SELF-ADMINISTRATION OF MEDICATION (SAM) POLICY
NOVEMBER 2018
This policy partially supersedes previous policies for self-medication in collaboration with the pharmacist
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Policy title Self-administration of medication
Policy reference
PHA15
Policy category Clinical
Relevant to All staff supporting patients to self-administer medicines
Date published November 2018
Implementation date
November 2018
Date last reviewed
November 2018
Next review date
November 2021
Policy lead Lucy Reeves, Chief Pharmacist
Contact details Email: [email protected] Telephone: 0203 317 7169
Accountable director
Vincent Kirchner, Medical Director
Approved by: Drugs and Therapeutic Committee
Ratified by: Quality Committee
Document history
Date Version Summary of amendments
Apr 1995 1 New policy
Mar 2002 2 Updates
Aug 2006 3 Updates
Dec 2015 4 Rewritten
Nov 2018 5 Updated
Membership of the policy development/ review team
Beverly Boateng, Clinical Pharmacist, Audrey Coker, Lead Pharmacist for Clinical Services, Simon Peel, Lead Nurse for Medicines Management.
Consultation
Chief Pharmacist, Lead Pharmacists, Team Managers
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Contents
1 Policy statement 4
2 Executive summary 4
3 Duties and responsibilities 4
4 Definitions 5
5 Levels of self-medication 6
6 Assessment and care planning 9
7 Management of incidents and errors 11
8 Physical assistance with self-medication 11
9 Dissemination and implementation arrangements 12
10 Training requirements 12
11 Monitoring and audit arrangements 12
12 Review of the policy 14
13 References 14
14 Associated documents 14
Appendix 1: Equality Impact Assessment 16
Appendix 2: Self-administration of medicines risk self-assessment and 17
Consent form
Appendix 3: Record for patient filling adherence aid finger or an adherence 19
aid
Appendix 4: MAR Chart 20
Appendix 5: Monitoring concordance for patients chart 21
Appendix 6: Self-medication concordance sheet – levels 1 and 2 22
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1. Policy statement
Supporting patients to self-administer their medicines is to help to promote recovery, through the development of skills and knowledge required to manage treatment. Supervised self-administration is a core function of services across the rehabilitation pathway, and trust services in the Community e.g.:
Inpatient rehabilitation wards
Community rehabilitation units
Supported housing projects
Acute day units
Crisis houses
Crisis teams/home treatment teams
Assertive outreach teams
SAM involves a multidisciplinary approach and emphasises the need for better management
of patients’ medication between hospital and community settings. This policy does not apply
to patients living at home in the Community and taking their medicines independently.
Implementation of this policy supports assurance of compliance with Regulation 13 of the Care Quality Commission (CQC) Essential Standards: Management of medicines, by ensuring that patients have their medicines when they need them, in a safe way, and understand the purpose of their medicines.
2. Executive summary
Aims of the policy:
To establish a standardised approach for assessing the patient’s ability to self-administer medicines safely
To define the different levels of the self-administration process
To define the responsibilities of each member of the multidisciplinary team in the self-administration process
Scope This policy applies if self-administration of medicines is supervised by staff employed by C&I. There are no exceptions to the policy in the trust services. Staff must use this policy when planning care that involves supervising patients self-administering medicines, in accordance with the scope of practice appropriate to their role. The policy must be read in conjunction with the medicines management policy and any standard operating protocol specific to the service.
3. Duties and responsibilities
Service managers are responsible for ensuring:
policies are adhered to within their service areas
staff are trained and competent within their services to practice in accordance with their role
staff are supported to work within, and not exceed, their sphere of competence
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Ward, Team and House managers are responsible for deciding whether self-administration of medicines can be safely practised within the services. They are also responsible for ensuring that bedside lockers are available (if applicable) and for ensuring nursing staff and other members of staff are trained in the use of this policy. Doctors are responsible for prescribing (for patients) to comply with this policy and for communicating any changes in medication to the patient, nurse, pharmacist and team members as appropriate.
Pharmacists and pharmacy technicians are responsible for following the instructions in
this policy relating to the assessment and supply of medicines for use by patients.
4. Definitions
Self-administration
The preparation and administration of medication to oneself.
Administration/use of medicines
The activities undertaken when a medicine is administered; i.e. given by introduction into the body, or by external application to the patient.
