Effectively managing medicines can be a minefield. You need to comply with strict regulations. You need to make sure staff are properly trained to administer, record and dispose of medicines correctly. There is no room for error. 

A mock CQC inspection can help ensure that you’re operating in line with NICE guidelines for both domiciliary and residential care. But what exactly are you required to do when it comes to managing medicines in each of these settings?

 Administering medicines in a domiciliary setting

The role of home carers in administering medicine can vary. Some service users may be able to manage their own medication, but where support is provided, carers need to record who administered what kind of medication and whether it was taken or declined.

This includes prompting service users to take medicine or leaving out doses for them to take later, helping them remove packaging or actively administering medication. If a carer is leaving doses to be taken later this must be agreed with the service user in advance, recorded in their care plan and should only go ahead following a risk assessment.

Medicines administration records (MARs) should include: 

• the name of the service user 
• the name, formulation and strength of the medication, including the number of pills in a blister pack if relevant
• when and how often medication should be taken
• the route of administration
• the name of the GP practice
• the stop or review date if relevant
• any specific instruction relating to how the medicine is taken.

If a service user is prescribed new medicines, the old prescription list should be dated and stored securely for future reference. New prescriptions should be confirmed in writing before the first dose is given and the care plan should be updated within 24 hours.

Healthcare professionals may delegate tasks, such as giving injections or administering drugs via feeding tubes, to carers. In this case, staff will need extra competency training and a record of consent from the service user.

If individuals require time-sensitive medications, such as insulin, medicine containing paracetamol or drugs that should be given before or after food, carers should take this into account when planning their daily visits.

When a service user is taking medicines belonging to them and stored in their own home, there is no need to keep a record of controlled drugs or for double witness signatures prior to administration or support.

View the full guidelines on how to manage medication in the community here and book your mock CQC inspection to find out how well you’re meeting requirements.

Regulations for care homes

Having a medicines policy for your care home is a must. You should review it regularly to make sure it’s up to date and based on the latest legislation. It should include: 

1. Processes supporting service users to make informed decisions about their medication. This includes recording consent for medication to be administered. When applicable, a health practitioner may need to assess an individual’s ability to give informed consent as defined in the Mental Capacity Act 2005. Medication should be reviewed regularly in line with guidance from the service user’s GP and must involve the service user and/or their family as well as their local health and social care team. 
2. Confidentiality protocols. Information sharing must comply with the HSCIC guide to confidentiality in health and social care (2013) and staff should have relevant training on this.
3. Transfer processes to ensure continuity of care. When a service user is transferred between care settings, you must ensure accurate and comprehensive information is shared. See the recommendations on minimum information shared here. 
4. Accurate and up-to-date records. Care plans should include administration records, relevant correspondence and copies of prescriptions. Medications should be listed accurately, along with known allergies or adverse reactions to drugs. 
5. Processes for safeguarding residents. This covers identifying, reporting, reviewing and learning from any mistakes relating to medication. Incidents may need to be reported to the CQC or other relevant regulators. Information will need to be readily available in case of an investigation. 
6. Regulations for ordering, storing, dispensing and disposing of medicines. Ensure drugs are only given to the service user if they were prescribed for and that unwanted, surplus and expired products are disposed of responsibly. Only authorised members of staff should have access to stored medication, and conditions such as temperature should be monitored regularly.  

Mock CQC inspection services from Care Skilled include a thorough review of your policies to make sure they’re watertight ahead of your real CQC inspection.

How to administer medication in a care home

To determine how to administer medication, carry out a risk assessment for each service user considering:

• individual preference 
• whether self-administration will pose a risk to themselves or others 
• if they have the mental capacity to take the right dose at the right time in the right way 
• how medication will be stored 
• what responsibilities care home staff will take 
• how often the risk assessment should be repeated.

Carers must be trained to both help service users administer their own medication and know when drugs should be administered by a team member. In extreme circumstances they may have to resort to covert administration. There are legal frameworks to protect both the service user and carer administering medicine in this way. Establish a policy on this for your care home.

To help staff remember the administration process, the CQC has defined ‘6 Rs’ — right service user, right medicine, right route, right dose, right time and the service user’s right to refuse.

Carers should be skilled in administering pills, patches, creams, inhalers, eye drops and other liquids. They should also know what to do if the service user’s usual schedule is disrupted, for example if they’re eating, sleeping or visiting relatives when their medication is due.

It’s vital to record both scheduled medication and any ‘as required’ drugs in the person’s care plan.

If a carer uses any non-prescription medicines for minor ailments (known as ‘homely remedies’) these should be recorded and a waiver signed confirming they will be held accountable for their actions if an adverse reaction occurs.

The carer must demonstrate a thorough knowledge of both required drugs and homely remedies. This includes knowing what they treat, the maximum daily dose and frequency of doses. They should consult records to check if there are products or ingredients that a service user shouldn’t be given. For example, they should not be given paracetamol for a headache if they are already taking it for something else. Carers should also cross reference ingredients against a service user’s list of known allergies.

Training your carers

It’s your responsibility to make sure that carers have completed the right training and that they have the necessary skills to administer medication — this is not a box ticking exercise. 

Be thorough. Use accredited learning providers so your team is assessed externally. Give them an annual review to make sure their knowledge and skills are up to date. If there is a medicine-related safety incident, take no chances and carry out more frequent reviews to identify where additional support and learning is required.

You can read the full NICE recommendations for care homes here. To make sure you’re on track to meet these requirements, book a mock CQC inspection with Care Skilled. Our comprehensive report will flag any areas for improvement before they impact your overall rating.

Call our expert team on 0333 444 5344 or email info@careskilled.co.uk for more information.