An important and central part of modern care and treatment is giving medication, those in social care have to accept responsibility for administration and, educate themselves about the complexities of the substances they are handling.
However onerous this may be, we must not forget the first principles of medication administration, and it worth reminding ourselves of some of the issues. To help us is the Royal Pharmaceutical Society (2007) has produced guidance for the handling of medicines in social care. The regulator has also produced some invaluable guidance (CQC website). All this information talks about the safety of the recipient be it in care home or any other setting. The starting point is with the service user (person) they. They may be quite used to managing their own medicines for years, and would probably like to continue. It would be wise to conduct a risk assessment to establish the safety and indeed the capacity of the person to continue to do so.

Medicines are of course the person’s property (medicines Act 1968) so; we must not assume that we should automatically claim the right to administer them on their behalf. That sorted, safe storage within the person’s own environment must be made available.

Next question is the competency of the person administering the medicines, It will be necessary for to have completed an accredited course. For registered Nurses they must adhere to the Nursing & Midwifery Council’s guidance. The verification of actual administration should be down to the Management who will observe staff and give authority to carers/nurses to carry out this procedure.

Today with any procedure we must obtain consent from the users of the service, as well as address issues of competence. Homes are advised to get written consent from users about administration. Those who lack capacity under the Mental Capacity Act 2005 will require an assessment and decision making procedure to be followed and written in the care notes. We also have to be mindful of the deprivation of Liberty Safeguards (2009) and if we believe we are abridging these we will need to refer for a “best interests “decision, particularly relevant in this area is when the person refuses to take prescribed medication. Is this a capacity issue, how do we proceed, when do we call the G.P.; - all part of medication administration?  Similarly with PRN prescribed medication: - medication to be given “when necessary”. Easy decision if resident complaining of pain however more difficult decision if it related to emotional or behavioural aspects of the service user. Forget crushing or covert administration – crushing can lead to over dosage as well as prosecution for altering the manufactured product, covert administration can become an abuse issue. To be able to justify why we are giving is the most important consideration. In every respect we must ensure the right person, right dose, right time and right medication is the mantra we must follow.

Very occasionally errors occur and staff must ensure the safety of the person is a priority, usually by phoning the G.P. for advice. Mistakes must never be covered up and the home/agency procedures should give guidance to the staff as to what they must do.

New “blister” systems, such as those produced by Protomed, are available and look like being another step forward for the safety of administration of medication.

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