Medication Administration Record (MAR) chart
A MAR chart is a written record of medicines that have been self- administered. It is not a prescription. MAR charts must not be used to obtain medicines from the pharmacy department. The MAR chart must be written by a nurse or allied professional who have undertaken trust accredited medicines management training two-day course or a nurse or allied health professional who has successfully completed the medicines management competency framework. The Trust MAR chart is in appendix 4. Alternatively, houses may obtain preprinted MAR charts from Community Pharmacies.
Medication chart
A medication chart is a record of all medicines prescribed and administered.
Dispensing/issuing/supply
Medicines are issued to services where they will be used, or supplied direct to the patient. This includes the supply of both stock, and individually named items.
Capacity
The MCA states that a person is ‘unable to make a decision’ if they cannot do one or more of the following four things:
Understand information given to them
Retain that information sufficiently to be able to make the decision
‘Weigh up’ and evaluate the information available to make the decision
Communicate their decision verbally or by using sign language or by muscular movement, for example, blinking or squeezing a hand
See Mental Capacity Act 2005 (incorporating the deprivation of liberty safeguards) policy.
5. Levels of self-administration
5.1 Levels of self-administration There are three levels of self-administration. Each level denotes the responsibility that patients have for managing medicines. See summary of each level below. The assessment must take place on referral to the service or when the decision to start self-medication is made. Patients can be managed by using a combination of the levels according to their
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needs. For example, a patient residing in a community rehabilitation unit may independently manage the storage and self-administration of nicotine replacement therapies (level 3). However, the patient may require prompting and direct supervision of the self-administration of their antipsychotic treatment (level 1). Before initiating self-administration, an assessment of the patient’s capacity and adherence must be undertaken. The patient must be informed of the responsibility that each level holds. The levels below apply to a ward or house environment. There is no specific duration for each step of the self-administration process. The decision is dependent on the patient’s needs.
Patients should be educated about their medication and given access to written and verbal explanations of the medication by a doctor, nurse or pharmacist. The Choice and Medication link or MAPPs can be used to provide written information. An individualised patient information leaflet can be given during admission stay and/or at discharge. This leaflet can be created from the MaPPs ® (found under clinical resources on the intranet).
Summary of each level:
Level 1 - Staff led
The patient must be supervised by a staff member throughout the self-administration
process. Medicines will be stored in a central medicines cupboard or trolley, and patients
will not have independent access to them. This is usually the first level on the wards and
may be the first level in a crisis or residential house.
When administration is due, the staff member will prompt the patient that their medication
is due, and will ask if they want to take it. They will hand the medicines bag/box/blister pack
to the patient and will request him/her to:
Select correct medicine(s) from the bag/box/blister pack.
Advise the staff member the medicine, dose and number of tablets they are taking.
Count out the correct number of tablets/capsules/volume of liquid, and take the medication correctly.
Return closed item(s) to bag.
The observing staff member must check what the patient states they are taking correlates
with the record on the MAR chart (appendix 4) /medication chart before the self-
administration occurs.
• Staff led • Service user fully supervised by staff
throughout the process Level 1
• Service user initiated • Service user is expected to remember the
scheduled times to come for their medication
Level 2
• Service user led •Service user has sufficient knowledge and has demonstrated that they can be responsible for their medication in every aspect
Level 3
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The member of staff will then observe the patient preparing and taking the medication and
will intervene to prevent the patient from taking medicines incorrectly if necessary.
The member of staff will initial the MAR chart/medication chart and make an entry in the
electronic patient record and the self-medication concordance sheet (appendix 6).
The member of staff should make any further comments relevant to the self-administration.
The information must be shared with the multidisciplinary team (MDT) and any concerns
regarding a patient’s safety during self-medication must be escalated. For level 1 during
Community visits, the patient’s medicines will be kept in the team base and would be
supervised when the staff member arrives at the patient’s home. The medicine chart must
be taken to the patient’s home.
Level 2 – Patient initiated
The patient will be informed of self - administration times. The patient is expected to come
and ask for medication at the scheduled time(s). The staff member will hand the
medicines bag/box/blister pack to the patient, and will request they:
Select correct item(s) from own bag/box. Advise the staff member the medicine, dose and number of tablets they are
taking. Count out the correct number of tablets/capsules/volume of liquid, and take
the medication correctly. Return closed item(s)
Initially, the member of staff will not remind the patient when to take their medication. If
he/she forgets to ask for the medication and 30 minutes have elapsed, then he/she must be
reminded. The reminder must be recorded in the progress notes and discussed within the
MDT.
