Administer medication and monitor effects
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1. Identify current legislation, guidelines policies and protocols relevant to the administration of medication. The Medicines Acts 1968 and various amendments cover the legal management of medication. While I as a cae assistant am not expected to have detailed knowledge of the legislation, I do need to be aware of the legal difference between types of drugs and the legal framework that would allow me to handle medicines on behalf of my residents. The following is a list of legislation that has a direct impact upon the handling of medication within a social care setting. * The Medicines Act 1968 requires that the local pharmacist or doctor is responsible for suppling medication. They can only do this on the receipt of a prescription from a authorised person like a doctor.
* The Misuse of Drugs Act 1971 controls dangerous or harmful drugs, designed as Controlled Drugs (CDs). The main purpose of this is to prevent the misuse of controlled drugs. * The Misuse of Drugs (Safe Custody) Regulations 1971 amended by Misuse of Drugs Regulations 2007 specifies about handling, record keeping and the storage of controlled drugs correctly. These are classified according to the harm that they cause, if misused. there are three classes A, B and C. The regulations define the classes of person authorised to supply and possess controlled drugs while undertaking their professional duties.
* The NHS Scotland Pharmaceutical Service (Regulations) 1995 * The Social Work Act 1968 as amended by The Regulation of Care Act 2001 * The Children Act 1989 * The Mental Capacity Act 2005 Specifies that you must take all reasonable steps to help a person with their decision making whether they lack capacity or where you help to make a choice with them, protecting their rights and freedom and promoting their dignity. * The Children’s Act 1995
* The Data Protection Act 1998 this act requires any organisation that keeps personal records on computer to register as data user and they must comply with specific regulations. They must keep all information secure, allow the person access to their records, record only relevent information, only use and disclose the information for its stated purpose. you are responsible for maintaining the confidentiality of ll the people you support or in your care. * The Care Standards Act 2000
* The Regulation of Care Act 2001
* The Health and Social Care Act 2008 Regulations 2009 These regulations describe the standards of quality and safety that people who use health and social care services have the right to expect. * Adults with Incapacity Act 2000 Social Care Association * The Health Act 2009 * Health and Safety at Work Act (1974) underpins regultions intended to reduce the risk posed by the hazardous substances. * The Control of Substances Hazardous to health Regulations (1999)(COSHH)
This regulation requires all employers to take responsible measures in protecting employees from protentially dangerous substances or matrerials that they come into contact with while in the work place. * Hazardous Waste Regulations (2005) defines household and industrial waste aand includes medicines tht are no longer required. Care homes with nursing must use a clinical waste company to dispose of their unwanted medicines. Other care homes can return their medicines to the supplying pharmacy for destruction.These regulations direct towards maintaining a high standard of safety when dealing with medicine. * Mental Capacity Act (2005)
* The Access to health records Act (1990)
The National Minimum Standards require the registered person puts in place policies and procedures for the receipt, recording, storage, administration and disposal of medicines. These policies and procedures are to protect not only the residents but also the staff.
2. Describe common types of medication including their effects and potential side effects.
Paracetamol: Works as a painkiller by affecting chemicals in the body called prostaglandins. Prostaglandins are substances released in response to illness or injury. Paracetamol blocks the production of prostaglandins, making the body less aware of the pain or injury. Paracetamol reduces temperature by acting on the area of the brain that is responsible for controlling temperature. Possible Side effects of paracetamol are rare but can include Erythematous or urticarial rashes, fever, nausea and Mucosal lesions. Even more rarely, they can include Neutropenia, thrombocytopenia and pancytopenia
Ferrous Sulphate: This medicine is used to treat and prevent iron deficiency anaemia. It belongs to a group of medicines called iron supplements. This medicine contains the iron salt, ferrous sulphate which helps restore iron levels in the body when levels are low. One of the most important functions of iron in the body is in the formation of red blood cells. Iron is a component of haemoglobin which is the oxygen-carrying pigment of red blood cells. This medicine is available as tablets that are taken by mouth, Iron preparations are absorbed better on an empty stomach. However, you make take them after food to prevent gastro-intestinal effects.
Possible side effects are allergic reaction like itchy skin rash, swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, constipation occasionally causing faecal impaction, diarrhoea, stomach pain, feeling sick and blackened stools. Aspirin: Is an antiplatelet medicine, which means it reduces the risk of clots forming in your blood. This reduces your risk of having a stroke or heart attack. Small cells in the blood called platelets make the blood clot. When a platelet detects a damaged area of a blood vessel, it produces a chemical that attracts other platelets and makes them stick together to form a blood clot.
