The Self Administration of Medicines (SAM) Policy...Self-Administration of Medicines Policy Version...

Self-Administration of Medicines Policy Version No 5.0

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The Self Administration of Medicines (SAM) Policy

Document Author Authorised

Written By: Pharmacist & Lead Technician (Medicines Use and Safety Team) Date: 08 November 2014

Authorised By: Chief Executive Date: 14th November 2017

Lead Director: Executive Medical Director

Effective Date: 14th November 2017

Review Date: 13th November 2020

Approval at: Corporate Governance & Risk Sub-Committee

Date Approved: 14th November 2017


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DOCUMENT HISTORY (Procedural document version numbering convention will follow the following format. Whole numbers for approved versions, e.g. 1.0, 2.0, 3.0 etc. With decimals being used to represent the current working draft version, e.g. 1.1, 1.2, 1.3, 1.4 etc. For example, when writing a procedural document for the first time – the initial draft will be version 0.1)

Date of Issue

Version No.

Date Approved

Director Responsible for Change

Nature of Change Ratification / Approval

29 Mar 12

2.0 28 Mar 12 Executive Medical Director

Logo and wording update for new organisation

19 Apr 13

2.1 Executive Medical Director

Amended to include SAM level 2 specific

25 Jul 13 2.2 Executive Medical Director

Minor amendments

Ratified at Acute Quality & Risk

3 Oct 13 2.3 Executive Medical Director

Minor amendments

Ratified at Matrons Action Group

9 Sep 13 2.4 Executive Medical Director

Minor amendments

Ratified at Clinical Leads Nursing Forum

29 Oct 13

3 29 Oct 13 Executive Medical Director

Minor amendments

Approved at Policy Management Group

14 Nov 14

3.1 Executive Medical Director

Section 7.13 Controlled drugs

5 Dec 14 3.2 Executive Medical Director

Ratified at Clinical Standards Group

16 Dec 14

4 16 Dec 14 Executive Medical Director

Approved at Policy Management Group

27/10/17 4.1 Executive Medical Director

For ratification following review

Clinical Standards Group

14/11/17 5.0 14 Nov 17

Executive Medical Director

Approved subject to new Appendix A approval at HRC

Corporate Governance & Risk Sub-Committee

8/1/18 5.0 Executive Medical Director

Appendix A approved

Health Records Committee

NB This policy relates to the Isle of Wight NHS Trust hereafter referred to as the Trust


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Contents Page

1. Executive Summary…………………………………………...... 4

2. Introduction……………………………………………………….. 4

3. Definitions………………………………………………………… 4

4. Scope……………………………………………………………… 5

5. Purpose…………………………………………………………… 5

6. Roles & Responsibilities………………………………………… 5

7. Policy Detail / Course of Action………………………………… 6

8. Consultation……………………………………………………… 13

9. Training…………………………………………………………... 13

10. Monitoring Compliance and Effectiveness…………………… 13

11. Links to other Organisational Documents…………………… 14

12. References……………………………………………………… 14

13. Appendices……………………………………………………... 15

A Self-Administration Assessment Tool/ Consent B Medicines Information Card C Initiation of Self Administration Checklist D Self Administration of Medicines Patient Information E Patient Counselling Tips F Financial and Resourcing Impact Assessment on Policy Implementation G Equality Impact Assessment (EIA) Screening Tool


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1 Executive Summary The aim of this policy is to ensure the safe management of the self-administration of medicines within the Isle of Wight NHS Trust. The policy applies to all employees of the Isle of Wight NHS Trust, including bank and agency staff who are involved with patients who wish to self- administer their medicines during their stay in hospital.

2 Introduction The Self-administration of Medicines (SAM) scheme allows patients to have control over

administering their medication whilst in hospital, as appropriate on a graded scheme of independence.

2.2 Self-administration of medicines is a scheme used in St Mary's Hospital, meeting the

requirements of the National Service Framework for Older People, the Audit Commission’s “A Spoonful of Sugar” and Nursing and Midwifery Council (NMC) Standards for Medicines Management.

2.3 The failure of patients to adhere to the medication regime when they leave hospital is

a major healthcare problem. Only half of people with chronic diseases take their medicine as recommended, even if their condition is life-threatening. The Self-Administration of Medicines (SAM) scheme encourages patients to be as independent as possible, participate in their own care and make decisions about their treatment in partnership with medical and nursing staff. Almost all patients who self-administer prefer it because it gives them more control, and it has been shown to improve compliance significantly, thereby making medicine regimes more efficacious.

2.4 The Department of Health, pharmaceutical and nursing bodies have advocated the benefits of self-administration programmes, these can include:

Increased patient empowerment.

