Introduction

Decent Care participants may be required to take medications during the provision of support. Many participants will manage and take their medications independently, while others may ask for some form of support or assistance. This policy and procedure provide guidance and direction for team members and Support Services Program Manager in the administration of participants’ medication. At no point will medication be administered without the essential training of the person supporting the medication management process.

Scope

Decent Care is responsible for ensuring that all medications are correctly managed in accordance with this policy. This includes:

• Correctly managing documentation
• Safe, secure storage and handling of medication
• Safe support or administration by appropriately trained or qualified team members

Policy

Decent Care ensures that where a participant requires assistance with their medication, the nature of the assistance will be recorded in detail and the participant's consent confirmed. The medication will be managed and administered in line with the six (6) rights of medication and the processes outlined in this policy.

Procedure

Where a participant has identified within the intake and assessment process that they would like support with Medication Management, Decent Care will seek information from the participant that has been provided by the prescribing practitioner. This information must be no more than three (3) months old. Decent Care (with the participant, carer or advocate's consent) will liaise with the family or support network, general practitioner, pharmacist, registered nurse, or an enrolled nurse to clarify aspects of the medication management, if it is unclear. The following principles are to be followed when administering all medication including topical medications, inhaled medications, and eye drops:

Safety considerations:

• Perform hand hygiene (See Infection Control and Prevention Policy)
• Confirm participant ID utilising the process of 6 Rights of medication
• Check allergy information listed on the medication chart against medication.
• Plan medication administration to avoid disruption:
  • Dispense medication in a quiet area.
  • Avoid conversation with others.
  • Prepare medications for ONE participant at a time.

Step 1-
Check the medication administration chart is consistent with instructions on the medication label or doctors’ orders. Where the medication chart is not consistent contact the Support Services Program Manager who will contact the prescriber. Team members must ensure they perform hand hygiene before administrating medication and wear appropriate PPE when administering topical medication.

Step 2-
Perform the six rights of medication, this must be completed for each medication on at least two separate occasions-

• when the medication is taken out of its storage place
• when medication is being removed from packaging
AND
• when taking medication to bedside (e.g., eye drops) where applicable

Six Rights of Medication:

1. Right Person
   • Ask the participant their first and last name and date of birth
   • Does the order match the participant?
2. Right medicine –
   • Does the medication label match the order/ medication administration chart?
   • Be vigilant with look-alike and sound-alike medications, check expiry dates on packaging to confirm the medication has not expired.
3. 3. Right dose –
   • Does the strength and dosage match the order?
   • Is it half, whole, or multiple tablets/drops/dose?
4. Right time –
   • Does the administration time match the order?
   • Before administering a PRN medication, ensure specified time interval has passed and permission is sought from the Support Services Program Manager
5. Right route –
   • Does the route match the order?
6. Right documentation -
   • Document immediately after the medication is administered

Team members must NEVER document that they have given a medication until they have actually administered it.

Step 3.
Administer medication as per instructions on the medication administration chart/ medication label.

Step 4.
Document administration on the participant’s medication administration chart, if a medication was refused or missed document this on the chart and contact the Support Services Program Manager

Step 5
Perform hand hygiene (see Infection Control and Prevention Policy)

Step 6Return medication back to original storage place and monitor participant for any side effects.
All Team members will follow the Management of Medication Policy by:

• Always ensuring to document all administration in the participant’s medication chart leaving notes in their file if they have any side effects or are not taking a medication
• Ensuring the relevant completed medication chart is placed on the participants file at the end of each week
• Ensuring safe and appropriate storage of medications in locked cash containers and locked cupboards where Decent Care is responsible
• If team members are unsure about medication to always check with the Support Services Program Manager who will contact the pharmacist that is detailed on the medication label. Medication leaflets provide information on what the medication looks like, the side effects, storage information.
• Always checking they have the right person by checking their identifying characteristics and always checking allergies against medication
• Confirming correct medications by checking the medication to be administered against what is listed on the medication chart; this could include counting the number of tablets in the Webster pack blister with what is documented on the Webster pack medication sheet. Contact the Support Services Program Manager if there are any discrepancies.
• Following the ‘6 rights of medication administration’ and if a medication is missed/forgotten or the participant refuses medication to contact the Support Services Program Manager who will contact the participants GP, follow the incident report procedure and complete a NDIS online incident report (where required).
• Always giving medicines listed in Behaviour Support Plans strictly according to the directions on the Behaviour Support Plan

PRN Medication/Chemical Restraint (Behaviour Support Plans)
Team members are to consult with the Support Services Program Manager before administering PRN Medications. Where a participant has a behaviour support plan in place PRN medications are only to be administered in line with the plan as a last resort after consulting the Support Services Program Manager.