The member of staff will observe the patient preparing and taking the medication and will
intervene to prevent the patient from taking medicines incorrectly if necessary.
The member of staff will initial the MAR chart (appendix 4)/medication chart; make an entry in the electronic patient record and the self-medication concordance sheet (appendix 6). The member of staff should make any further comments relevant to the self-administration.
Records in the electronic patient record: If the patient asked for the medicines Identified what medicines he/she was taking The patient read the instructions correctly If the patient prepared the medicines correctly If the patient self-administered medication correctly Any prompting or intervention provided
Records in the electronic patient record: If the patient asked for medicines Identified what medicines he/she was taking The patient read the instructions correctly If the patient prepared the medicines correctly If the patient self-administered medication correctly Any prompting or intervention provided.
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This information must be shared with the multidisciplinary team (MDT) and any concerns
regarding a patient’s safety during self-medication must be escalated.
In the community, patients will keep medicines at home. He/she will be supervised when the
staff member arrives at the patient’s home or the patient comes to the team base. The
medicine chart must be brought with the staff member.
Level 3 – Patient led - The patient will have sufficient knowledge about their medicines and
be able to handle their medicines safely, taking the correct dose at the right time without
direct supervision from staff.
The patient takes their medicines correctly with minimum intervention from staff.
The patient will ensure the medicines are kept locked in the bedside locker/cabinet.
The staff member in charge must hold a duplicate key (but routine concordance
checks must be done in collaboration with the patient)
Monitoring of concordance must be completed at least twice weekly using the form in
appendix 5. It may be completed more frequently if clinically indicated (e.g. every 48
hours for patients taking clozapine).
Controlled drugs must be retained by staff in a controlled drugs cupboard and will be
monitored as level 2.
The level of self-medication must be recorded in the patient’s care plan and on the MAR
chart/medication chart.
In the Community, patients will take medicines independently.
Level 1, 2 or 3
For patients on wards, the pharmacists can either:-
a. Ask the medical staff to write an electronic leave prescription for dispensing or
b. Complete a ward sheet with the patient name, medicines and dosage instructions for
dispensing.
5.2 Self-administration in bedded services (wards, crisis houses, assisted accommodation projects)
Wards and assisted accommodation projects are able to support service across different
phases of self-medication in accordance with patient needs, provided appropriate storage is
available and staff can manage any risks.
Wards use medication charts rather than MAR charts to record self-administration. The
medication chart must be annotated with the level of self-medication carried out. Self-
medication will only be supervised and signed for by a nurse or trained member of staff.
The crisis house must use a MAR chart to record the observation of self-administration. The
MAR chart must be written by a doctor or a trained member of staff. If medication is required
from the pharmacy department, then a medication chart must be written. The contents of the
medication chart and MAR chart must match. A doctor or trained staff members must
update the MAR chart.
Concordance must be recorded in the electronic patient records. For patients at level 3,
tablet counts can be done using appendix 5 - monitoring concordance for patients.
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5.3 Self-administration in community teams (crisis teams, home treatment teams, assertive outreach teams)
Teams in the Community who supervise the self-administration of medicines must use the
appropriate section of the crisis team medication charts to record each supervised self-
administration.
Some patients treated by these services may require this level of direct supervision during
self-administration. The patients may retain their own medicines at home. Patients are not
be required to lock the medicines in their own homes. The patients must be encouraged to
keep medicines safely from children and pets. Advice must be documented in the care plan.
Concordance must be recorded in the electronic patient records.
6.0 Assessment and Care planning Inclusion and exclusion criteria
To introduce the self-medication programme, the following criteria must be considered:
Table 1: Criteria for self-medication
Inclusion
criteria
Patients who are on a stable medicine regime
Patients who are expected to remain on the ward/unit for at least 7 days or
have been admitted to a crisis house
Capable of understanding the purpose of the medication, remembering the
directions for use and agreeing to take the medication prescribed.