Medicine rehabilitation.

Improved awareness, both of the patient's ability to cope with their medication while they are on the ward (in a safe environment) and on discharge.

Improvement in patient education and concordance.

Good use of time in the ward environment by nursing and pharmacy staff.

Potential reduction in medication administration errors at home.

Reduction in hospital re-admissions due to medication administration errors.

Demonstrates trust – which has psychological benefits for patients.

3 Definitions

3.1 Self- administration is the process in which a patient and/or carer takes responsibility for managing their own medication following a period of assessment and education

3.2 All staff definitions are given in the current Medicines Policy, on the intranet. SAM Self-Administration of Medicines.


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MDT Multidisciplinary Team. NMC Nursing & Midwifery Council. STAT dose The medication is given immediately as a single dose. POD Patient’s own Drugs. PILs Patient Information Leaflets. Clic-loc lid Child resistant bottle top. Level 0 Patient not suitable to self-administer or admitted taking no medication Level 1 Patient able to self-administer with supervision Level 2 Patient able to self-administer without direct supervision Level 2 Specific Patient able to self-administer a specific medicine without direct

supervision JAC Pharmacy electronic prescribing system

4 Scope

4.1 The policy applies to all employees of the Isle of Wight NHS Trust, including bank and agency staff, and all in-patients and day attenders who are deemed suitable to self-administer their own medication supervised and unsupervised accordingly. Each member of staff will need to complete a specific training package (there are training packages available for prescribers, nurses and pharmacy staff) before practicing the self-administration of medicines scheme.

5 Purpose

5.1 The purpose of this policy is to provide clear guidance for all practitioners of their responsibilities when initiating, supervising or discontinuing the self-administration of medicines by patients and to ensure that the Trust handles self-administration of medicines safely and securely in accordance with the Trust’s Medicines Policy, legislative requirements and best practice.

6 Roles and Responsibilities Appointed Nurse in Charge (Ward/ team Manager)

To ensure that:

The environment of care within which the self-administration of medicines is being considered is appropriately assessed for risk and that where necessary for the stage of the policy, secure individualised storage facilities are in place.

The appropriate training has been completed for any member of the nursing staff participating in the scheme.

The scheme is audited appropriately 6.2 Nursing Staff

To ensure that:

Their training requirements are kept up to date.

They retain the responsibility for the safe and correct administration of medication and for adequate and appropriate care of the patient with respect to their medication.

Patients in their care are educated and monitored appropriately though out the scheme.

They inform the ward Pharmacy Team of any proposed initiation of self-administration for an individual patient


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They bring to the attention of the Multidisciplinary Team (MDT) or appropriate clinical forum any problems or risks encountered with the patients in their care with respect to medication.

They obtain informed consent from the patients in their care before embarking on the scheme.

They ensure concordance prior to the patient self-administering.

They inform Pharmacy of changes in medication as soon as possible. 6.3 Prescriber

To ensure that:

The medication regime is simplified prior to the patient starting the scheme.

Any changes in medication are notified to the patient and nursing staff as soon as possible so that the ward Pharmacy Team may be informed.

Their training requirements are kept up to date. 6.4 Pharmacist/Pharmacy Technician

To ensure that:

Their training requirements are kept up to date. They work effectively to ensure that the ward Pharmacy Team can provide a quality service to support the ward staff and patients within their care.

The patient’s understanding of their medication is supported by written information leaflets and verbal counselling where required.

Any compliance and concordance issues are addressed with the patient and MDT.

To provide a medication review to assist in the simplification of the regimes prior to the patient starting on the scheme.

It is acknowledged that the level of Pharmacist and Pharmacy Technician support available will vary across the Organisation, however any problems should be resolved with Pharmacy even if the Ward Pharmacy Team are not available on the ward.

7 Policy detail/Course of Action 7.1 Risks

The potential risks of allowing patients to self-administer their medicines in hospital are overdose (intentional or accidental), under dose, theft or loss of medicines from a patient who is self-administering, or unauthorised access to the patient’s medicines by confused patients or visitors.

The risks associated with self-administration are minimised by:

Strict adherence to the agreed written protocols.

Only allowing suitably trained staff to participate. All Nurses involved must be registered, with a current NMC registration, have undergone suitable further training and been deemed competent by the Nurse in Charge.

The use of lockable bedside drawers to which only the patient, Nurse and Pharmacy hold a key card.

The separation of confused patients from those self-administering (where practicable).

Only providing patients with a limited supply of medicines.

Close supervision of patients self-administering.

Regular compliance checks.


