The Care and Social Services Inspectorate Wales (CSSIW) are the regulatory body that provide us with standards that are expected of us when administrating medication. Under The Medicines Act 1968, which is a major piece of legislation, governs the responsibility we have in administering medication to our clients. There are three important statements from this piece of legislation, which are: Medicines prescribed to a person are that person’s property and may not be used by any other person. Anyone can administer prescribed medicine to another person, as long as they follow the directions given by the prescribing medical profession. Doses of prescribed medicine must not be varied without the prescriber’s consent. (includes stopping, reducing, or increasing doses). There are five other policies that take part in governing our responsibility when administering medication. These are: The Misuse of Drugs Act 1971
Health and Safety at Work Act 1974
Data Protection Act 1998
COSHH Regulations 1999
Mental Capacity Act 2006
There are many types of medication that carers will come across across, below are a few examples. Analgesics (painkillers)
Examples of analgesics are paracetamol and ibuprofen used to relieve pain. Analgesics work by blocking pain signals going to the brain or by interfering with the brains interpretation of the signals. Side effects may include nausea, vomiting, drowsiness, dry mouth, postural hypotension and constipation. Severe side effects may include stomach bleeds, confusion, hallucinations, and addiction. Laxatives
Laxatives are used to help people pass stools more easily. There are four major types of laxatives that act in different ways and have different side effects. These are: Bulk-forming laxatives which bulk up stools to help them retain water which in turn encourages the bowel to contract and move the faeces along. Examples of bulk-forming laxatives are Fybogel, Celevac and Normacol. Side effects of these drugs are bloating and flatulence (wind). Stimulant laxatives which speed up the movement of the bowel by stimulating the muscles in the digestive system. Examples of stimulant laxatives are Dulkolax and Senokot.
These drugs may cause stomach pain and if over use then may lead to a weakened bowel. Osmotic laxatives make stools softer by increasing the amount of water in the bowel. Examples of Osmotic laxatives are Movicol and Microlette. When using these drugs, they may have side effects which include abdominal pain, bloating and flatulence. Stool softener laxatives add water to stools to lubricate them, making them more slippery and easier to pass. Stool softener are Docusol and Dulcoease which can cause abdominal cramps, nausea and a skin rash. Antacids
Antacids is a substance which counteracts stomach acidity. In other words, antacids are stomach acid neutralisers which are used to treat heartburn and indigestion. These type of medication are called Rennie and Gaviscon, which can cause diarrhoea, vomiting, nausea, blood in stools, flatulence and constipation. Anti-Depressant
Antidepressants are medication that is used to treat depression or prevent it from re occurring. They are also used for people with long term pain conditions. Antidepressants work by increasing levels of brain chemicals called neurotransmitters. An example of this is serotonin which helps improve mood. Types of antidepressive medication are fluoxetine and citalopram which may cause constipation, dizziness, insomnia and nausea. Anti-inflammatory (NSAIDS)
Anti-inflammatories are used to treat inflammation, pain and to bring down a high temperature. Anti-inflammatories work by blocking the effects of cox 1 and cox 2 enzymes which make prostaglandins; therefore by stopping the body from making these prostaglandins, which means, less swelling and less pain. Examples of anti-inflammatories are Naproxen, Ibuprofen, Flurbiprofen which may cause indigestion, stomach ulcer and increased blood pressure. Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy is used to treat the symptoms of menopause. It works by replacing female hormones, such as oestrogen and progesterone that are at a lower level as you approach the menopause. HRT can be taken in the from of tablets, patches or implants. Such as FemSeven patches, Femoston and Hormonin. There are many different types of tablets and many can contain side effects. The side effects for oestrogen medication are fluid retention, bloating, breast tenderness or swelling, nausea, leg cramps, headaches, indigestion. The side effects for progesterone include fluid retention, breast tenderness, headaches, mood swings, depression, acne and backache. The Medicines Act 1968 and The Misuse of Drugs Act 1972 classify drugs into various groups. These are: General Sales List Medicine (GSL)
These medicines can be sold by a wide range of shops, such as newsagents, supermarkets and even petrol stations. A prescription is not required to purchase these medicines such as paracetamol and cough syrup. They are often low in strength or a limited pack size. Prescription Only Medicine (POM)
This type of medication cannot be obtained without a prescription (usually from a GP). This medication is usually in the form of Antibiotics. Controlled Drugs (CD)
Controlled Drugs have a stronger effect on the body and have different protocols when handling, storing, administering and disposing them. Examples of these drugs are morphine, pethadine or methadone. Physiological measurement is the process in which an individual’s vital signs are being recorded. Such as blood pressure, heart rate or temperature. For example Trimethoprim is a anti biotic commonly used to treat an urinary tract infection. A doctor would usually test urine and temperature for signs of an infection before prescribing trimethoprim, then after the course is taken the urine would be checked again along with the individual’s temperature for signs that the infection has cleared. Another, is, Atenalol which is a drug that treats angina and hypertension. It is used to relieve high blood pressure. It is prescribed once the doctor has measured an individual’s blood pressure, helping to reduce the risk of a heart attack. There are many common adverse reactions to medication.