Exclusion
criteria
Patients who are confused or who have an unstable mental state
Patient deemed unable to participate due to lack of capacity* as defined under the Mental Capacity Act (2005)
Patients on an unstable medicines regime
Patients at risk of self-harm
Patients who do not self-administer when they are not in hospital, e.g. carers
administer their medication
6.2 Risk assessment An appropriately skilled registered nurse or trained member of staff must carry out an individual risk assessment to determine how much support a patient needs to self-administer their medicines. For assisted accommodation and crisis houses, this must ideally occur prior to transfer into the service. Risk assessment must consider the following items, and a management plan addressing these must be recorded within the ‘evidence of risk of harm from others’ section of the risk assessment in the electronic patient record (see Risk and Safeguarding section):
Patient choice re: self-administration and their consent to engage in the process.
If self-administration will be a risk to the patient or to other residents/carers (for example, could leaving a medicine in their home pose a risk to another person)?
If the patient can take the correct doses of their own medicines at the right time and in the right way (for example, do they have the mental capacity and manual dexterity to self-administer)?
The frequency of the assessment based upon individual patient need.
How the medicines will be stored.
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The responsibilities of the care home/crisis team/crisis house/assisted accommodation staff (as applicable).
See appendix 2. If the formulation of the risk assessment exceeds the sphere of knowledge of the nurse, additional input must be sought from colleagues e.g. the pharmacist, RMO, or Trust Mental Capacity Lead. For patients who lack the manual dexterity to administer medicines themselves (with or without adherence aids), support from occupation therapy colleagues in the assessment process must be sought if available.
If a patient does not have capacity, a best interest’s decision must be taken. The MDT retains ownership of responsibility for making best interests decision, however the membership of the group taking a best interests decision must be proportionate to the level of restriction placed on the patient. For example, it may be appropriate for a decision regarding supervision of self-administration for a patient who has fluctuating capacity to be taken by a single registered healthcare professional. However, a decision to transfer the patient to a registered care facility would be taken in conjunction with other professionals and a representative for the patient.
NB Certain medicines may not be suitable for self-administration (level 3)
Controlled Drugs (Schedule 2 and 3) – in accordance with the Controlled drugs policy
Injections (unless the patient is self-administering their medicines at home e.g. insulin)
Once only doses Variable doses
Some “When required” medication
Patients at level 1 or 2 may have controlled drugs provided there is a controlled drug
cupboard. Level 3 patients’ controlled drugs will be monitored at level 2.
Medication supply for SAM
Wards and certain crisis houses (Daleham (House) Crisis House and Rivers
Crisis House):
- Routine medicine prescriptions must be requested from GP surgery. For medicines
initiated or changed by the medical team, a supply can be requested either via a TTA
or a pharmacist writing an order with a ward sheet.
- For level 1 & 2, a month’s supply will be provided for medication suitable for
inclusion.
- For level 3, four batches of 7 days will be supplied. The patient will have
responsibility for one batch at a time, unless otherwise agreed by the
multidisciplinary team and documented.
Community teams and Crisis teams:
- Medicines must be requested as defined in the policy/procedure for each service.
This may be via GP/community pharmacy, with the use of pre-packs or by using the
trust pharmacy service.
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Patients wanting to hold ‘as required’ medicines.
Patients may hold the following medicines provided there is a locked cupboard/bedroom or
they are holding it on their person There must also be a documented patient specific risk
assessment documented in Carenotes:-
Drops
Sprays
Inhalers
Creams
Ointments
NRT products
Environmental factors
For patients considered to be appropriate for level 3 self-administration, a lockable
medicines cupboard must be securely located within the patient’s bedroom. The patient
must be able to lock the bedroom.
Duplicate keys are available for both locker and bedroom drawer, in case of loss by
patient.
Room temperatures must be monitored each day if the patient has a medicine locker.
There must a trust approved room temperature record sheet in the rooms.
6.3 Review
Review of capacity, risk, and consent must be an on-going process during a treatment episode/admission. The risk assessment/care plan must be updated in response to:
Deterioration in mental state
Changes in medication
After a self-administration error
Withdrawal of consent
Review of treatment via CPA or other care review
In wards and in community rehabilitation, the multidisciplinary team in line with their treatment review schedule must review the unit’s progress against the self-administration pathway. This must be aligned with 6 monthly CPA cycles at a minimum. Risk assessment and care plans must be updated.
