1.1 Current legislation include; Health and Social Care Act, the Medicine Act and the Misuse of Drugs Act. Control of substances Hazardous to Health (COSHH) regulations, Health and safety at work act, the misuse of drugs (safe custody) regulations, essential standards, data protection act, hazardous waste regulations. Guidelines include the Nursing Midwifery Guidelines for the management of medicine administration, where registered nurses and senior carer for residential units such as myself. I should abide the guidelines at all times. In my workplace I try my very best of ability to follow the policy and the procedures of the home in terms of medication. Anyone who is administering should be trained and competent. If unsure of medication, there is the BNF book in the unit and also manager/ deputy manager always in reach. The gp of the home visits every Tuesday and if there is urgent situation such as service user with chest infection, the surgery is within reach. Medication policy is in place in order to ensure safe and secure handling of medicine. the policy should clearly state all required details such as storage, ordering, administering, disposing and recording of medicine.
The policy should allow staff to work with the same system when handling medicine. Protocol is a procedure that needs to be followed such as, disposing of controlled drugs and other medication. For example in my workplace, there is a returned medication book and box. The start of new cycle each month, all unwanted and controlled drugs need to be documented with name of the medication, dose, frequent, reason for returning/destroying and signature of the staff. In my workplace our chemist collects all returned medication and as the home does not have licence for destroying unwanted medication.
2.1 Common types of medication could Antibiotics, Analgesics, Anticoagulants, and Antidepressants. Anticoagulants e.g. warfarin Anticoagulants are used to prevent blood clotting ramps, throw up, heartburn. Irritation of the stomach, and intestines. A side effect common to all anticoagulants is the risk of excessive bleeding (haemorrhages). Side effects may include passing blood in your urine, or faeces, severe bruising, rashes, diarrhoea, nausea (feeling sick) and vomiting. Analgesics e.g. Paracetamol Analgesics are used to relieve pain such as headaches. Addiction to these can happen if taken over a long period of time. Feeling dizzy, nausea, sleepiness, confusion. Constipation, diarrhoea. Antibiotics e.g. amoxicillin, trimethoprim, Ciprofloxicillin Antibiotics are used to treat infections caused by bacteria. Diarrhoea, feeling sick and vomiting are the most common side effects. Antidepressants e.g. Mirtazapine, Citalopram; Antidepressants work by changing the chemical balance in the brain and that can in turn change the psychological state of the mind such as for depression.
Common side effects include: blurred vision, dizziness, drowsiness, nausea, restlessness, shaking or trembling, and difficulty sleeping. Other side effects include: dry mouth, constipation, and sweating. All of the above medicines that I have mention are the common medication that most of the service users in my units are on and I am familiar with. There were times where some service users had an allergic drug especially the antibiotics, where the residents complained fever, breathing problem, rash, swelling of the face/lips. Depending on the situation, if very serious such as breathing difficult and swelling of face, emergency services were called immediately as the swelling could easily spread and could block the airways. Anything else the gp were called and doctor immediately prescribed antihistamine tablets and the suspected drug was discontinued. Service user reassured, manager and family informed and all incidents recorded. In my workplace each unit has a copy of the British National Formulary (BNF). It is really good source as I normally check if unsure of any medication’s side effects. This book is regularly updated.
2.2 Some of the medications that demands the measurement of specific physiological measurements could include; for example Warfarin, Digoxin and insulin. Warfarin is used to thin the blood in order to reduce risk of clots developing which could cause health hazards such as stroke or cardiac problems. Anyone who is on Warfarin should have blood test to monitor the INR (international normalised ratio) frequently and as required. Service users who are on insulin need to be checked their glucose level before administering the insulin. Digoxin tablets are used for service users with heart beat irregularities in order to slow and steady the heart. Before administering this type of medicine, I always check the Pulse of the individual while also following the instructions of the doctor and manufacturer. The pulse should be above 65 normally but if below 60, I would seek advice from medical personal/ contact the doctor. Document all information, and reassure the service user.
2.3 Common adverse reactions might be diarrhoea (some antibiotics for example); skin rashes; nausea – through to serious adverse reactions such as anaphylactic shock (facial swelling, blistering of the skin, wheezing and hives) leading to total system collapse and (if not treated with adrenalin) death. Unexpected adverse reactions can happen for any drug potentially that an individual is taking. For example one individual I work with has an adverse reaction to penicillin, anaphylactic shock; the signs of this are the swelling of for example the lips or face, a skin rash and the individual may also have breathing difficulties. This is why it is important that all information about an individual is recorded in full in their care plan and medication administration record (MAR). All adverse reactions and full actions taken following advice given must be recorded in full in the individual’s care plan, daily report and medication administration record (MAR).
2.4 There are different routes for administering medicine into the human body such as; Inhalation, Intradermal, Oral, Intramuscular, Intravenous, Parenteral, subcutaneous, rectal and Vaginal drug sublingual, topical drug and transdermal drug. I will explain bit more of how each routes is administered.
