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Handling of Medication . Jane Hancock DipClinPharm BPharm MRPharmS. NEWS HEADLINES Seven in ten care home residents is 'victim of drug error', The Daily Telegraph , October 6 2009

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handling of medication

Handling of Medication

Jane Hancock DipClinPharm BPharm MRPharmS

slide2
NEWS HEADLINES

Seven in ten care home residents is 'victim of drug error',The Daily Telegraph, October 6 2009

Fears over care home drug errors, BBC News, October 6 2009

Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009

More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009

Elderly hit by muddles over drugs, Daily Express, October 6 2009

slide3
Medication errors affect three

quarters of care home residents

6 October, 2009

slide4

Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

The University of Surrey, in conjunction with the London School of Pharmacy and Leeds School of Pharmacy

Qual Saf Health Care 2009;18:341-346 doi:10.1136/qshc.2009.034231

study details
Study Details
  • 55 Care Homes
  • 256 Service Users
  • Average of 8 items of medication each
findings
Findings
  • 178 (69.5%) of Service Users had one or more errors
  • 57 Service Users had 116 administration errors, including being given the wrong dose of medication or not being given their medication at all
contributing factors
Contributing Factors
  • G.P.s not readily accessible
  • Did not know the service user
  • Lacked information in the homes when prescribing
contributing factors8
Contributing Factors
  • Home Staff had high workload
  • Lack of medicine training
  • Interruptions during medicine rounds
  • Lack of team work between Home, Surgery and Pharmacy
  • Inefficient ordering systems
  • Inaccurate medication records
  • Verbal communication
conclusion from the study
Conclusion from the study
  • "People in care homes are a frail and vulnerable population at particular risk from medication errors, and it is a cause for concern that two-thirds of care home residents in this study were exposed to one or more errors."
the five rights of administration
The five rights of administration
  • Right service user
  • Right medicine
  • Right dose
  • Right time
  • Right route
types of medicines
Types of medicines
  • Systemic
  • Topical
systemic medicines one
Systemic medicines - One

Oral medicines

- Solid dose forms

- Tablets and capsules

- Soluble/dispersible/effervescent tablets

- Lozenges

- Enteric coated tablets

- Sustained release tablets and capsules

- Liquid dose forms

- Solutions

- Syrups

- Suspensions

  • Mixtures
  • Linctus
systemic medicines two
Systemic medicines - Two
  • Rectal medicines
  • Injections
  • Medication given via PEG tubes
  • Transdermal Patches
topical medicines
Topical medicines
  • Eye, ear, nasal drops
  • Creams and ointments
  • Inhalers
  • Rectal medicines
  • Vaginal preparations
applying topical medicines
Applying topical medicines
  • Just as important as oral medicine
  • When opening new tubes or drops etc. always record opening date
  • Unless labelled otherwise the general guidance is:

- Jars - discard one month after opening

- Tubes - discard three months after opening

- Eye drops and eye ointment - discard four weeks after opening

giving the medicines one

*

*

Measure the dose - Liquids

Read at the bottom of the Meniscus

Giving the medicines - One
  • Be prepared
  • Check the medicine record
  • Find the medicine
  • Measure the dose*
  • Check the label
giving the medicines two
Giving the medicines - Two
  • Take the medicine to service user
  • Check service user is the correct person
  • Make sure they are in an upright position
giving the medicines three
Giving the medicines - Three
  • Give the medicine
  • Offer a drink
  • Record immediately what has been given or declined
medication administration records and request marr
Medication Administration Records and Request (MARR)

TRACK MEDICATION – EVERY SERVICE USER –

RECORD IMMEDIATELY

The Home is expected to carry out a minimum of five audits:

1. Quantity received audit

2. Quantity disposed audit

3. Administration audit

4. Ordering audit

5. Information audit

Therefore:

Medication Containers & Labelling + Reminder Cards + MARR + Returns Book = FULL AUDIT TRAIL

storage
Storage
  • Locked cupboard or trolley
  • Cool, dry room
  • Key security
  • Self medicator’s medicine
  • Fridge temperature
  • Oxygen
waste medication
Waste Medication
  • Hazardous Waste Regulations 2005
  • Care Homes classed as domestic waste record and return to Pharmacy
  • Care Homes with Nursing classed as industrial waste collected from home by specialised waste contractor e.g. Cannon, PHS
controlled drugs
Controlled Drugs
  • Medicines Act 1968
  • Misuse of Drugs Act 1971
requirements of a controlled drug prescription
Service User’s name & address

Age (if under 12)

Name of Medicine

Strength

Dose Form

Quantity (in words and figures)

Dose

Doctor’s Signature

Prescribing Date

Requirements of a Controlled Drug Prescription
storage of cds
Must comply with Misuse of Drugs (safe custody) regulations

Made of steel

5 lever or 6 pin lock

Fixed to a solid wall or a wall that has a steel plate mounted behind it

Fixed with rag or rawl bolts

Storage of CDs
the five rights of administration28
The five rights of administration
  • Right service user
  • Right medicine
  • Right dose
  • Right time
  • Right route
slide29
NEWS HEADLINES

Seven in ten care home residents is 'victim of drug error',The Daily Telegraph, October 6 2009

Fears over care home drug errors,

BBC News, October 6 2009

Study reveals alarming level of drug errors in care homes, The Guardian, October 6 2009

More than two-thirds of care home residents given the wrong prescription, Daily Mail, October 6 2009

Elderly hit by muddles over drugs, Daily Express, October 6 2009