7. Management of errors and incidents
Errors must be clinically managed in accordance with the protocols for managing medication
incidents described within local SOPs. This will usually include:
Escalation to Prescriber/GP and Trust pharmacy during working hours
Escalation to duty doctor and on call pharmacy out of hours
All errors/incidents related to the self-administration of medicines must be reported using
Datix online incident reporting.
8. Physical assistance with self-administration
Patients who require assistance with preparing medicines for self-administration (for example a patient whose hands shake and require help with pressing out the tablets into a pot) must have:
The capacity to have made the decision to self-administer the medicines
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Requested for assistance from staff in supporting them to remove the medicines from the packaging
A blister packs/adherence aid may be used if a decision is made by the MDT. If the person is an inpatient, the ward pharmacist must be consulted as part of the decision-making process. The GP surgery must be contacted to check if a referral for a blister pack will be made on discharge. Refer to appendix 2.
In residential and crisis houses, arrangements for patients away from the home are as follows: When the patient needs to take their medicines away from the home, the original dispensed supply should accompany the patient. If possible, for a short-term leave, the original supply should be sent with the patient, provided it can be returned. If a return of the medicines is uncertain, a prescription for the short-term leave period should be requested from the GP. The prescription should be sent to the Community Pharmacy. Alternatively, if the patient is on leave for one day, the patient can transfer the medicines into a adherence aid finger. This must supervised by the nurses or accredited members of staff. The supervision must be documented on the designated form (appendix 3).
If a patient wishes to keep their medicines in an adherence aid, the Community Pharmacist must be contacted to request the medicines are dispensed in it. The adherence aids must be purchased.
If the community pharmacists cannot provide this service and the patient still wishes to use adherence aids, they must fill the boxes under a supervision of nurse or an accredited member of staff. Advice must be obtained from the Trust pharmacist or Community Pharmacist as to the stability of the medicines in adherence aids. The MAR chart and labels on the dispensed medicines must be used as reference sources by the staff member during the supervision. The patient under supervision by the member of staff must complete the adherence aid label. The staff member must not fill the adherence aid on the patient’s behalf. Once completed, the member of staff must record the observation in appendix 3 and in the electronic patient record.
See the Trust medicines management policy for more information.
9. Dissemination and implementation arrangements
The policy will be circulated to divisional directors, service managers and team managers for dissemination. The lead nurse for medicines management, mental capacity act lead, and lead pharmacists will be available to support services in its implementation.
10. Training requirements
For training requirements please refer to the Trust’s Mandatory Training Policy (Intranet) and Learning and Development Guide (Intranet).
Staff involved in supervised self-administration of medicines is required to participate in
training and competence assessment processes pertaining to these interventions.
11. Monitoring and audit arrangements
Nurses based within services are expected to lead on the local monitoring and audit of processes around the management of medicines, with additional support from the pharmacy department as required.
The criteria below must be checked on a weekly basis by the manager or designated nurse. The service manager will monitor results of the audit checks. Required actions will be identified and completed in specified time frames.
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MAR chart checks
Any entries on MAR chart are signed and dated by the staff member supervising self-administration
Medicines administration is recorded or reason for not administering (by code) on the
MAR. There are no blank spaces on at due times for administration.
Patients on level 3 of self-administration have had their concordance recorded in the concordance sheet in appendix 5 at a frequency determined by the multidisciplinary team or at a minimum of weekly checks.
Medicines (expiry, storage, disposal) checks
All medicines administered are in date.
All medicines are stored appropriately in locked medicines cupboard, CD cupboard or medicines fridge.
Fridge temperature is monitored daily and appropriate action taken where temperature has deviated outside 2-8°C.
All rooms where medicines are stored are temperature monitored daily and
appropriate action taken where temperature has deviated above 25°C.
Nursing staff must also complete weekly checks to verify the quantity of each medicine. This is to ensure that medicines are appropriately used.
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AUDIT AND MONITORING/GOVERNANCE
12. Review of the policy
November 2021 or earlier should practice change.