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7.2 Levels of Supervision for SAM 7.2.1 Level 0

Each patient admitted into hospital will automatically enter the SAM scheme at this level as a default. This level is for patients who simply do not wish to self-administer their medicines or are deemed unsuitable to self-administer their own medication. Administration of their medication would therefore be undertaken in the conventional manner with complete Nurse supervision, but providing an opportunity for familiarisation and education regarding their medicines.

7.2.2 Level 1

a. On the medicine round the suitably trained Nurse will supervise the patient as they select the relevant drug(s) for that time, according to the ‘Medicine Information Card’ (Appendix B) or a printed copy of the JAC administration chart, from the patient’s bedside medicine drawer.

b. The Nurse will check and electronically sign for the administration on JAC. c. If the medicine was incorrectly selected or omitted then the Nurse must administer

the medicine in the correct way. See SAM procedure 6 for more information.

7.2.3 Level 2 Specific

This level allows specific patients (for example insulin dependent diabetics, patients suffering from myasthenia gravis, or Parkinson’s disease) to self-administer their usual specific medicines for that particular condition, which require adhering to a sometimes complicated individual time-related medicine regimen. However, administration of the patient’s other medication (which may require monitoring) would be undertaken in the conventional manner with complete Nurse supervision, but providing an opportunity for familiarisation and education regarding their medicines. For example this would allow a patient suffering from Parkinson’s disease to self-administer their usual Parkinson’s medicines only, at their normal regimen without the need to rely on a nurse being available to administer a medicine at a specific time outside of the usual ward ‘medicine rounds’.

The level 2 specific patients would be identified by the term ‘Level 2 Insulin’ or ‘Level 2 Parkinsons’ etc. according to which condition /specific medication this level is referring to.

7.2.4 Level 2

This level allows the patient to have complete control of their medication administration, including possession of the key card to their large bedside medicine drawer. A suitably trained Nurse will monitor the patient’s compliance to their medicine regime by completing regular checks.

The patient may move up or down the SAM levels according to the patient’s condition and changes to their medicine regime.

7.3 Criteria for Patient Selection

The following patients should not be considered for inclusion in the self–administration programme above level 0:

Patients who will not be responsible for administering their own medication after discharge.


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Patients whose medication regime is not stable. (see below for Level 2 Specific patients)

Patients who have no wish to self-administer their medicines in hospital.

Patients who are too ill or confused to self-administer.

The following patients will not normally be considered for inclusion in a self-medication program, but may be considered for Level1, and in some cases eventually Level 2 following full assessment by the MDT if, after discharge they will be responsible for managing their own medication. Inclusion in the program provides an opportunity to monitor safety and concordance with medication and to plan discharge arrangements accordingly:

Patients who are confused or forgetful.

Patients with a current history of alcoholism.

Patients with a current history of drug abuse or deliberate over-dosing.

Patients who are severely depressed or who have suicidal tendencies.

Patients on paediatric wards

Medical day cases.

For Level 2 specific patients, the specific medicine regimen they are to self-administer must be stable, however the patient’s other medicines may not yet be stable and should therefore be administered by a nurse.

7.4 Medicines to be excluded from Self-Administration

The following medication should be excluded from self-administration:

Intravenous/intramuscular medication.

STAT doses.

Variable regimens, e.g. loading doses of warfarin.

Reducing courses of chlordiazepoxide.

Sliding scale insulin.

Patients requiring Controlled Drugs (CD) or items requiring refrigerator storage should not be excluded from the SAM scheme, see Section 7.13 for more information.

Should a patient’s medication be packaged in a Multiple Dosage System (MDS) or similar compliance aid, they can be used by the patient to self-administer only if:

The MDS is labelled with the patient’s name

The Pharmacy Team have checked that the medicines are suitable for the patient to administer.

The medicines have not expired/ MDS no more than 1 month old

The MDS is correctly labelled for each medicine contained

The patient’s current prescription is for all of the medicines contained in the MDS

Should the patient’s prescription change and one medicine in the MDS is stopped, the MDS should not be used and all required medicines should be issued by the Pharmacy.

7.5 Patient Selection and Assessment

If the patient self-administers their medicines at home, their nurse/doctor feels that the patient would be suitable for assessment and the patient is willing, time should be taken to initiate the patient at the first opportunity. This does not necessarily need to be completed in the emergency admission setting, although Parkinson’s patients,


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insulin dependent diabetics, patients suffering from myasthenia gravis (those patients suitable for Level 2 specific) should be given priority to self-administer their medicines as soon as possible.

