When providing medication management, Continuity Care staff must first ensure the participants/consumer/client has provided consent via a Medication Plan and Consent Form. The Medication Plan and Consent Form provides detailed information about the medications, the type of support required and consent for Continuity Care to provide medication management.
Participants/consumer/clients must be informed about Continuity Care ’s medication management processes in a way that meets their communication needs and cognition.
Participants/consumer/clients are encouraged and supported to be involved in decision making as far as possible according to their capacity, including Continuity Care focussing on supporting and encouraging participants/consumer/clients to self-administer their medication as the first step where appropriate.
If the participants/consumer/client is unable to provide consent, an authorised person responsible for making health related decisions is able to provide consent.
Where Continuity Care is uncertain about a participants/consumer/client’s ability to safely manage and administer their own medication, a capacity/competency assessment must be completed by a qualified health care professional (such as a General Practitioner) in consultation with the participants/consumer/client and those involved in their care.
Given capacity can vary over time, a reassessment should be completed regularly by a qualified health care professional to determine if the participants/consumer/client’s capacity has changed.
Where appropriate, participants/consumer/clients should be supported to implement strategies to work towards improving their capacity to self-administer and manage their medications.
Staff Training and Requirements
Continuity Care, as per the Human Resources Policy and Procedure, will ensure that the support workers employed have a level of competency to provide appropriate and safe support to a person with disability. This includes medication management.
Continuity Care must have a process in place to ensure the recruitment, training and scheduling of staff are competent in medications management.
All support workers supporting participants/consumer/clients with medication management (prompt, assist and administer) must have already completed training in the following, delivered by a Registered Training Organisation (RTO):
· First Aid;
· Recognise Health Body Systems; and
· Assist Clients with Medication.
An employee may also be assessed as competent if they have a higher qualification, for example a Registered Nurse who is acting within the scope of their employment.
If the support worker is required to undertake more complex medication administration to support an individual’s complex health Support Plan, additional training relating to more complex medication administration must be arranged, and a suitably trained staff member will assist the participants/consumer/client until such a time this can occur.
Support workers must participate in a review of their medication management knowledge and performance at least every 12 months by a suitability qualified staff member.
Continuity Care will ensure all support workers involved in management of participants/consumer/clients’ medications complete refresher training at least every 3 years, including coverage of recent changes in medication management practices and review of competencies.
In addition to an annual review of knowledge and performance, Continuity Care may provide refresher training to staff should the following occur:
· an incident or error occurs that is linked to medication management competencies;
· a request is made by a support worker;
· a request is made by the [Position Title e.g. Care Manager] where there are performance issues relating to specific medication management tasks;
· there is a change in a participants/consumer/client’s health or medication needs requiring a different range of competencies; or
· there is a change in the [participants/consumer/clients] accommodation or environment impacting on the [direct support workers] ability to perform the medication management tasks.
Participants/consumer/clients Self-administering and Managing their Own Medications
Continuity Care will support and encourage participants/consumer/clients to manage and administer their own medication where appropriate.
Where required, the Care Coordinator or delegate will request written advice from a participants/consumer/client’s medical practitioner or authorised representative, notifying that a participants/consumer/client has appropriate training and skill to assume responsibility for the management of their own medication.
Participants/consumer/clients Unable to Self-administer their Own Medications
Staff members are to provide the participants/consumer/client with the agreed upon assistance (prompt, assist or administer) as per the signed Medication Plan and Consent Form and in line with the participants/consumer/client’s Support Plan.
Types of Management
1. Prompting Medication
Given participants/consumer/clients still remain in control of their medicines, this type of management is where staff simply remind the participants/consumer/client of the need to take their medications.
The participants/consumer/client’s Support Plan must clearly stipulate the time of day for the staff member to prompt the participants/consumer/client, regardless of whether the participants/consumer/client chooses not to take them or take them later.
Staff remind the participants/consumer/client the time of day and ask them if they have taken their medication. This may occur as a stand-alone service or part of other services provided.
Prompting does not include:
· pouring out liquid medication.
· popping tablets out of containers.
· physically handling tablets or medicines.
· selecting the medicine for the participants/consumer/client.
· advising which medicine to take; or
· explaining dosage, applying creams or giving injections.
Staff are required to complete the Medication Management Checklist for each prompting service to demonstrate correct processes have been followed.
2. Assisting with Medication
Staff are to assist participants/consumer/clients who are able to retain control of their medication management however need assistance with the mechanical tasks associated.
Assisting with medicines can include:
· take medication in its container from the area where it is stored and hand the container to the participants/consumer/client as requested;
· provide assistance with opening a medication container as requested by the participants/consumer/client;
· remove medication from a container and place it into another container (such as a Pil-Bob) or the participants/consumer/client’s hand as requested;
· observe the participants/consumer/client to ensure they do not experience difficulty in administering their medication;
· assist the participants/consumer/client to make a record of the medication taken.
Staff are required to complete the Medication Management Checklist for each assistance service to demonstrate correct processes have been followed.
3. Administration of Medication
If participants/consumer/clients have been assessed as unable to administer or manage their medication, the Support Plan and Medication Plan and Consent Form must contain clear instructions about the physical assistance and supervisory role the staff will take in the administration of medications.
The level of support a participants/consumer/client requires varies and will regularly need to be reviewed throughout their time receiving care.
All medication to be administered by staff must be prescribed by the participants/consumer/client’s health practitioner and within its original packaging or a Dose Administration Aid.
An up-to-date pharmacy/health practitioner’s list of the participants/consumer/client’s current medications must be kept with the medications to be administered. This list must be updated with each medication change the participants/consumer/client experiences.
Staff are to follow their accredited training in medication management in relation to the rules for safe administration of medication.
