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Medication timings

This is the second in my series of articles about common pitfalls of compliance. This one focusses on a specific aspect of medication administration, that of the timing of medication. The following legislation places responsibilities on care providers to administer medication as prescribed:-

• The Medicines Act 1968

• The Health and Social Care Act (Regulated Activities) Regulations 2014 – England only

• The Registration and Inspection of Social Care (Wales) Act 2016 – Wales only

• The Health and Safety at Work Act 1974

One of the first things to check is that the information on the medication administration record (MAR) matches that on the medication. This ought not to be an issue when the pharmacy has printed the MAR sheets but there are a number of examples of pharmacies supplying the wrong medicine with the correct label. Care providers must check that the medication matches the label every time medication is received. If the care provider uses handwritten MAR then there is a greater potential for the incorrect information to be copied onto the MAR. One way to guard against this is to copy from the medication label rather than from the last MAR. NICE recommend that handwritten or hand altered MAR are checked by a suitably trained and competent person.

Now to the issue of timing, the most likely error is that the medication is administered at the incorrect time in relation to meals. Consider this example.

Jack is prescribed the following medication

• Lansoprazole, 15mg, Take ONE in the morning. Warning: take this medication 30-60 minutes before food.

• Metformin, 850mg, Take ONE tablet THREE times a day. Take this medication with a meal.

• Paracetamol, 500mg, Take ONE or TWO tablets up to 4 times a day, Maximum 8 in 24 hrs.

The prescriber intends that the medication is taken in these amounts at these times so that it will be effective in treating the conditions and will be safe for Jack. In this case Jack’s care provider must ensure that the Lansoprazole is administered 30-60 minutes before Jack has breakfast and that the Metformin is administered with; breakfast , lunch and tea. The paracetamol can be administered when required by Jack provided that the maximum dose is not exceeded and there is a minimum of 4hrs between doses. If Jack’s care provider does not ensure that the medication is administered as prescribed then Jack is at risk of harm. This may be considered to be a safeguarding referral with the consequential notification to the service regulator.

So, how can care providers ensure that medication is administered at the correct time, here are some tips:-

1. Provide appropriate training for staff who administer medication. This training must include the principles known as the 6 rights and the theory behind these. The 6 rights as defined by NICE are:-

a. Right medication

b. Right dose

c. Right person

d. Right TIME

e. Right route (or method)

f. Right to refuse

2. Assess the competence of staff entrusted to administer medication. Competence is being able to do something correctly every time. NICE recommend at least an annual review of skills, competence and training.

3. Check both medicines and MAR upon receipt, check for discrepancies and times of administration. Allow plenty of time for these checks and to address any issues which arise.

4. Cross reference the requirements for medication administration with; care plans, risk assessments and care records (more on these in article 5 to follow)

5. Plan care schedules and staffing to meet people’s needs in a person centred way. This means meeting their needs and preferences rather than those of the care service. If the care service cannot meet people’s needs then the service should not be providing care for the person.

6. Audit compliance with MAR, care plans and risk assessments. Identify and address areas of non-compliance using SMART action plans.

7. Refer issues back to the prescriber to see if there are suitable alternative medicines which do not need to be administered at specific times. This may be a solution in home care settings where the amount of time allocated to the care call is not sufficient for the medication to be administered as prescribed.

Remember, that a care service which does not ensure that medication is administered as required:-

• Is in breach of the care regulations

• Is in breach of other pieces of legislation

• Is failing to demonstrate evidence based best practice

• Is putting the people who use the service users at risk of harm

• Is failing to deliver person centred care which meets the persons needs

• Will not deliver positive outcomes for the people who use the service

Coming soon articles on the potential pitfalls with:-

3. Safe premises

4. Consent and mental capacity

5. Care plans, risk assessment and care records

6. Staff competence

7. Managers knowledge and competence

8. Supervisions and appraisals

9. Professional development and training

10. Quality assurance and governance

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