Assessment of a patient’s suitability to self-administer should be conducted by a suitably trained Nurse Doctor or Pharmacist by completing the appropriate ‘Self-Administration Assessment Tool’ (Appendix A). The patient should be shown sample bottles and labels to assess their ability to read directions. The patient should also be asked to open bottles, blistered tablets, pour liquid medicines onto spoons, or into cups to assess the patient’s dexterity. Patients with special requirements regarding packaging and labelling should be referred to the ward Pharmacy Team. Any patient deemed unsuitable on initial assessment may be reassessed in the future or after appropriate discussion by the MDT.

See SAM procedure 1 for more information.

7.6 Patient Information and Consent

Patients, and where appropriate, their family and/or their carers should be fully informed of the purposes of self-administration and how the scheme works. A suitably trained Nurse or Pharmacist may give this information.

All patients must be given the ‘Self-Administration of Medicines Patient Information’ leaflet (Appendix E). It must be made clear to the patient that they do not have to self-administer their medication if they are not happy to do so and that there is a nurse available to administer their medicine if they so wish.

Once the patient has read all the information and understands what the scheme involves, they must sign the consent box of the assessment form if they wish to participate in the scheme at level 2/level 2 specific. Two registered nurses must witness the consent (a pharmacist can be the second witness if required). See SAM procedure 1 for more information.

7.7 Prescribing

Before medicines are prescribed for self-administration the medicine regime should be reviewed by the Doctor, Nurse and (where possible) Pharmacist to include only necessary medication and to select dosing regimens and formulation that are as simple as possible.

All patients on the SAM scheme will require the hospital electronic prescription to be written on JAC according to normal Trust procedures.

The SAM status of the patient and date can be recorded on the ‘Clinical Note’ page of JAC, under ‘Self Administration Note’ (POE program).The SAM note page should be used for all communication regarding the patient self-administering.

Medical staff must bring any changes to the medicine regimen to the attention of the patient and Nurse caring for the patient at the time the change is made. See SAM procedure 2 for more information.

7.8 Storage and Supply of Medication

Patient’s own drugs (POD’s) may be used for self-administration, provided that they have been reconciled and assessed as suitable. All other medication will be supplied to the patient according to Trust policy.


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All prescribed drugs for self-administration will be clearly labelled with directions as for discharge medication. The instructions on the medicine label must be the same as the prescription and Medicine Information Card.

Usually four weeks supply of medication will be dispensed but this may be reduced if appropriate to suit the needs of the individual patient.

Each patient on Level 2 will be supplied with a key card to their large lockable bedside medicine drawer which they must sign for. Patients should keep the key card on their person at all times. Medicines security must be fully explained to the patient.

For ‘Level 2 Specific’ patients their specific medicines e.g. insulin, should be stored in the small lockable bedside drawer to allow access to that medicine only, all other medicines will be stored in the large lockable bedside medicine drawer, to which the patient does not have free access.

If the patient leaves the hospital or ward for any reason (e.g. when a patient is taken to Theatre) their key card must be returned to the Nurse in charge. See the SAM procedure 4 for more information.

7.9 Lost Key cards

If a key card is lost, the medicines must be removed from the medicine drawer and stored securely.

If the key card is not found the lock must be re-programmed and a Trust Electronic Incident Report form completed. See SAM procedure 11 for more information

7.10 Counselling the Patient

A nurse or member of the Pharmacy Team should carry out initial patient counselling. Following the initial counselling, the pharmacist should be contacted for further patient counselling if a problem is encountered. The patient should be further counselled if the drug therapy is changed, and also to discuss the drug regime with the patient at discharge. See SAM procedure 3 for more information.

7.11 Initiating Self-Administration

Before a patient is allowed to start to self-administer their medicines the nurse must ensure that all steps within the ‘Initiation of Self-Administration Checklist’ (Appendix D) are completed. If the form is used, this should be filed in the patient’s medical notes. See SAM procedure 1 for more information.

7.12 Checks and Controls

The nurse must check the drug regime daily to ensure that no changes have been made which necessitate an amendment to the drug supply held by the patient.

Any change in the patient’s condition may necessitate a return to levels 0 or 1 as appropriate.


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‘The nurse retains the responsibility for the continued assessments of self-administrating patients and is responsible for recognising and acting upon changes in a patient’s condition, which may prejudice their safety in continuing with the SAM scheme’ (NMC 2010).

At Level 2 or Level 2 specific, the patient’s ability to adhere to both the medicine regime and the storage requirements should be constantly evaluated, in addition to a regular assessment at the end of each nursing shift. If there is doubt about a patient’s comprehension and compliance they should return to level 0 or 1 and the problems discussed/resolved with the MDT.