Here are some and the best course of action to take, when this does occur. Rashes, itching, head ache, nausea, and constipation. If these symptoms to occur then ring the GP for advice and a change of medication. However on rare occasion symptoms such as fits, high blood pressure, low blood pressure, bleeding, stomach ulcers do occur then ring 999 for immediate assistance. Oral administration is where medication is taken through the mouth and have a systemic effect. Reaching different parts of the body through the blood stream. Sublingual administration is where medication is taken under the tongue.
Therefore, allowing the drug to disperse into the blood stream through the tissues under the tongue. Inhalation administration is the route through the nose or the mouth, to deliver drugs to the lungs. An example is an inhaler and a nebulizer. Injection administration is commonly known as intravenously. In other terms injecting a drug into the blood stream. Therefore reaching different parts of the body quickly and thoroughly. Topical administration of drugs is applying a drug direct to the skin. Such as prescribed creams and steroids such as hydrocortisone. Rectal administration is a drug administered through the anus. Therefore suppositories reach the blood system efficiently and effectively. Vaginal administration is when a drug is applied inside the vagina. Therefore affecting the vaginal structure such as the cervix.
Blister packs can be used to ensure the right medication and right dose is in each pocket, ready for when medication is due. A medication pot can be used to place the medication in, therefore promoting good infection control and health and safety. The use of gloves are worn throughout the process to reduce the risk of contamination. When using inhalation administration the use of a nebulizer will allow the drug to go straight to the lungs.
Medication and prescription charts (MAR chart) should contain name, telephone number address and DOB of the client, along with their doctors and pharmacy details. Along with this each MAR chart should include the type of medication, the strength, the dose, the form of medication i.e, liquid, capsule and the times of day in which it should be taken. There should be boxes where carers put their signatures to say they have given medication. Also on a MAR chart we will see codes, for any reason to why any medication was not taken. There should be MAR chart details, if, there is more than one MAR chart. The appropriate timing is usually four hourly gaps in between doses. Unless stated otherwise by the GP. This will be stated on the clients MAR chart. When administering medication we are looking to see if there is a correct gap before giving medication. This is to ensure that it has had its full length of time to work. Therefore we must be paramount and thourough regarding the clients dose incase of an overdose. Incase of a medication administration error carers are to;
Check to see if the client is safe, looking out for symptoms of overdose or reaction. Ring NHS Direct where you will be transferred to a duty doctor. If the client is not alert, drowsy, has difference in behaviour or non responsive then ring 999 immediately. Make sure clients details, medication and dosage are at hand. Reassure the client at all times. Do not panic.
Ring the office immediately so the family can be informed.
Stay with the client until next of kin has arrived or the paramedics are at hand and have said it is safe to leave. It is paramount that carers are always with clients when administration medication to make sure they have taken it. Medication is prescribed by the doctor for their own health benefits, to ensure they have a quality of life and to help with any health conditions. Therefore, if being passed to another client, they may be allergic to that medication or even interact with their own medication causing serious harm. The Special Waste Regulations 1996 classes all prescription drugs as special waste. Out of date or par used medications must be disposed of by a pharmacy.
The Controlled Waste Regulations 1992 regulates the standards in which care home dispose their medication. The care home must make arrangements for it to be collected by a licensed waste disposal company. If carers work in the community then all out of date or un used medication must be sealed and given to a senior member of the team for disposal. The clients must always ensure they have the clients authorisation to remove medication from the property as set out by the Drugs Act 2005.