Safety
Participants are to be observed for any changes to their health status and, if noted, reported straight to the Support Services Program Manager who seeks the advice of a professional. Where a participant refuses the administration of medication, the Support Services Program Manager is to be advised. Relevant health professionals, i.e., doctor, registered or enrolled nurse, will be consulted where necessary. Team members will not decide to withhold a participant’s medication unless certain about the participant’s health status. Team members must consult with a Support Services Program Manager before withholding medication and follow the Support Services Program Manager decision, in consultation with relevant health professionals, e.g., doctor, RN or EN. Where a participant is required to carry emergency medication for outings, the support worker must place the medication in a locked case. If a support worker does not remember the medication, it could result in disciplinary action.

Documentation
At the initial intake of a participant two documents must be completed including:

• • A Medication Administration Consent form that includes the participant’s consent to be assisted and for the administrator to contact the dispenser if there are adverse reactions
• • Medication Schedule and Administration Chart which contains all details about the medication administration requirements.

The medication administration chart will be held in a medication folder located in the respite accommodation office and a copy held on the participant’s file. On completion of stay the medication administration chart is to be scanned through to the participant’s file. Team members are to record each participant’s administration on the participant medication chart. This includes the date and time of medication administration along with their signature and printed name. Team members must record any changes to medication or health issues in the participant’s file notes and follow up with the Support Services Program Manager who will contact the relevant person, carer or pharmacist for any additional information that may be required. Any medication errors are to be recorded on an Incident Report Form. This will be recorded on the Incident Register and be reviewed by the Managing Directors for continuous improvement processes.

Adverse drug reactions

• Adverse drug reactions must be actioned immediately in line with Incident Management Procedures
• This must then be reported immediately to the Support Services Program Manager
• The Support Services Program Manager will inform the general practitioner/nurse immediately and document actions taken in the participant's health record
• An adverse drug reaction is an incident and must be recorded on an Incident Form and in the participant’s health record, including symptoms and actions taken.

Medication disposal
All unused medication is to be disposed of by returning to a pharmacy who undertakes an incineration process to prevent medication from cycling back into the water supply.

Team members training for medication assistance
Team members involved in assisting or supporting participants with their medication are trained in the steps to take in the event of an incident involving medication and understand the side-effects of medication. Decent Care will ensure that all team members hold current first aid and cardiopulmonary resuscitation (CPR) qualifications, so they can correctly respond when monitoring any adverse reactions that require action, intervention, and escalation. Team members have relevant skills and experience, and a level of competency, to provide appropriate and safe support to a person with a disability. Decent Care’s team members participate in regular supervision by the Support Services Program Manager to affirm their knowledge and practice. The Service Manager will monitor expiry dates of training. Details will be recorded in team members files, where appropriate

Definitions

Medication Management

Involves:

• Reminding, or prompting, a participant to take medication
• Assisting with opening medication containers
• Providing other assistance, not involving medication aid

Medication assistance

Involves:

• Storing of medicines
• Opening medicine container/s
• Removing the prescribed dosage (from an approved container)
• Giving the medication as per instructions

Responsibilities

The Managing Directors are responsible for:

• Ensuring the policy and procedure is reviewed annually or where there may be identified deficiencies in the process
• Providing the necessary training to team members by a qualified person, which includes the effects and side-effects of medications and the safe and secure methods for medication storage, in addition to medication safety
• Documenting team members levels of skill and knowledge of medication safety, storage, and administration through a yearly competency assessment

Support Services Program Manager is responsible for:

• Monitoring training requirements for team members concerning medication supporting assistance and administration
• Ensuring team members follow professional guidelines in the delivery of medications.

Team members are responsible for:

• Following the Management of Medication Policy and related medication policies
• Participating in annual training
• Providing services that are consistent only with their level of training and competence
• Seeking advice from a Support Services Program Manager where doubt exists
• Following the instructions from the Medication Form and as per support plan requirements
• Seeking instruction from a Support Services Program Manager when a medication requires refilling.