6 rights of administration
According to the NICE Guidance, there are 6 rights to administering medication under UK governance.
Right person
Right medication
Right dose
Right time
Right route
Right to refuse
You can only administer medication from the original packaging or blister packs dispensed and levelled by the Pharmacist. Carers may not administer medication dispensed in dosette/cassette boxes. All medications must have the original labels with clear instructions and the person’s name on them.
Please report any suspected tampering with blister packs to the office immediately, as these medications could have been exposed to air and administering them could risk your care recipients' health and safety.
Before administering, you should refer to the Care Plan and Medication Administration Record (MAR) for the level of medication support, times, frequency and route of dosage and storage of medication. It will set out clearly the roles and responsibilities of all parties involved. You must also read the instructions of medications carefully.
Important: You WILL NOT administer any invasive therapy i.e injections, enemas or suppositories. You MUST not initiate the introduction of, purchasing of, or provide a recommendation with regards to any form of medication, remedy including homeopathic and herbal remedies. All information regarding care recipients must remain confidential.
Levels of medication support:
Level 0: Care Recipient self-medicating
Any care recipient wishing to administer his or her own medication must be assessed as capable by the Care Manager and with the agreement of the GP. Their capacity should be assessed to ascertain their understanding of the following:
Their awareness of the requirement of safe storage and security of medication;
Correct dosage and timing (e.g before or after meats etc.)
Action if any medication is lost/mislaid;
Compliance with the prescription;
If taking PRN medication.
The care recipient's GP and the dispensing pharmacy must be notified when self-medication commences and when/if it ceases.
The capability of the resident in self-medication and their compliance with the prescribed dosage etc must be regularly monitored. The care recipient’s GP should also review the process on a regular basis.
If a Care Recipient’s condition deteriorates so as to compromise their ability to safely take his or her own medication, self-medication may be withdrawn either by the Care Recipient’s GP or any medical professional that has the authority to do so. Similarly, it should be withdrawn for any other reason which would compromise safety.
NB. No MAR chart is required
Level 1: Physical Assistance
The Care Recipient is independent in their medication, will control their medication, reorder prescriptions and will be responsible for taking their own medication as prescribed. Only with specific instructions from the Care Recipient, Carers may need to assist the Care recipient with the following;
Opening a bottle of liquid medication or popping tablets out of a blister pack at the request of the Care Recipient and when the Carer has NOT initiated this support
Shake bottles and pour out liquids
Removing lids from bottles and putting them back on safely
Dispensing medicines for the Care Recipient to take themselves at a later time
NB. No MAR chart is required
Level 2: Prompts
The Care Recipient requires a minimal level of support through daily reminders to enable them to administer their own medication. This means that the Care Recipient physically takes their medicines and only receives support from their Carers in form of:
Requesting repeat prescriptions from the GP or pharmacist
Collecting medicines
Disposing of unused medicines safely e.g. return to the pharmacy
Reminders or prompts from the Carer to the Care Recipient to take their medicines when they are due or if they have not already taken them
NB. Whenever there is any involvement of the above from the Carer, the MAR chart must be signed for and documented accordingly.
Level 3:Administering
The Care Recipient has been assessed as ‘’unable to manage their own medicines without support’’ due to a form of impaired cognitive awareness or as result of a physical disability, or has chosen not to manage this. Carers will need to assist by doing the following;
Following the 6 R’s of administration as per NICE guidelines. These should be followed by the additional 2 R’s outlines in edyn.care Medication training; Right to Informed Consent and Right Documentation
Selecting and preparing medicines for timely administration against the MAR. This might be through selection from a monitored dosage system or compliance aid, and includes measuring doses of liquid medicines
Topical application of creams/ointments/lotions and/or administers inhaled medication or/and instals ear/eye/nose drops or medication patches
Observing administration of medication
NB. The Carer must witness the Care Recipient taking their medication safely and document the MAR chart accordingly at all times.
Level 4: Special Route Administration
Special training is required and a risk assessment must be put in place for Carer and Care Recipient. The Carer needs to be provided with special training by a trained healthcare professional e.g. District Nurse, Pharmacist or Care Manager who holds a ‘’train the trainer’’ certificate. The Carer must also be shadowed in the field and signed off once confident in administering Level 4 medicines.
Administration through a Percutaneous Endoscopic Gastrostomy (PEG)
Blood Sugar Monitoring and Insulin Administration
Bowel management eg: inserting suppositories
Inserting pessaries
NB. The Carer must document and sign a specialised MAR or Insulin Administration chart accordingly. The risk assessment must be reviewed every 3 months.
a) What is the procedure?
Before administering, you should refer to the Digital Care Plan and Medication Administration Record (MAR) for times, frequency and route of dosage and storage of medication.
Safe administration of medication:
Wash hands
Explain the procedure to the client
The care recipient must provide their consent to medication before administering.
Check expiry dates of medication
Give medication via the appropriate route
Wash hands again
Record medication taken on Medication Administration Record (MAR)
b) What to do if a service user refuses their medication?
You must adhere to the Mental Capacity Act and its assumption that care recipients are able to make a decision not to take medication or receive treatment. If a person does refuse their medication, sometimes they may just need a gentle reminder that it is vital to their well-being.
Consider the following when a client refuses their medication:
Explain the importance of the medication.
Give them some space to consider the information (go away for a short time).
Follow any specific guidance in their care plan or risk assessment which will be there if they have a history of refusing their medication.
If Care Recipient continues to refuse medication then:
Do not force the Care Recipient to take the medication as this is a deprivation of their liberty. Instead place the medication into a clearly labelled envelope and store it in a safe place.
Record refusal on the MAR and give an explanation.
Inform the Registered Care Manager or a member of Care Management Team, Care Recipients emergency contact of the refusal and where appropriate GP or pharmacist.
c) What happens if I make a medication error?
A medication error is when a prescribed medication has not been administered in line with the guidance of this procedure. These errors can be administration, procedural or recording errors. It is edyn.care’s policy to avoid any of the following to safeguard all of our service users:
Medication error:
Medicines given at the wrong time than prescribed
Incorrect dose given
Medication given to the wrong person
Missed medication or not given as prescribed
Overdosing/more than prescribed dose given
Not signing the MAR sheet after administering medication
Procedural errors:
Not recording medication received or disposed of
Not disposing of medication correctly
Not following the guidance/procedure on administering medication
Errors in the administration of medication may also be deemed as gross misconduct and dealt with in line with edyn.care’s disciplinary procedure. In these situations edyn.care’s management team should be informed immediately.
In the event of a medication error the following steps should be taken:
Check the welfare of the care recipient
If you notice any adverse reactions or side effects call 999
Call edyn.care team on 020 3970 9900
Report using event form
Registered manager will then decide on an appropriate course of action
d) What happens if medication is missing?
If you discover medication is missing check the blister pack against the MAR chart to ensure it has not been discontinued/has it been received by the service/is there an incident report/ has it been disposed of?
If the medication is still missing and is required for the care recipient you may need to do the following:
a) Follow up if the pharmacist if it has not been delivered
b) If required phone the GP if a new prescription is required
c) Inform Registered Care Manager or a member of Care Management Team on 020 3970 9900
d) Record on the MAR sheet
You can find pharmacist and GP contact details in the care plan.