Medication Management Policy

1. Purpose and scope

This policy governs all support we provide with medicines to people in their own homes. It covers ordering, receipt, storage, administration, prompting, recording, disposal, audit and the management of errors. It applies to all care staff, senior carers, office staff and managers, whether permanent, bank or agency.

Support with medicines is delivered only where it is specified in the person's care plan and has been assessed as safe, following the principles in NICE guideline SC1 (Managing medicines for adults receiving social care in the community).

ExcelCare Agency is registered to provide personal care without nursing. We do not employ nurses and do not deliver clinical treatment. Any clinical task is carried out only where it has been delegated by a community nurse under a written plan, and only by a member of staff assessed as competent for that specific task.

2. Levels of support

• Prompting — reminding a person to take their medicine, without handling it.
• Assisting — opening containers or selecting the correct dose for the person to take themselves.
• Administering — a trained, assessed member of staff gives the medicine, including applying creams, eye drops or patches.
• Specialist techniques — for example PEG feeds, insulin or oxygen, delivered only by staff with documented competency and, where relevant, a clinical delegation from a district nurse.

Where a person lacks capacity to consent to treatment, staff follow the Mental Capacity Act 2005 and our Mental Capacity & Consent Policy.

3. Accountability and training

The Registered Manager is accountable for the safe management of medicines across the service. A named Clinical Lead provides oversight of complex medicines.

Staff may only support medicines after completing medicines training, passing a written assessment and a practical competency observation. Competency is re-assessed annually and whenever a concern arises. Records are held on each staff member's training matrix.

4. Ordering, receipt and storage

1. Repeat prescriptions are ordered at least seven days before the current supply runs out, using the route agreed in the care plan.
2. Medicines are checked on receipt against the prescription, quantity and expiry date, and any discrepancy is reported to the pharmacy and the Registered Manager the same day.
3. Medicines are stored in the original container, in a cool, dry place out of reach, and in a locked cupboard where one is provided or where children or others may be at risk.
4. Medicines requiring refrigeration are kept between 2°C and 8°C with a daily temperature record.
5. Controlled drugs are stored in a locked, fixed receptacle where the person has agreed to one, and are counted at every visit.

5. Administration

Before administering, staff must follow the rights of administration: right person, right medicine, right dose, right route, right time, and right to refuse. Staff must also check the expiry date and read the label in full.

• Staff wear gloves and follow hand hygiene before and after administration.
• Medicines are never decanted or transferred between containers, and tablets are not crushed unless a pharmacist has confirmed that it is safe to do so.
• If a person refuses a medicine, this is respected and recorded, the visit is not prolonged to persuade them, and the refusal is reported to the prescriber and the family or advocate where agreed.
• Where a PRN (as required) medicine is given, the reason, dose and effect are recorded.
• Medicines are never left unattended at the point of administration.

Never administer a medicine that has been prepared by anyone other than the person or the pharmacy, that is unlabelled, or that has been altered from its original form.

6. Recording

Every visit involving medicines is recorded in the electronic medication administration record (MAR) or equivalent at the point of administration — never retrospectively. Records must show the medicine, dose, time, outcome, and the initials of the member of staff. Refusals include the reason stated by the person where they give one.

The paper MAR, if used, is written in black ink, signed in full and corrected with a single line and signature. Correction fluid is never used.

7. Disposal

Unused or out-of-date medicines are returned to a pharmacy, ideally with the person or their representative present, and a record of disposal is kept. Controlled drugs are destroyed only with an independent witness. Staff never dispose of medicines in household waste or the sink.

8. Errors, near misses and adverse reactions

1. Make the person safe and, if there is any risk, telephone 111 or 999 and call the GP.
2. Inform the person, and their family or advocate where appropriate, immediately.
3. Report the incident to the Registered Manager the same day.
4. Contact the prescriber for advice where a dose was missed, doubled or given late.
5. Record the incident on the incident management system within 24 hours.
6. Where an incident causes, or could cause, serious harm or death, notify CQC under Regulation 18 and consider whether the Duty of Candour applies.
7. Investigate at root cause, agree learning and update the care plan and training where needed.

9. Audit and monitoring

• Monthly medication audits sample records for completeness, time accuracy and signatures.
• Controlled drug balances are checked monthly and at every visit.
• Any person transferring between services has their medicines reconciled before the first visit.
• Audit findings are reported to the Board quarterly and discussed at team meetings.

10. Clinical and professional boundaries

Staff do not alter prescriptions, do not add medicines to a blister pack themselves, and do not advise on treatment. Clinical questions are referred to the GP, pharmacist or district nurse.