Medication Support

The following are some of the important principles that apply when providing medication support:

• Medication procedures must always reflect current regulations around ordering, transporting, storing, administering and disposing of medicines;
• Nobody must carry out medication tasks until they are fully competent, skilled and knowledgeable to do so;
• Prescription medicines must always be given in line with the instructions of the prescriber;
• Full and proper records of medicine administration must always be kept;
• Consent must always be sought before administering medication;
• Medication must be administered in ways that uphold dignity;
• Opportunities to promote independence, choice and control should always be maximised;
• Covert administration of medication can only be used if a best interest decision has been made by a medical professional or a court under the Mental Capacity Act 2005;
• Medication must never be used as a form of punishment and may only be used as a form of restraint where a best interests decision has been made as such under the Mental Capacity Act 2005. (see 1.1 below).

Supporting someone with medication is an opportunity to promote independence, choice and control. The importance of these principles and values are explained in separate chapters of this Handbook, which you should refer to as required:

Choice and Control

Promoting Independence and Strengths

Consent must always be sought before administering medication. A person has the right to refuse to take their medication at any time.

Where possible, consent should be sought prior to preparing medication. This helps prevent unnecessary waste of medication should the person subsequently decide not to take it.

For guidance on consent see: Consent

If a person refuses to take their medication, you should explain the potential negative consequences and establish whether they understand them. If they do understand they have capacity and deciding not to take the medication is their choice, even if the decision appears to be unwise.

Where there are concerns that the person may not understand the reasons why the medication should be taken, a formal assessment of their capacity to make decisions about taking or refusing the medication should be carried out by an appropriate professional. This would normally be their GP.

For guidance on mental capacity see: Mental Capacity.

Medical advice should be sought whenever medication is refused to ensure their safety is not compromised by the decision they have made. Depending on the likelihood and severity of potential consequences, this could be telephoning the GP or Pharmacist, or it could be calling 101 or 999 for more urgent medical advice. We have a duty of care, so this advice can be sought without the person’s consent.

In all cases you should also try to find out why someone does not want to take their medication. There could be many reasons for this, some of which can be easily rectified.

For example:

• It may taste horrible;
• It may be difficult to swallow;
• It may have negative side effects they want to avoid;
• They may not believe the medication is helping them;
• They may not want you to give it to them;
• They are tired and don’t feel like taking it at that time.

Potential solutions to rectify the above could be:

• Providing a flavoured drink with the tablet;
• Speaking to the GP about more palatable options;
• Looking at the patient information leaflet to explain what the medication does;
• Asking a medical professional to explain what the medication does;
• Asking a colleague to administer the medication;
• If the medication is not time specific, trying to administer it later.

Note:  Under no circumstances must anyone administer medication covertly, unless the person lacks capacity to refuse consent and crushing, hiding or disguising their medication has already been determined by a medical professional or a court to be in their best interests. Guidance about covert medication is provided in section 8. below.

A record must be made of the refused medication, why it was refused, any views on the person’s capacity to make this decision and what action was taken to ensure safety was not compromised. Any advice given by a medical professional should be clearly recorded. Full guidance on recording can be found below: Recording administration of medication.

The person’s individual care or support plan and/or medication risk assessment must be updated where necessary. Any changes must be communicated to anyone that administers medication.

Needs, preferences, and risks must be established before the service begins.

A formal review of needs, preferences and risks should take place annually, and whenever there are signs that needs, preferences or risks have changed. For example, a medication is stopped, started or dosage is changed.

All medicines administration records should:

• Be legible;
• Be signed by staff;
• Be clear and accurate;
• Have the correct date and time (either the exact time or the time of day the medicine was taken);
• Be completed as soon as possible after the person has taken the medicine;
• Avoid jargon and abbreviations.

Some people are prescribed controlled drugs. Examples of controlled drugs are:

1. Morphine and pethidine for pain;
2. Methadone to help with drug withdrawal;
3. Ritalin to treat attention deficit hyperactivity disorder (ADHD).

For a full list see; List of most commonly encountered drugs currently used under the misuse of drugs legislation.

Controlled drugs are usually administered by a health professional. However, controlled medication can be administered by appropriately trained staff and this should be witnessed. The use of a witness is intended to reduce the possibility of an error occurring. Please see: Delegated healthcare activities.

Please note: If a person is living at home or is managing their own medication within any regulated service, an assessment of the person’s medication support needs should be in place (including support with controlled drugs) and should detail how the medication is stored.

For CQC guidance on managing controlled drugs in care homes, see: Controlled drugs in care homes.

For CQC guidance on managing controlled drugs in the community, see: Controlled drugs in home care.

Covert administration is when medicines are given to someone without their knowledge or consent. This usually happens by crumbling the medicine into or hiding it within food.

If a person has the mental capacity to make decisions about medication, it is unlawful to give them medicines covertly. They have the right to refuse to take their medication, even if this is detrimental to their health and wellbeing.

However, the reason that they are refusing should be understood as it could be something easily rectified. For example, they may find a tablet difficult to swallow or not realise the benefit of taking it.

If a person lacks the capacity to make decisions about taking medication, giving it covertly does become an option to be explored. However, it should never be the first option.

It is only necessary and appropriate to give medication covertly when:

• The person actively and routinely refuses their medication; and
• They lack the capacity to make medication decisions; and
• A health professional or court has determined that taking the medication is in their best interests; and
• A health professional or court has decided that giving covert medication is the least restrictive way of administering the medication.

For further guidance see: Mental Capacity

The National Patient Safety Agency defines a medication error as

“A patient safety incident involving medicines in which there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring, or providing medicine advice, regardless of whether any harm occurred”

Information about medication errors, including what to do if there is a medication error can be found in a separate chapter of this Handbook.

See: Information and Guidance for Specific Safeguarding Issues

All staff administering medication must have undertaken appropriate medication safety training. This should be refreshed regularly.

Some medication can only be provided by staff that have received specialist training and been deemed competent by a relevant health professional. This included epilepsy medication and non-oral routes of medication.