7.13 Controlled Drugs and Refrigerator items

Controlled drugs should be stored in the ward controlled drugs cabinet or Omnicell unit and patients at Level 1 or 2 of the scheme may request these medicines from the nurse on duty when required. However, according to national guidance, there may be exceptional circumstances where a Level 2 patient may need to have a small quantity of their own controlled drugs in their lockable bedside drawer, for example in palliative care. This must be risk assessed on an individual basis and recorded in the controlled drug register and the patient’s notes. The controlled drugs must be closely monitored.

Patients at Level 1, 2 or Level 2 specific of the scheme may request items stored in the refrigerator from the Nurse in Charge when required. NB: Insulin in use should be stored out of the refrigerator and the expiry reduced to one month from the date of removal from the refrigerator. Spare stock should be stored in the refrigerator.


7.14 Missing Medicines

If medicines go missing the patient’s Doctor and Pharmacist should be informed.

The Level 2/Level 2 specific patient should reduce to Level 1. Self-administration at Level 2 or Level 2 specific should be recommenced only if considered appropriate after patient evaluation and further counselling.

A Trust Electronic Incident Report form must be completed.


7.15 Medicine Administration Error

If a patient administers an inappropriate dose or drug the patient’s doctor should be informed immediately.

The doctor should assess the severity of the error and take appropriate action. The pharmacist should be informed and a Trust Electronic Incident Report form completed.

The Level 2/Level 2 specific patient should reduce to Level 1. Self-administration at Level 2/Level 2 specific should be recommenced only if considered appropriate after patient evaluation and further counselling.



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7.16 Withdrawal

The patient may withdraw from Level 2/Level 2 specific at any time. The patient should sign the ‘Withdrawal of Consent to Self-Administer’ form (Appendix C), this must be witnessed by the Nurse in Charge. Medicines will then be administered as for Level 0 or 1, as appropriate.


7.17 Transfer to a different ward

Should a patient be transferred to a different ward, all of their medicines (including those stored in the refrigerator, CD cupboard or Omnicell unit) should be placed in the ‘My Medicines green bag’ and transferred with the patient, the patient’s key card(s) should be returned to the nurse in charge for safe storage. On arriving to the new ward, the patent’s medicines should be stored securely in their bedside medicine drawer(s), key card(s) issued to the patient and the self-administration of medicines process should resume as on the previous ward.

7.18 Discharge

Discharge is planned from the time of admission and participants in the SAM scheme should be independent before discharge. Only patients who are capable of attaining Level 2 are suitable for discharge, unless alternative arrangements have been made for the patient to be supervised at home.

In any case where the patient had special needs e.g. compliance aid, large labels the Nurse in Charge or Pharmacist will document this in the patient’s discharge summary to inform the patient’s General Practitioner and Community Pharmacist, so that the patient can continue to self-administer their medication safely at home. The patient’s medicines will be placed in the ‘My Medicines’ Green bag.


7.19 Patient Information

Patients must be given good verbal and written information about the SAM scheme, see the ‘Self Administration of Medicines Patient Information’ form (Appendix E).

7.20 Medicines Information

In addition to the Medicines Information Card (Appendix B) or printed copy of the JAC electronic administration chart, Pharmacy will supply Patient Information Leaflets (PILs) for all medicines dispensed for a patient and electronically produced compliance aids. These will be made available as part of the patient’s education on the ward. Pharmacy will supplement the leaflets with verbal information as and when requested. Where other information is required e.g. steroid cards or anticoagulant books, Pharmacy will normally be responsible for their supply.


7.21 Compliance Aids

An expanding range of compliance aids will be offered as the scheme develops. This range will include: large print labels, non clic-loc lids, inhaler aids, and alarm clocks. Some tablet boxes for daily dosing schemes may become available in the future.

8. CONSULTATION


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The Self Administration Policy has been revised in light of current practice and Department of Health recommendations in consultation with senior leads for medicines management, nursing and other healthcare professions.

9 Training

This Policy for the Self Administration of Medicines (SAM) does not have a mandatory training requirement but the following non mandatory training is recommended:-

9.1 All staff to be involved with the SAM scheme will need to read this policy, procedures

and complete the appropriate training tracker modules (there are different training packages available for nurses, prescribers and pharmacy staff) before the scheme is implemented at ward level.