Inhalation; gas or vapour is inhaled through the nose or the mouth and then medicine is absorbed into the bloodstream through the lungs, an example for this type of medicine would be Asthma inhalers and Carbocisteine capsules for people with chronic obstructive pulmonary disease (COPD).
Oral drug; is taken by mouth and is absorbed into the bloodstream through the stomach or small intestine, for example painkillers such as Paracetamol. Parenteral drug; is administered by injection using a needle and syringe or a needle and intravenous (IV) tubing into the body. Intradermal drug; injection within the layers of the skin.
Intramuscular (IM); injection into a muscle.
Intravenous (IV); into a vein.
Subcutaneous (SQ); beneath the skin.
Rectal/Vaginal drug; is in the form of a suppository or liquid and is inserted into the rectum. Such as Diazepam for epileptic. 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. Sublingual drug; is placed under the tongue and is absorbed into the blood vessels there. Topical drug; is applied to a particular area for local action (generally lotions, ointments, and eye or ear drops). Transdermal drug; is absorbed into the bloodstream through the skin by means of a controlled release patch. Nicotine patch.
3.1 Materials and equipment need for the administration of medicine via different routes include; syringes used for oral suspension medicine for individuals who finds difficult to swallow, medicine cups/spoons for tablets and liquid medicine to measure, crusher for crushing tablets for individuals who have covert medication agreement in place, glasses and water jugs for individual’s to have their medicine with and gloves for when applying ointments/creams on the body and so on. Inhalation
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 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.
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 is 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, Transdermal
Transdermal medications come in the form of patches that are applied to the skin; the locations of where they should be applied and how to change these will be explained in the instructions that come with these. Topical
Topical medications come in the form of creams and gels and instructions should be followed. Instillation
Instillation medications come in the form of drops or ointments and can be instilled via the eyes, nose or ears. Drops, sprays and ointment tubes need to be available and instructions followed. Intravenous
Intravenous medication involves giving an injection. This route can only be done by a doctor or trained nurse. Rectal/Vaginal
Rectal medications are absorbed very quickly. Suppositories and are given into rectum. Pessaries are used 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. Subcutaneous
Subcutaneous medications involve giving an injection. Only after training can these medications be administered. Intramuscular
Intramuscular medications involve giving an injection. This route can only be done by a doctor or trained nurse. 3.2
‘The individual’s details: their full name, address and date of birth. The medication: the name of the medication, the dose, strength, frequency to be taken, the route and form, when the medication should be started and ended. Other: special instructions, any known allergies, prescriber signature.
I always check and read service user’s daily report before administering in order to avoid over dose, for example a service user might have been given Paracetamol before the due time on the MAR charts due to pain the individual complained. All medication have a specific time difference before second dose could be administered, such as Paracetamol where two tablets 4-6 hours difference is allowed for adult person a day. Checking and double checking MAR charts is essential in order to minimize risk of overdose and also if service user is not taking their medication, it need to be recorded and informed their doctor, so that alternative option can be put in place.
I always pay attention to ensuring I maintain individuals’ dignity, choices and preferences. Sometimes individuals refuse their medication, this is their right to as I cannot legally and according to our medication policy administer their medication without their consent. I listen to why they are refusing; sometimes because they can’t understand why they need to have their medication, other times because they can’t swallow tablets. I explain what their medication is for and their effects and also give them information about how medication is available in liquid form which they would find easier to swallow.
If the client refuses their medication I have to record it on their MAR and in their care plan and inform my Manager then I would contact with the service user’s doctor for advice. This may involve a medication review to see what else can be offered. For example in my unit there is Mrs D who is always refusing to take her medication whether tablet, capsule or liquid form she completely refuses and spits out. It came to a point where the doctor signed a covert medication agreement form with the consent of her family and manager as it was for her best interest. Now all her medication are crushed and hidden within her food and our chemist was also informed about it.
It is my duty to make sure that that the individual is taking their prescribed medication and that their condition is monitored so the health of the service user does not deteriorate. When I am administering medication, I always ensure the right individual has taken the correct medicine and I do not leave any medication on table as the service user could pass it on to their friend or person sitting next to them. Most of the service users that I work with have dementia, so I take a great deal of ensuring there are not any preventable mistakes. Taking medication that is not prescribed for the individual could result overdosing or feeling ill. In my workplace the policy states any medicine should not be left out and staff to make sure service user has taken their medication before leaving. In my unit, each service user has their picture and medication chart attached together with covert medication agreement form if applies. This is a safe practice and also makes easier for new staff to find the right person for the right medication.
In my workplace there is a return medication book and box where all left overs, unwanted medication are disposed and recorded until end of the cycle, the return medication box stays in the treatment room which is locked at all times until the chemist collects it. Such medications could be if a service user refuses to take their tablets, or a service user has an allergic reaction to antibiotics where then the course has been stopped and also deceased service users medication (after seven days after death could it be destroyed). The hazardous waste regulations, the medication policy and under the care home standards, it is a legal requirement that all medication to be disposed/destroyed safely.