site, and include a simpler method for tracking wastes once they have been moved. They include a new system to ensure that certain sites where hazardous waste is produced are notified to the Environment Agency. This will improve the whole regulation of the hazardous waste chain from source site to waste site. These regulations had previously amended certain clinical, medicinal & dental wastes they are now affected by the new Regulations as well as, you must not mix hazardous with non-hazardous waste. Soft/hard clinical waste, sharps and pharmaceutical-sharps
This waste may be classed as hazardous, due to its infectious nature. The Department of Health has produced important new guidance in ‘Safe Management of Healthcare Waste’ Offensive waste includes sanitary, incontinence, red lidded sharps. Feminine hygiene, nappy and incontinence wastes and fully discharged syringes are not classed as hazardous or special waste and do not require consignment notes.
The Guideline policies and protocols in place I work in.
In my workplace, I have the Medication Policy and Handbook that covers assessment of individuals’ needs, administering, storage, recording and disposal of medicines’.
Know about common types of medication and their use.
2.1. Describe common types of medication including their effects and potential side effects.
Analgesics: i.e. Codeine, used for pain relief, such as head-aches, the side effects can be light-headedness, dizziness, nausea, vomiting, shortness of breath, and sedation. Codeine can also cause allergic reactions, symptoms of which include constipation, abdominal pain, rash and itching. Addiction, irritation of the stomach, liver damage and sleep disturbances as some analgesics contain caffeine, if taken over a long period of time. – Acetaminophen (Paracetamol)-generic name. Brand names include – Tylenol, Acephen, Actamin, Apacet, Genapap, Feverall, Halenol, Panadol, Paramol, Pediapap, Redutemp, Tactinal, Tempra, Tylophen, and Uniserts.
Some painkillers are in a group called non-steroidal anti-inflammatory drugs (NSAIDs). Most common is Ibuprofen, it is a painkiller, which is available over-the-counter, without a prescription. It is to ease mild to moderate pain – such as toothache, migraines and period pain control a fever (high temperature, also known as pyrexia) – for example, when someone has the flu (influenza) ease pain and inflammation (redness and swelling) caused by rheumatic diseases (conditions that affect the joints) and musculoskeletal disorders (conditions that affect the bones and muscles) – such as rheumatoid arthritis and osteoarthritis ease pain and swelling caused by sprains and strains, such as sports injuries. Ibuprofen is made by many different companies, under many different brand names and in a wide range of forms, including: tablets or caplets, gels, sprays and liquids. Ibuprofen should be avoided by people with certain health conditions, such as a current or recent stomach ulcer, or a history of bad reactions to NSAIDs. It should be used with caution by older people, and people with certain health conditions, including asthma or kidney or liver problems.
Antibiotics: i.e. Amoxicillin, a penicillin based antibiotic which fights bacteria in your body. It can only be taken if you are not allergic to Penicillin and do not have asthma, liver or kidney disease, or a history of Diarrhoea. Feeling sick and vomiting are the most common side effects. It is used to treat many different types of infections, such as ear infections, bladder infections, pneumonia, and salmonella however it can cause side effects including, getting a fungal infection such as thrush after treatment with antibiotics for a longer period of time, sores inside your mouth, fever, swollen glands, joint pain, muscle weakness, severe blistering, peeling, and red skin rash, yellowed skin, yellowing of the eyes, dark coloured urine, confusion or weakness, easy bruising, and vaginal itching.
Doses of antibiotics can be provided in several ways:
– Oral antibiotics – tablets, pills and capsules or a liquid that you drink which can be used to treat most types of mild to moderate infections in the body – Topical antibiotics – creams, lotions, sprays or drops, which are often used to treat skin infections – Injections of antibiotics – these can be given as an injection or infusion through a drip directly into the blood or muscle, and are usually reserved for more serious infections There are now hundreds of different types of antibiotics, I found the most common, on the internet, to help they are classified into six groups.