9.2 Ongoing training and support for all personnel involved in the SAM scheme will be

provided by the pharmacy team. 9.3 Doctors and nurse prescribers should complete the ‘Educational Training Tracker

Package for Prescribers’. 9.4 Nurses should complete the ‘Educational Training Tracker Package for Nurses’. 9.5 Pharmacist/Technicians should complete the ‘Educational Training Tracker Package

for Pharmacists/Technicians’. 9.6 It is the Ward Sister’s responsibility to ensure any new staff are aware of the

appropriate training tracker package before practising the SAM scheme. 9.7 Trained staff should complete the Training Tracker annual assessment regarding

self-administration to keep up to date. 9.8 Records of staff training will be held within the Trust. 9.9 Each ward will have the support of the Pharmacy Team to implement this change to

practice.

10 Monitoring Compliance and Effectiveness 10.1 Wards will be supported and monitored by the ward Pharmacist on a daily basis. 10.2 The Self-Administration scheme will be audited annually on a patient satisfaction

level as well as on an operational level. 10.3 Staff training will be audited annually. Training will be recorded and monitored through the Learning Management System

11 Links to other Organisational Documents Medicines Policy Standard Operating Procedure for the administration of medicines in a clinical area Procedures for the self-administration of medicines (available on the Trust’s intranet)


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12 References 1. The National Service Framework for Older People. Department of Health March

2001. Nursing and Midwifery Council Guidelines for the Administration of Medicines 2002. Nursing and Midwifery Council, London.

2. A Spoonful of Sugar. Medicines Management in NHS Hospitals, The Audit Commission London 2001

3. Self-Administration of Medicines – Educational Package, Salford Royal Hospitals

NHS Trust, sponsored by the Foundation of Nursing Studies. 4. The NHS Plan: a plan for investment. London: Department of Health 2000. 5. Implementing the NHS Plan. A programme for Pharmacy in the future. Department of

Health September 2000. www/doh.gov.uk/pharmcyfuture/ 6. Protocol for use of Patient’s Own Drugs (11.26 in Pharmacy File) 7. Nursing and Midwifery Council ‘Medicines Management’ (2010) 8. Protocol for One Stop Dispensing (now called Dispensing for Discharge) (11.56 in

Pharmacy File) 9. Self-Administration of Medicines by hospital inpatients.

www.healthcarecommission.org.uk 10. Policy for the self-administration of medicines Cumbria Partnership NHS Foundation

Trust. 11. Self-administration of Medicines Policy Version 2:10 Plymouth NHS Teaching

Primary Care Trust 12. The Medicines Policy, NHS Isle of Wight, December 2012 13. Standards of Care, Care Quality Commission, Outcome 9 (Regulation 13) (2010) 14. Safer Management of Controlled Drugs – A guide to good practice in secondary care

(England) May 2007Appendices

13 Appendices

A Self-Administration Assessment Tool/ Consent B Medicines Information Card C Initiation of Self-Administration Checklist D Self-Administration of Medicines Patient Information E Patient Counselling Tips F Financial and Resourcing Impact Assessment on Policy Implementation G Equality Impact Assessment (EIA) Screening Tool

http://www.healthcarecommission.org.uk/


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Appendix A

Self-Administration Assessment Tool


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Appendix C INITIATION OF SELF-ADMINISTRATION – CHECKLIST

To be completed by nursing staff

Patient Name: ____________________ Ward: ____________________ Hospital Number: _________________ Date of Birth: __________________

The following must be carried out before a patient is allowed to self-medicate. Each stage MUST be signed and dated by the nurse as it is completed.

Action Signature Date

1 The patient has been given an information leaflet about self medication.

2 The patient has been assessed with the Self-Administration Assessment Tool.

3 An adequate supply of the correct medication, appropriately packaged and labelled, has been dispensed for the patient.

4 The following have been explained to the patient by a Pharmacist, Nurse or Doctor:

a The purpose of the medicines prescribed.

b The dose and time of administration.

c Any relevant warning or special instructions.

d Possible side effects.

5 The patient has been given a Medicines Information card completed and checked by the nurse or Pharmacy team (for levels 1, 2 and level 2 specific only).

6 SAM level …. And Date .. has been endorsed on JAC ‘Clinical Note’ Individual medicines have been marked as ‘self-administration on JAC by the prescriber or pharmacist.

7 Patient’s SAM status has been recorded in the ward handover sheet.

8 For level 2/level 2 specific patients, an explanation has been given to the patient of:

a Medicine security - a key card to the appropriate lockable drawer has been supplied.

b The consent form signed by the patient, nurse, second nurse witness or pharmacist.

c Procedure for administration of any medicine needing refrigeration and controlled drugs.

d Nurse monitoring of the scheme.