13. References
This policy has been developed in accordance with the following NICE guidelines
SC1 - managing medicines in care homes (2014)
CG76 – Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence (2009)
NG5 – Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (2015)
14. Associated documents
Medicines Management Policy
Patients own drugs policy
Medication optimisation policy
Controlled Drugs Policy and Procedures
Standard Operating Procedure (SOP) for Medicines
Management in Crisis Houses
Standard Operating Procedure (SOP) for Medicines
Management in Community Rehabilitation Units
Standard Operating Procedure (SOP) for Medicines
Management in Hanley Gardens and Caledonian Road
Medicines management procedure for SAMH Home Treatment
Team Medicines Management Procedure
Medicines Management Procedure for Crisis Teams
Elements to be monitored
Lead How Trust will monitor compliance
Frequency Reporting
Acting on recommendations and Lead(s)
Change in practice and lessons to be shared
MAR chart and concordance for level 3
Manager of the service
Audit /
Pharmacy checks
Weekly / monthly
Divisional quality forums
Required actions will be identified and completed in a specified timeframe
Required changes to practice will be identified and implemented within a specific time frame. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders
Medicine storage, expiry, disposal
Manager of the service
Audit /
Pharmacy checks
Weekly / monthly
Divisional quality forums
Controlled Drugs
Manager of the service / Lead Pharmacist
Audit /
Pharmacy checks
Weekly / monthly
(quarterly trust CD audit)
Divisional quality forums
DTC
Self-administration assessments
Manager of the service
Audit Quarterly Divisional quality forums
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Appendix 1
Equality Impact Assessment Tool
Yes/No Comments
1. Does the policy/guidance affect one group less or more favourably than another on the basis of:
Race No
Ethnic origins (including gypsies and travellers) No
Nationality No
Gender No
Culture No
Religion or belief No
Sexual orientation including lesbian, gay and bisexual people
No
Age No
Disability - learning disabilities, physical disability, sensory impairment and mental health problems
No
2. Is there any evidence that some groups are affected differently?
No
3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
N/A
4. Is the impact of the policy/guidance likely to be negative?
No
5. If so can the impact be avoided? N/A
6. What alternatives are there to achieving the policy/guidance without the impact?
N/A
7. Can we reduce the impact by taking different action?
N/A
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Appendix 2: SELF-ADMINISTRATION OF
MEDICINES RISK ASSESSMENT AND CONSENT FORM
1. Introduction 1.1. Patients with difficulty remembering to take their medicines should be considered for
a medication reminder (produced from MAPPs) as a first option. 1.2 The tool below must be used to assess the patient’s needs. 1.3 Medication adherence aids are devices designed to help patients to take their
medication. They may be helpful in assisting patients who are motivated to take their medication, but sometimes forget. They are of no value in patients where non- adherence is intentional.
1.4 If a medication compliance aid is required, a blister pack or alternative compliance aid must be considered. This can be obtained by contacting the GP surgery. The GP surgery will make a referral to the chosen Community Pharmacy. The Community Pharmacy will make an assessment as to whether a blister pack is appropriate. Once accepted, blister packs will be provided. For inpatients, the ward pharmacist must be contacted. As part of the assessment for inpatients, the ward staff must contact the GP surgery to check if a referral to the Community Pharmacy can be made on discharge.
Tool for assessing patients for managing their medicines
Patient Name NHS Number
Ward Date of Birth
Risk Level of Risk Comments/adjustments
Patient’s mental state is unstable and/or confused (unaware of time and space)
Is there any history of alcohol/drug abuse
Is there any history of overdose, accidental or intentional
Patient has history of non-compliance to medication leading to relapse or risk of relapse
Yes/No
Is the patient currently able to manage medicines?
If Yes , no further assessment required
Is the patient motivated to commence self-medication
If Yes, consider the options below
Is the patient able to manage medication with a reminder card from MAPPs)?
If Yes , no further assessment required
Does the patient require counselling with an interpreter to ensure information isunderstood?
If Yes, organise an interpreter and reassess if the patient can then manage medicines.
Could the medication regimen be simplified? If yes contact the prescriber.
If Yes, review with the prescriber before completing the assessment
Can the patient manage with opening child-resistant closures foil?
If Yes , no further assessment required
Can the patient manage by opening ordinary (non-CRC) screw lids?
If Yes , contact Community Pharmacist
Does the patient have any difficulty reading the label on their medication packet?
If Yes, ascertain the difficulty and contact the Community Pharmacist e.g. to check if larger labels are possible.
Is the patient not able to manage, but here are systems at home which are satisfactory?