– Penicillin are widely used to treat a variety of infections, including skin infections, chest infections and urinary tract infections. – Macrolides can be particularly useful in treating lung and chest infections. They can also be a useful alternative for people with a penicillin allergy or to treat penicillin-resistant strains of bacteria. – Tetracyclines can be used to treat a wide range of infections. They are commonly used to treat moderate to severe acne and a condition called rosacea, which causes flushing of the skin and spots. – Fluoroquinolones are broad-spectrum antibiotics that can be used to treat a wide range of infections. – Cephalosporins can be used to treat a wide range of infections but are also effective in treating more serious infections such as septicaemia and meningitis. – Aminoglycosides tend to be used only to treat very serious illnesses such as septicaemia as they can cause serious side effects, including hearing loss and kidney damage. They break down quickly inside the digestive system so they have to be given by injection. They are also used as drops for some ear or eye infections.
Anti-hypertensive: i.e. Lisonopril used for lowering blood pressure, it is also effective in the treatment of congestive heart failure, and to improve survival after a heart attack. Not to be used by people with liver or kidney disease, diabetes, rheumatoid arthritis. Side effects can include feeling faint, restricted urination, stomach swelling, and flu like symptoms, heart palpitations, chest pains, skin rash, depressed mood, vomiting and diarrhoea. These are some of the medications, my family are taking, others were found on the internet, to help lower blood pressure and handle Heart problems. Lisinopril is a medicine which is used in hypertension, heart failure, preventing complications after a heart attack and treating kidney problems in people with diabetes. Lisinopril is a medicine which blocks the action of a chemical in the body. Blocking this chemical has many effects on the heart and circulation. Lisinopril is used to treat a number of conditions that relate to the heart and circulation.
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels. The most common side effect is a persistent dry cough. If side effects become particularly troublesome, a medication that works in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist (ARB), may be recommended. ACE inhibitors can cause unpredictable effects if taken with other medications, including some over-the-counter ones. Check with your GP or pharmacist before taking anything in combination with this medication. Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels. This widens your arteries (large blood vessels) and reduces your blood pressure. Drinking grapefruit juice while taking some types of calcium blockers can increase your risk of side effects. You can discuss the possible risks with your GP or pharmacist.
Diuretics – Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine. Diuretics may sometimes be used as an alternative to calcium channel blockers. Beta-blockers work by making your heart beat more slowly and with less force, thereby reducing blood pressure. Beta-blockers used to be a popular treatment for high blood pressure but now they only tend to be used when other treatments have not worked. This is because beta-blockers are considered to be less effective than the other medications used to treat high blood pressure.
Amias, for COPD works by relaxing and widening the blood vessels, making it easier for the heart to pump blood around the body. ARBs are used for controlling high blood pressure, treating heart failure, and preventing kidney failure in people with diabetes or high blood pressure. They may also prevent diabetes and reduce the risk of stroke in patients with high blood pressure and an enlarged heart. ARBs may also prevent the recurrence of atrial fibrillation. Since these medications have effects that are similar to those of ACE inhibitors, they often are used when ACE inhibitors are not tolerated by patients (for example, due to excessive coughing). Ventolin Evohaler – contains a medicine called salbutamol. This medicine belongs to a group of medicines called bronchodilators, they help the airways in the lungs to stay open, making it easier for air to get in and out .Relieving chest tightness, wheezing and coughing. Side effect – if you are allergic to (Hypersensitive) to salbutamol sulphate you must inform your doctor if you have heart problems as angina.
Doxazosin – belongs to a group known as vasodilators. These substances cause the blood vessels to widen, reducing blood pressure. In some cases it can reduce tension in the muscles tissues of the prostate and urine tract. Serious side effects can be swelling of the face and throat, shin rash with red blisters or chest pains, increased or irregular heartbeat. Many more side effects can be found on the package leaflet in the box with the medication, read this before taking the medication or contracted your doctor.
Atorvastatin- is an oral drug that lowers the level of cholesterol in the blood. It belongs to a class of drugs referred to as statins, which includes lovastatin (Mevacor), simvastatin, (Zocor), fluvastatin (Lescol), etc. All statins, including Atorvastatin, prevent the production of cholesterol in the liver by blocking HMG-CoA reductase, an enzyme that makes cholesterol.
Statins reduce total cholesterol as well as LDL cholesterol in blood. LDL cholesterol is believed to be the “bad” cholesterol that is primarily responsible for the development of coronary artery disease. Reducing LDL cholesterol levels retards progression and may even reverse coronary artery disease. Atorvastatin also raises the concentrations of HDL (“good”) cholesterol that protects against coronary artery disease and reduces the concentration of triglycerides in the blood. Ferrous Sulphate – theses tablets belongs to a group of medicines called iron supplements. These tablets are to replace the minerals that the body needs to produce red blood cells. Side effects, they don’t mix well with a lot of other medication so you have to talk to your doctor first before taking them.
