Shailesh Patel MSc MRPharmS is an experienced pharmacist whose primary focus is on managed care settings. He is the Managing Director of Pharmacyspace and has advised Careberry on medication management and electronic Medication Administration Records (MARs) over the past few years.
The administration and management of medicines is an important part of the care process. The use of medications can help manage symptoms and improve conditions, but sometimes unwanted effects can occur. It is important for care providers to be able to recognize these and know how to handle them if they occur.
Here are eight things to keep in mind while handling medicines in a care setting:
1) Assessment – It's critical to remember that requiring care does not imply that people are unable to handle their medications. People who need care still have freedom to choose how to manage their medicines. If we are asked to support someone with their medicines an assessment can establish the level of support required and the risks involved. An assessment should determine what medicines a person take, how they are taken, what they are used for, where they are stored and importantly their ability to take medicines and what adaptations or support is necessary for them to continue to take their medicines as independently as possible.
2) Competency – carers who handle medicines should be competent and the care provider should be able to demonstrate how the competency is acquired. This can be accomplished by external or internal training, as well as competency checks during induction phase, during which a carer is signed off as competent to handle medicines. Incompetency in handling medicines can result in life threatening errors. Carers should be competent in administering medicines as well as marking them off correctly.
3) Record keeping - You must maintain a thorough account of medicines, dose, timing, and instructions if you are handling medicines as a homecare business or a care home company. These records must be created in such a way that the Care Quality Commission is satisfied. To minimise mistakes, an electronic medication management system can be used in which medicines are logged and care workers sign them off when they are dispensed.
4) Storing Medicines – If you are handling the medications, it is your duty to ensure that they are stored safely and securely to avoid exposing them to air or temperatures/humidity that are not appropriate. It's also crucial to make sure that the medicines don't expose a risk to the client or anybody else. It is critical to instil in the team the mindset that medicines are expensive and valuable things that, if handled improperly, may cost lives and money.
5) Access to advice – it is important to ensure you have access to advice from a community pharmacist. Community pharmacists can help with a variety of issues related to medicines. For example, advice on missing a dose, how to take medicines, alternative medicines to manage some specific side effects, and safe disposal of unneeded medicines. Your practice pharmacist based at your GP surgery may also be able to offer a free structured review of your clients’ medication if they take several different medicines.
6) New medicines - when starting a new medicine, it is important to keep the following factors in mind:
• Initially, there may be side effects, as the body adapts to the new medicine, and after a period of time these symptoms can settle down.
• Recognise the side effects and what to do. Some medicines, for example, may need to be started at night when a person is sitting in bed to reduce the risk of falling before the body becomes accustomed to them.
• How long the side effects usually last and what to do if they persist.
• It is important to understand that side effects are not the same as adverse events. While side effects are predictable effects that may happen, adverse events are unpredictable and are often affected by specific susceptibilities such as allergies and intolerances.
7) Stopping medicines – Many medicines can be stopped immediately without any problems. Some medicines need to be stopped at a slower rate and your doctor will advise on how these medicines should be stopped. If you are unsure, always check with your community pharmacist. When stopping a medicine, keep these things in mind:
• The time that medicine needs to stop
• Sometimes you need to switch from one medicine to another. Identifying overlaps and knowing what to do, as well as whether the old medicine should continue or not, is crucial.
• Things to watch and expect when stopping a medicines
8) Hospital Discharge – Discharges from hospitals can lead to medicines errors. Here are some points to consider to prevent errors:
• Check the Discharge Summary to find out which medications have been started or stopped in hospital. If clients are given medicines to go home with, make sure they are aware that these maybe the same medicines that they have at home.
• High risk patients are now referred to community pharmacists from hospital through the Discharge Medicines Services, where community pharmacists can review the discharge summary and follow up on any changes and tell you what medicines have ended and what new ones have been added. Any discrepancy should be brought to the client's GP's attention.
It is impossible to cover all aspects of medication management in a short blog post. It is advisable to prepare your own reference sources to be used in conjunction with your own safe medication management policy and protocols.