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Appendix D

SELF ADMINISTRATION OF MEDICINES PATIENT INFORMATION

Self-Administration of Medicines (SAM) is a scheme used on this ward to enable you to have possession and take your own medication under various levels of supervision. Level 0 Your Nurse will give you your medicines to take at the appropriate time. Level 1 Your Nurse will supervise you while you take your medicines. Level 2 specific You will have the key card to your small lockable bedside medicine drawer and take your

specific medicine/s only e.g. insulin or Parkinson’s disease medicines as you would normally do at home. All other medicines will be administered to you by your nurse until you are ready for Level 2.

Level 2 You will have the key card to your lockable bedside medicine drawer/s and take your medicines unsupervised as you would normally do at home.

This scheme hopes to improve your knowledge about your medicines, and may help you cope more easily with your medicines when you go home.

Your own medicines, if suitable will be used initially as this allows you to continue with familiar medicines and containers. Any more or new medicines will be given to you by the hospital. These medicines will be placed in the lockable medicine drawer next to your bed.

Self-administration on the ward should help you understand:

1) How to take or use each of your medicines safely 2) The purpose of each of your medicines

Self-administering your medicines is not compulsory; you do not have to take part. If you don’t want to take part, your medicines will be administered in the normal way (level 0) and your care will not be affected.

You will have the opportunity to discuss exactly what self-administration means and what the benefits might be for you. You will also have the opportunity to discuss any points regarding your medication with a Pharmacist or a Pharmacy technician during your stay.

A Nurse will check your medicines regularly. This is to make sure you have enough supply and are not having any problems. When using a lockable bedside medicine drawer Please make sure your medicines are kept locked in your personal medicine locker. The key card must be kept with you at all times. If you cannot find your key card tell your nurse straight away. If anyone else tries to take your medicines please call a nurse at once. If you forget what medicines you have taken or you have any problems please talk to your nurse. When you leave hospital please make sure you hand back your key card to the nurse in charge


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Appendix E

Patient Counselling Tips Before counselling a patient, check that you know the correct purpose for each prescribed medicine. Ask the patient if they know what medication they take, when, and what for. Check that the patient can read the labels on their medicines and that they can open the containers. Explain the following to the patient for each medicine: a) Name and description of medicine. b) The purpose of the medicine. c) How many/much to take, the frequency, and the most appropriate times. d) Any special instructions for administration e.g. before food, after food, with a glass of water. e) Any common side effects. Any side effects mentioned should be those that the patient can recognise e.g. blackened stools, headaches, nausea etc. Use language appropriate to the individual patient. NB The patient should also be told that it is not possible to mention every possible side effect for every drug. If they experience any problems, which they think could be related to one of their medicines, they should discuss this with their primary nurse, the pharmacist or doctor. f) Interactions with alcohol or other medication e.g. warfarin and aspirin. g) Explain what to do if a dose is missed - make sure the patient knows that they should not double the next dose to make up for missing a dose. Give the patient an opportunity to ask questions. Check the patient’s comprehension by asking them to: a) State the correct purpose of each drug. b) State the correct dosage instructions. Other points to mention on discharge: How long to take the medicine for e.g. a set course, or not to stop without the advice of their doctor. Where to store their medication e.g. in a cool place, out of reach of children, not in the bathroom. Indicate any medication that may need to be kept in the fridge. Explain how to obtain further supplies and the need to obtain these before their medication runs out. Tell the patient not to take any other medication which they may have at home (unless agreed with the pharmacist or doctor). Inform the patient or carer of how to dispose of any unwanted medication i.e. take to a local pharmacy. Explain to the patient the need to either show their Medication Information Card or explain to the pharmacist what medication they are on if they buy any medicines at all. Also, not to take medication offered by a friend or a relative without advice from a doctor or pharmacist. It should be explained to the patient/patient’s carer that the Medicine Information card refers ONLY to discharge medication and will need to be amended if the GP or other doctor, changes the prescription.


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Appendix F

Financial and Resourcing Impact Assessment on Policy Implementation

NB this form must be completed where the introduction of this policy will have either a positive or negative impact on resources. Therefore this form should not be completed where the resources are already deployed and the introduction of this policy will have no further resourcing impact.

Document title

Self Administration of Medicines

Totals WTE Recurring £

Non Recurring £

Manpower Costs 0 0

Training Staff minimal minimal

Equipment & Provision of resources minimal minimal

Summary of Impact: There is minimal impact forecast for implementing the Self-Administration of Medicines Policy. Risk Management Issues:

Procedures are in place to minimise risk.