Aspirin reduces the ability of the platelets to stick together and reduces the risk of clots forming. Possible side effects are black, bloody, or tarry stools, coughing up blood or vomit that looks like coffee grounds, severe nausea, vomiting, or stomach pain, fever lasting longer than 3 days, swelling, or pain lasting longer than 10 days; or hearing problems causing ringing in your ears. Less serious side effects of aspirin may include: Upset stomach, heartburn, drowsiness or headache.
3. Identify medication which demands the measurement of specific physiological Measurements.
Blood pressure is a physiological measurement and would need measurement for the prescribing of antihypertensives. Blood tests measure levels of Lithium to anticonvulsants which lead to the determination of drugs given. Drugs like Insulin (blood has to be taken from a pinprick so that glucose can be measured before the insulin can be given); Warfarin to thin the blood – again blood levels must be checked regularly; Digoxin to slow and steady the heart (pulse should be checked prior to administration and advice taken if the pulse dips below 60 beats per minute).
4. Describe the common adverse reactions to medication, how each can be recognised and the appropriate action(s) required.
Common adverse reactions are diarrhoea, headaches, constipation, weight gain, drowsiness, shaking, stiffness, vomiting, skin rashes, sickness, facial swelling, blistering of the skin, breathing difficulties and wheezing. Serious adverse reactions are unwanted or unexplained reactions after taking a medicine. serious reactions such as anaphylactic shock are facial swelling, blistering of the skin wheezing and hives leading to total system collape and death if not treated with adrenalin in time.
These can all be recognised by reading the side effects on medication packets or contacting a pharmacist. The appropriate action to take if a person supported is having an adverse reaction is to inform your manager stop the medication immediatly record the effects record on the MAR sheet and in the care plan, contact doctor or hospital so they can be treated appropriately. All details of a reaction should be reported to the pharmacist so they can make a clinicl judgment for all medicines precribed to be dispenced.
5. Explain the different routes of medicine administration.
Medication route refers to the way that a drug is introduced into the body. This is based on the specific medication being used, the rate of absorption desired and the specific site of action where the medication needs to have an effect. Most drugs are manufactured for a specific route of administration and must be used as directed for safety and efficiency. Orally: Medications are taken by mouth in a pill, capsule or liquid form and absorbed into the system through the digestive system. Absorption is slow. Medications that use this option cannot be used if vomiting is occurring. Rectally: Medications are administered into the rectum via a suppository and absorbed by the lower digestive tract. These are absorbed into the body very quickly.
Inhalation: Medications are delivered by a nebuliser through the nose or mouth and are absorbed through the nasal mucosa or bronchioles, respectively. this method is used mostly for people with chronic respitory problems like asthma. This enables the medicine tobe delivered to the site where it is most needed. Sublingually: This is where tablets or liquids are administered under he tongue for speed of absorption. These are niterolingual sprays for angina or buprenorphine tablets for pain. Intravenous injection administeration: Any medication administration that involves injecting a drug directly into a vein (intravenous) is absorbed rapidly into the body which is good in a life threatening situation. (intramuscular) into a large muscle either the bottom or the leg. Artery (intrarterial), abdominal cavity (intrperitoneal), heart (intracardiac) or into the fatty tissue beneath the skin (subcutaneous) insulin is injected this way.
The speed of absorption varies but is faster than oral administration. This is used when more complete and faster absorption of a drug is needed. Percutaneous: Medications are absorbed directly through the skin into the blood stream. Some hormone replacements are administered by patches that are absorbed slowly and evenly. Instillation administration: The medicine is in the form of a suspension or liquid that can be installed in a number of ways, like the eyes, nose or ears in the form of drops. Vaginal administration: pessaries are formulated or creams applied using special applicators like thrush. Tropical application administered: This is where creams, ointments and gels are applied directly to the skin. They can be used to treat conditions or can be used as a delivery route for an analgsic. Transdermal patch administration: The drug is released slowly from the patch over a set period of time and is absorbed through the skin into the blood stream. These patches include fentanyl, hormone replacement therapy and nicotine patches.
6. Explain the types, purpose and function of materials and equipment needed for the administration of medication via the different routes.
