At Ridouts, we have recently seen a rise in medicine management concerns in CQC inspection reports. Many of the medicine management issues range from care providers not following their internal policies and procedures in relation to medicines management, criticism for not having competent staff to administer medication and in some cases, basic poor recording.
Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (The Regulations) states that care and treatment must be provided in a safe way for service users, which includes the proper and safe management of medicines.
The guidance to the Regulations states that staff are required to follow policies and procedures in relation to managing medicines and that the policies and procedures should reflect current legislation and guidance on medicine management and include: –
- supply and ordering
- storage, dispensing and preparation
Further guidance on good practice in medicine management is outlined in the National Institute of Health and Care Excellence (NICE) Medicine Management in Care Homes guidance. The NICE guidance is used by care providers to follow good practice on managing medicines in a care home setting. The guidance outlines prescribing, handling and administering medicines in care homes.
You do not need to be clinically trained to administer medication in a care home setting, however, staff in care settings need to complete training in medication administration, be assessed as competent in this area and have this under regular review by the management team at your service through supervisions.
The Department of Health’s “Administration of medicines in care homes (with nursing) for older people by care assistants guidance” states that staff should have training which includes learning about common issues associated with medication administration errors, including (but not limited to) the understanding that interruptions during the preparation and administration of medicines are associated with medication errors, medication errors are more likely to occur in the morning and that administering and managing inhalers and liquid medicines are much more likely to give rise to medication errors than tablets or capsules.
It is imperative that providers have a formal process in place to assess staff competence through carrying out an annual review and provider refresher training. This review can be used to identify any further training requirements in relation to medicine management and administration. The NICE guidelines also recommend that care providers should consider using an ‘accredited learning’ provider so that staff responsible for managing and administering medicines can be assessed by an external assessor.
In terms of ensuring good practice in recording medicine administration, The NICE guidelines recommend that medicines administration records should:
- be legible
- be signed by the care home staff
- be clear and accurate
- be factual
- have the correct date and time
- be completed as soon as possible after administration
- avoid jargon and abbreviations
- be easily understood by the resident, their family member or carer.
Whilst many care providers do follow good practice, some fall short when it comes to recording. CQC will rely heavily on written evidence when inspecting your service, therefore it is important that staff do their service justice and complete medicine administration records accurately and in line with the policies and procedures at the service.
It is important to note that, whilst this guidance is not legally binding, it is important that the recommendations in the guidance are followed to ensure best practice in medicine management. This is further reinforced in the Key Lines of Enquiry (KLOEs), the framework that CQC use to inspect services, which has up to 8 prompts for medicine management. One of the main prompts outlined in the KLOEs asks whether the service that is being inspected uses the relevant professional guidance in relation to medicines management. Care providers should incorporate legislation and guidance in their policies and procedures and ensure that staff are familiarised with them. Knowledge in this area can then be assessed through supervisions and should be recorded appropriately.
Care providers should regularly review their medicine management policies and procedures to ensure that it reflects the most up to date legislation and guidance in this area. Staff training in administering medicines should be assessed at least on an annual basis and reviewed regularly to ensure that they are competent to carry out safe medicine administration.