Benefits / Savings to the organisation: Financial savings are predicted in terms of reducing patient admissions or re-admissions due to medication errors at home. Achieving CQC requirements. Improved awareness of the patient's ability to cope with their medication while they are on the ward and on discharge. Improvement in patient education and concordance. Equality Impact Assessment Has this been appropriately carried out? YES Are there any reported equality issues? NO If “YES” please specify:

Use additional sheets if necessary. Please include all associated costs where an impact on implementing this policy has been considered. A checklist is included for guidance but is not comprehensive so please ensure you have thought through the impact on staffing, training and equipment carefully and that ALL aspects are covered.

Manpower WTE Recurring £ Non-Recurring £


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Operational running costs

minimal minimal

Totals: minimal minimal

Staff Training Impact Recurring £ Non-Recurring £

minimal minimal

Totals: minimal minimal

Equipment and Provision of Resources Recurring £ * Non-Recurring £ *

Accommodation / facilities needed 0 0

Building alterations (extensions/new) 0 0

IT Hardware / software / licences 0 0

Medical equipment 0 0

Stationery / publicity 0 0

Travel costs 0 0

Utilities e.g. telephones 0 0

Process change 0 0

Rolling replacement of equipment 0 0

Equipment maintenance 0 0

Marketing – booklets/posters/handouts, etc 0 0

Totals: 0 0

Capital implications £5,000 with life expectancy of more than one year.

Funding /costs checked & agreed by finance: Costs checked – agreed as minimal

Signature & date of financial accountant:

Funding / costs have been agreed and are in place:

Signature of appropriate Executive or Associate Director:


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Appendix G

Equality Impact Assessment (EIA) Screening Tool

1. To be completed and attached to all procedural/policy documents created within individual services.

2. Does the document have, or have the potential to deliver differential outcomes or affect in an adverse way any of the groups listed below? If no confirm underneath in relevant section the data and/or research which provides evidence e.g. JSNA, Workforce Profile, Quality Improvement Framework, Commissioning Intentions, etc. If yes please detail underneath in relevant section and provide priority rating and determine if full EIA is required.

Gender

Positive Impact Negative Impact Reasons

Men yes

Women yes

Race

Asian or Asian British People

Yes

Black or Black British People

Yes

Chinese people

Yes

Document Title: Self Administration of Medicines Policy

Purpose of document

The purpose of this policy is to provide clear guidance for all practitioners of their responsibilities when initiating, supervising or discontinuing the self-administration of medicines by patients and to ensure that the Trust handles self-administration of medicines safely and securely in accordance with the Trust’s Medicines Policy, legislative requirements and best practice.

Target Audience

The policy applies to all employees of the Isle of Wight NHS Trust, including bank and agency staff, and all in-patients and day attenders who are deemed suitable to self-administer their own medication supervised and unsupervised accordingly. Each member of staff will need to complete a specific training package (there are training packages available for prescribers, nurses and pharmacy staff) before practicing the self-administration of medicines scheme.

Person or Committee undertaken the Equality Impact Assessment

Gillian Honeywell/ Zoe Wells


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People of Mixed Race

Yes

White people (including Irish people)

Yes

People with Physical Disabilities, Learning Disabilities or Mental Health Issues

Yes

Sexual Orientation

Transgender Yes

Lesbian, Gay men and bisexual

Yes

Age

Children

Yes

Older People (60+)

Yes

Younger People (17 to 25 yrs)

Yes

Faith Group Yes

Pregnancy & Maternity Yes

Equal Opportunities and/or improved relations

yes

Notes: Faith groups cover a wide range of groupings, the most common of which are Buddhist, Christian, Hindus, Jews, Muslims and Sikhs. Consider faith categories individually and collectively when considering positive and negative impacts. The categories used in the race section refer to those used in the 2001 Census. Consideration should be given to the specific communities within the broad categories such as Bangladeshi people and the needs of other communities that do not appear as separate categories in the Census, for example, Polish.

3. Level of Impact This policy can have a positive impact on all patients irrelevant of colour, age, gender or faith.

If you have indicated that there is a negative impact, is that impact:

YES NO

Legal (it is not discriminatory under anti-discriminatory law)

Intended

If the negative impact is possibly discriminatory and not intended and/or of high impact then please complete a thorough assessment after completing the rest of this form.

3.1 Could you minimise or remove any negative impact that is of low significance? Explain how below:

3.2 Could you improve the strategy, function or policy positive impact? Explain how below:


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3.3 If there is no evidence that this strategy, function or policy promotes equality of opportunity or improves relations – could it be adapted so it does? How? If not why not?

Scheduled for Full Impact Assessment Date:

Name of persons/group completing the full assessment.

Date Initial Screening completed

Date post:	24-Jul-2020
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