If Yes , no further assessment required
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Are you confident that any assistance provider e.g. carer, friend or relative is competent to order, collect, supervise self-administration of medicines?
If Yes , no further assessment required
Is the patient residing in/to be discharged to a nursing home?
If Yes , no further assessment required
Is a specific community pharmacy used / to be used for obtaining medication? If so, give details below). Name, address, telephone
Name: Address: Telephone number:
If the patient is confused by the number of medicines taken and it is felt that a compliance aid would relieve this confusion in which case record reasons below. The GP must be asked to make a referral to the Community Pharmacist for a compliance aid assessment.
Will the GP make a referral to the Community Pharmacy for a blister pack?
If Yes, request a referral.
If an adherence aid is preferred by a patient, the Community Pharmacist must be asked to fill the box. A patient may fill one day’s supply of medication in an adherence aid finger under supervision of an accredited nurse or a clinical support worker.
The adherence aids may need to be provided to the Community Pharmacy.
If the patient prefers to fill the adherence aid, he/she must undertake this task under the supervision of an accredited nurse or a clinical support worker.
The member of staff can only supervise the patient.
Additional Comments Risk Levels High (H) Unlikely to succeed with self-administration Medium (M) Likely to be successful with high levels of support Low (L) Likely to be successful with support None (N) Likely to be successful with the program
Consent Section
Name Signature Date
Consultant
Nurse
Pharmacist
Level to enter: MDT approved: Yes / No Consent completed: Yes / No
Consent
The self-administration scheme has been explained to me and I am willing to take part. I understand that I can withdraw my consent at any time. I understand that if the staff decides that I should stop the self-administration programme I will be informed. Patient signature
Date:
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Appendix 3: Record for patient filling the adherence aid finger or an adherence aid Patient Name: Age: Ward/Service: Electronic patient record no. Date Medicine Medicine chart checked
by a nurse of a clinical practitioner (signature)
Medicine added correctly to the adherence aid finger by patient. Checked by nurse or clinical practitioner (signature)
Appendix 4: MEDICINES ADMINISTRATION RECORD (MAR) FOR PRESCRIBED REGULAR MEDICINES AND WHEN REQUIRED MEDICATION
PATIENT NAME: ALLERGIES: DATE OF BIRTH: LEVEL OF SELF MEDICATION:
DATE (Month/Year)
MEDICINE DOSE AND FREQUENCY:
Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
19 20 21 22 23 24 25 26 27 28 29 30 31
Morning
Lunch
Tea
Night Pharmacy: Count
Record date(s) & Quantity(s) received with 2 signatures
Qty(s) returned/destroyed & signature:
Morning
Lunch
Tea
Night Pharmacy: Count
Record date(s) & Quantity(s) received with 2 signatures
Qty(s) returned/destroyed & signature:
Morning
Lunch
Tea
Night Pharmacy: Count
Record date(s) & Quantity(s) received with 2 signatures
Qty(s) returned/destroyed & signature:
Morning
Lunch
Tea
Night Pharmacy: Count
Record date(s) & Quantity(s) received with 2 signatures
Qty(s) returned/destroyed & signature:
Morning
Lunch
Tea
Night Pharmacy: Count
Record date(s) & Quantity(s) received with 2 signatures
Qty(s) returned/destroyed & signature:
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Entry Codes: Initials = supervised medicine given, D = medicine declined, SA = self-medication (not observed), O = medicine omitted, N = not available, F = any other reason record in notes.
Appendix 5 - monitoring concordance for patients
SELF-MEDICATION CONCORDANCE CHECKS
NAME OF PATIENT:
DATE CHART STARTED:
Medicine/dose/freq Date of check
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
No of tablets counted
No of tablets that should be left
21
Appendix 6 – self-medication concordance sheet – levels 1 and 2
SELF-MEDICATION CONCORDANCE SHEET – levels 1 AND 2
Dates
Week
Date MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
B L T N B L T N B L T N B L T N B L T N B L T N B L T N
Did person ask for
medicine
Read instructions
correctly
Takes medicines correctly
Comments (give date)
Week
Date MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Did person ask for
medicine
Read instructions
correctly
Takes medicines correctly
Comments (give date)
Y- Yes; D- Declined; B- Breakfast; L- Lunch; T – Tea; N - Night
22
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