Metformin Hydrochloride Tablets – one of a group of medicines called oral hypoglycaemic, theses work to reduce the level of sugar in the blood. This is only to treat Type 2 diabetics (not insulin dependent). Side effects can be a problem as there are many medications that will affect the way Metformin works even herbal medicines can be a problem, so you have to tell the doctor everything you are taking.
Bendroflumethiazide Tablets – these tablets belong to the group of medicines called Thiazide diuretics (in English, water tablets). These are to reduce fluid retention (oedema) particularly in the heart, kidneys and liver or the caused by medication, also increasing the flow of urine or blood pressure. Side effect are a lot if you allergy (hypersensitivity) to Thiazide. If you have any of the following-: Severely impaired kidneys, liver functions, high blood levels of calcium (hypercalcaemia), low blood levels of sodium (hyponatraemia), low blood levels of potassium, which is not responding to treatment (refractory hypokalaemia) or have gout (high levels of acid in the blood) causing crystals to deposit in the joints (hyperuricaemia) and Addison’s disease (syndrome due to low level of corticosteroid hormones secretion. If you are on insulin the doctor many need to adjust your insulin. This is why before taking any medication you need to talk to your doctors as there are many side effects, if you take other medication.
Omeprazole capsules- (gastro-resistant) these belong to the group of medicines called proton pump inhibitors; it works by reducing the amount of acid that your stomach produces. It is common to take these if you have a ulcer caused by other medicines called NSAIDs (Non-steroidal Anti-inflammatory Drugs). Omeprazole can also stop ulcers from forming, if you are taking NSAIDs. Side effects, if you are allergic to medicines containing proton pump inhibitorse.eg. Pantoprazole, Lansoprazole, Rabeprazole, Esomeprazole. Do not take Omeprazole if you are taking medicine containing Nelfinavir (used to treat HIV infection), if you are taking Warfarin or other blood thinning medication the doctor will need to monitor you when you start or stop taking Omeprazole.
2.2. Identify medication which demands the measurement of specific physiological measurement.
For certain medications, it is important that other checks are made, both before and after administering medication. Drugs like insulin (blood, has to be taken from a pinprick, so that glucose can be measured, before the insulin can be given); An individual’s pulse must also be taken before administering medication, used for heart irregularities such as digoxin. Blood pressure must also be checked after administering medication that is used for lowering individuals’ blood pressure. Warfarin to thin the blood – again blood levels must be checked regularly; digoxin to slow and steady the heart (pulse should be checked prior to administration and advice taken if the pulse dips below 60 beats per minute)
2.3. Describe the common adverse reactions to medication, how each can be recognised and the appropriate actions required. Unexpected adverse reactions can potentially, happen from any drug that an individual is taking. Someone can have an adverse reaction to penicillin, anaphylactic shock; the signs for these can be, the person has problems swallowing or the lips or face ballooning, a skin rash and the individual may also stop breathing, leading to total system collapse and if not treated with adrenalin, death. This is why it is important, that all information, about an individual’s medical records, must be up to date and in their care plans and also In the MAR Chart.
You don’t come cross this often, but you still have to look out for, other severe adverse reactions that could include a fever and skin blistering; these usually occur within an hour of the medications being administered. Sometimes adverse reactions can develop over a few weeks; they may cause damage to the kidneys or liver. If adverse reactions are not treated they could be fatal.
When individuals experience adverse reactions to medicines, my workplace policy is to inform the Manager immediately and explaining, in detail the adverse reactions, the Manager will then inform the individual’s GP and pharmacist and seek advice, the medication may also be stopped, unless the reactions are so serious, and then an ambulance will be called. I must continue, to observe the individual and monitor their vitals, speaking to them and looking at any changes, so as to ensure that the individual is not deteriorating. All adverse reactions and actions taken, following advice, given, must be recorded, in full, in the individual’s care plan, daily report and MAR chart.