Types of materials and equipment I might use are Gloves, Tongue blade or Cotton bud to apply cream to the area of the body where it is needed without my hands contaminating the cream and no cross contamination occurs. Spoons to place the tablet or capsual into the mouth so no contamination can ocur. Droppers to administer eye drops, nose drops and ear drops accuratly. Tablet crusher to crush tablets for those that find it hard to swollow tablets and capsuals. Measurement cup so that liquid medication can be measured out accurately. Syringe for accurate measurement of insulin or another drug that has to be administered buy injection throught the skin or medication that is administered through a peg feed site or for oral liquid medication. Douches for liquid forms of medication for rectal or vaginal medications. Skin patches for the relief of pain that is applied to clean hair free dry skin. Inhlers and Nebulisers for breathing problems like asthma.
7. Identify the required information from prescriptions / medication administration charts.
Information that should be on the prescription is: Full name, address, date of birth. Ensure that the prescription has a date and is still valid. Ensure that it is signed by the doctor complete with their registration number and details regarding the address of the practice make sure that it is printed from a computer or in ink if written by hand. Make sure that the drug prescrtion product is named complet with strength of dose and the quantity.
Information from administration charts: (MAR SHEET) The name and address of the service user, Date started, Medication details including name, strength and dose of medication, Time given/prompted/observed, Signature of staff, Code for Administration or prompting or observing. If a record needs to be amended. Cross out the original direction and write the new directions on a new line, Hand writing should be legible and in ink, Write the name of the prescriber who authourised the changes, Sign and date and where possible have another person witness this, Cross reference to daily notes Now I may not know which tablet or capsule is which – however I should know that the names on the box match the names on the chart (which have been checked against the prescription details) and that there are the correct number of tablets or capsules there to be given. There should be space for the name of GP and any allergies known.
8. Explain the appropriate timing of medication e.g check that the individual has not taken any medication recently.
It is imortant to give the correct amount of medication at the correct times as individual’s respond to medication in different ways. their doctor will concider these factors when precribing the medication. If the incorrect dose is prescribed then the medication is not as effective as if too small in dose, or if the dose is too much then the individual may suffer side effects. It is vital to follow the instructions on the label exactly, this is the only way to ensure that the individual receives the right dose at the right time. Whenever administering medication there are five rights that must be followed and checked before giving individuals their medication. 1 Right patient 2 Right medication 3 Right dose 4 Right time 5 Right route. Check on the individuals Marr sheet as to when the last dose of medication was given before administering the next dose.
9. Describe how to report any immediate problems with the administration.
I would follow the medicine’s policy and procedure document that is within my care home, report the problem to my senoir staff member and manager, discuss the issuse with the individual’s doctor record the problem on the mar sheet and write in the individuals care plan what the issuse was so that we have written evidence of the issue incase there is a follow on concern later.
10. Explain why it may be necessary to confirm that the individual actually takes the medication and does not pass the medication to others.
It is necessary to confirm that the individual has actually taken the medication in order to monitor their condition and to recognise any signs of adverse reactions to the medication that they may have. The individual may have a history of storing medication and monitoring them to ensure the inidividual has taking it prevents them building up a stoke pile and harming themselves or may cause halm to those individuals that they pass the medication onto.
11. Describe how to dispose of out of date and part-used medications in accordance with legal and organisational requirements. There are several safe ways to dispose of expired medicines. Experts recommend contacting a pharmacy about taking these drugs there, as pharmacies have a programs for recycling or disposing of out of date medicines. Medicines that are no longer needed must be recorded in the Mar sheet or the returns book.Special arrangemets apply to the disposeal of CDs (controlled drugs) and must be delt with under strick control in a care home registered to provide nursing care if supplied for the named person, denature CD using a kit designed for this purpose and then consigned to a licensed waste disposal company.
If supplied as a stock for care home (nursing) an authorised person must witness the disposal. For all social care settings the CDs should be returned to the pharmasist or dispensing doctor who supplied them at the ealiest opportunity for safe denaturing and disposal. When CDs are returned for disposal a record of the return should be made in the CD record book. It is good practice to obtain a signature for receipt from the pharmasist. or dispencing doctor. All care settings should have a written policy for the safe disposal of surplus unwanted or expired medicines. When care staff are responsible for the disposal, a complete record of medicines should be made. The normal method for the disposing of medicines should be by returning them to the supplier.
The supplier can then ensure that these medicines are disposed of in accordance with current waste regulations. In England care homes must not return medicines to a community pharmacist, but use a licienced waste management company. there should be a written policy within the care setting about the safe disposal of unwanted, surplus and expired medications, I may have to destroy medicines because an individuals treatment has changed or discontinued, an individual hs moved to a new care setting, or the medication has reached its expiry date like eye drops tht have a short shelf span. When an individual dies their mediction must be kept for a period of seven days incase there is a coroner’s inquest, after this period the medication can be distroyed.