Prior to administering medication, staff must prepare the participants/consumer/client by communicating and discussing the procedure, encouraging participation where possible. Staff must also establish the participants/consumer/client’s preference relating to medication administration, complete all personal hygiene steps and prepare all resources required.
Staff administering medication must ensure:
· the right medication is being administered.
· the medication is being administered to the right person.
· the right dose is being administered.
· the medication is being administered at the right time.
· the right route and administration method is being used as prescribed; and
· the right documentation is being completed.
Staff administering medication must also ensure the participants/consumer/client’s right to refuse their medication, ensuring to document this clearly within a Medication Incident Report Form.
Staff administering medication should as far as possible understand:
· the reason the participants/consumer/client is taking each medication.
· how the medication is to be stored and administered.
· the possible side effects of the medication and interactions with other medications; and
· how to utilise their first aid equipment and strategies if required.
Staff must not administer medication to participants/consumer/clients if:
· the above processes have not been followed.
· the medication is past its use by date or has been damaged.
· the participants/consumer/client is asleep, unconscious, drowsy, vomiting or having a seizure or other immediate health concern; or
· the staff member identifies a medication administration error from the previous administration service (i.e. missed medication from previous staff member visiting).
Following each administration service staff must monitor the participants/consumer/client for any adverse reactions and complete the Medication Management Checklist to demonstrate correct processes have been followed.
Participants/consumer/clients have the right to refuse their medications at any point during prompting, assisting or administering.
If a participants/consumer/client refuses to take any medication, staff are encouraged to:
· explore with the participants/consumer/client why they are refusing to take the medication;
· explain to the participants/consumer/client why the medication is needed;
· wait up to 30 minutes and discuss again;
· if refusal persists contact [Position Title] for further instruction; and
· record the participants/consumer/client’s refusal in their Medication Management Checklist and complete a Medication Incident Report Form immediately.
Restrictive Intervention – Use of Medication (Chemical Restraint)
Where a participants/consumer/client has a Behaviour Management Plan in place that involves restrictive interventions including the use of medication (chemical restraint), only staff who have expertise and the appropriate qualifications are permitted to carry out the proposed restrictive intervention.
Alterations to Medication
Some medications may have a reduction in effectiveness or a greater risk of toxicity or other harm if they are altered.
Prior consent must be obtained in writing from the participants/consumer/client’s pharmacist or health professional and noted within the Medication Plan and Consent Form prior to staff altering any medications. This includes crushing or breaking tablets.
Medication is not to be hidden in food or liquids.
Staff must not administer any medication that is not prescribed in accordance with this policy, including ‘over the counter’ medication.
Staff must not administer medications that require specialist or invasive techniques for example:
· Rectal administration of suppositories;
· Insulin given via pre-filled PEN devices; or
· Administration through a Percutaneous Endoscopic Gastrostomy (PEG) tube.
Staff must not administer medication to a participants/consumer/client who is clearly objecting in an informed manner unless there is an approved protocol in place, see ‘Restrictive Interventions’.
Staff must not administer medications to participants/consumer/clients in a manner that is clearly for organisational convenience and not reflecting the preference or needs of the participants/consumer/clients.
Staff must not leave medications of any type in an area where they are unsupervised and accessible to participants/consumer/clients or unauthorised persons.
Medication Management Documentation
A Medication Management Checklist is to be maintained for each participants/consumer/client who receives support with medication management from Continuity Care.
The Medication Management Checklist must be kept in the participants/consumer/client’s home, easily accessible by staff.
The Medication Management Checklist must:
· detail the participants/consumer/client’s name, address and any allergies or adverse drug reactions;
· detail the type of management required (prompt, assist, administer);
· allow the staff to record the date, time, source of the medication and type of support provided;
· remind staff to perform the medication Rights and confirm they have done so;
· allow the staff to record any observations of the participants/consumer/client before, during and after; and
· provide space for the staff member to list and sign their name as the person responsible for that medication support delivered.
Participants/consumer/clients managing their medication are to be encouraged to store their medicines in a manner that maintains the quality of the medicine and safeguards the participants/consumer/client, their family and visitors in their home.
The Managing director/Operational manager/Care Coordinator will be responsible for the appropriate storage and security of all participants/consumer/client’s medication held by Continuity Care.
Continuity Care will ensure that any medications that are to be stored for a participants/consumer/client will be kept as per the manufacturer’s recommendations. Medications that require refrigeration must be stored in the fridge (not in the fridge door) to maintain optimum temperature. Medication will be kept:
· in original containers or pharmacy issued dose administration aids.
· securely (locked) and out of reach of children.
· separately from food and/or other chemicals.
When medication needs to be transported, it should be placed in an appropriate storage container where required.
The Operational Manager/ Care Coordinator will be responsible for the keys/security code for any locked containers that store medication. A spare key will be kept with the managing Director. If any of the keys are lost/stolen or the security of the medication storage is compromised, then new keys (and spare key) will be arranged.
Disposing of Medications
Medication must be disposed of safely and in a manner that is not harmful to the environment. See Continuity Care ’s Waste Management Policy and Procedure (Pharmaceutical Waste) for further details on the appropriate disposal method.
Where staff have any concerns or questions about a participants/consumer/client’s medication management or their responsibilities they must report to Managing Director for guidance.
Incidents relating to medication refusal, misuse, errors or similar should be reported in accordance with Continuity Care ’s Incident Management Policy and Procedure.
Monitoring and Review
This policy and procedure will be reviewed at least annually by the Continuity Care and incorporate staff (where applicable), [participants/consumer/clients] and other stakeholder feedback.
Continuity Care Continuous Improvement Plan will be used to record, and monitor progress of any improvements identified and where relevant will be incorporated into service planning and delivery processes.