2.4. Explain the different routes of medication administration Inhalation – is for when you have, respiratory conditions, inhalers and nebulisers are used to deliver the medication directly in to the lungs. Oral – These are medication that you take, via the mouth, there are tablets or capsules. If you have a problem swallowing or you have a small child, liquids, syrups and suspensions are available. There is special medication called sublingual medications, these are, when the tablets are placed under the tongue to dissolve quickly. Instillation – This form of medication comes in drops or ointments and can be used via the eyes, nose and ears. Drops are for ears and eyes infections. Nose spray or ointment is used for hay fever or infections.
Transdermally – This medication comes in patches these are applied to the skin normally to the upper arm or the chest. These are released slowly and then absorbed, like nicotine patches or Hormone replacement therapy (HRT). Topical – this comes in the form of creams and gels. They are used on the skin surface to treat skin conditions. The medication routes below can only be administration by a Doctor or Trained nurse. Intravenous – This medication enters into the veins and absorbed quickly. Rectal/Vaginal – This medication absorbed very quickly Suppositories are given in to the rectum and Pessaries are given in to the vagina. Subcutaneous – This medication is injected just beneath the skin as in insulin. Intramuscular – This medication is injected directly in to the large muscles in the body, normally the top of the leg or the bottom. Understand procedures and techniques for the administration of medication
3.1. Explain the types, purpose and function of materials and equipment needed for the administration of medication via different routes.
Equipment may include: medicine trolley; medicine pots; spoons; syringes; Nebulisers; containers; wipes; drinking glasses; water jug; disposal bag; medication administration record sheets/charts. Gloves must be worn and hands washed before and after, when administering medication by all routes.
For those with respiratory difficulties Inhalers are used and can be either worked by the individual, when they breathe in or set automatically, to activate, when the individual breathes in, which is measured by the doctor, when prescribing this. Nebulisers can also be used and work differently; a liquid is placed into a chamber at the base of a mask, a fine mist of the medication is released into the mask and the individual inhales. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
This is medication that is taken via the mouth, commonly in the form of tablets; using a non-touch technique these should be administered; direct from the MDS system, if being used, which are tablets and capsules only contained in blister packs. Medication cups and spoons can be used to administer these. Some tablets must not be crushed as this can change how the medication works. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Transdermal medications come in the form of patches that are applied to the skin, gloves are always needed and wipes, to clean the skin before applying patch; the locations of where they should be applied and how to change these, will be explained in the instructions that come with these. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Topical medications come in the form of creams and gels and instructions should be followed, it will tell you how much to apply. Gloves are needed to apply these, as they can be absorbed into the skin very quickly. Topical medication should only be used for individuals, that it has been prescribe for. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Instillation medications come in the form of drops (these may be kept in the fridge) or ointments and can be instilled via the eyes, nose or ears. Drops, sprays and ointment tubes need to be available and instructions followed as in, how many drops, each time you give them and have many times a day and gloves. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Intravenous medication involves giving an injection; you will need the syringes; wipes to clean the area that the injection is going in; containers to put these items in and always gloves. This route can only be done by a doctor or trained nurse. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Rectal medications are absorbed very quickly. Suppositories are available and are given into the rectum. Pessaries are given into the vagina. Only after training can these medications be administered. Access to a bed pan, commode and/or toilet close by must be given in case of sudden urge for individual to empty their bowels or bladder. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Subcutaneous medications involve giving an injection; you will need the syringes; wipes to clean the area that the injection is going in; containers to put these items in and always gloves. Only after training can these medications be administered. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
Intramuscular medications involve giving an injection; you will need the syringes; wipes to clean the area that the injection is going in; containers to put these items in and always gloves. This route can only be done by a doctor or trained nurse. You must make sure that you enter this on the individuals, medication administration record sheets/charts as well as the individual’s MAR chart.
3.2. Identify the required information from prescriptions/ medication administration charts.
Full name, address and DOB of the patient are essential.
Ensure prescription is dated and still valid. Ensure it’s signed by the appropriate prescriber, complete with their registration number and details regarding the address of their practice. Make sure it’s printed from a computer or written in ink if done by hand. Make sure the drug/preparation/product is named, complete with strength, dose and quantity, the route and form, when the medication should be started and ended Other: special instructions, any known allergies.
Other Methods may include: picture of the individual or identification bracelet this is normally in hospitals. Prescription for controlled drugs has far stricter regulations.