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Medicines administration

Medicines has emerged as one of the more common areas of unsafe practice amongst services rated inadequate or requiring improvement. Where good and outstanding rated practice exists, effective processes, training and support are key.

There must be strong compliance with national guidance, and this will need to be reflected in your policies and procedures. Where possible, supporting people to safely manage their own medication will be viewed favourably, as will close monitoring and recording of medicines.

How people are supported around safe medication will vary across different providers, and the CQC may tailor this part of the inspection depending on your service type and what you offer.

The following film provides a summary of this area of inspection. It can help you and your teams learn about what will be inspected and what is important to demonstrate to deliver good or outstanding care.

Introducing medicines

Duration 02 min 07 sec

Whatever role your service has in regard to people’s medicines, it’s important that your processes and procedures are robust.

You’ll need to be clear about your staff roles and responsibilities around medicines … and ensure that people receive them as prescribed.

NICE guidelines will need to be followed and the CQC inspectors will want to assure themselves that your service is safely managing the ordering, transporting, storage, and disposal of medicines.

Your staff will be expected to be effectively trained and assessed as competent in how they administer and record medicines.

Regularly use opportunities such as one-to-ones to discuss medication issues and check understanding with staff.

Your staff will also need to be confident to discuss medicines with the people you support … and ensure this information and advice is clearly communicated.

Involve the people you support in how their medicines are managed. Try to encourage independence. Correct procedures will need to be followed, including when supporting people with limited capacity.

Your medication management may also need to involve external healthcare professionals.

The CQC inspectors will review data from your service prior to interviewing people, staff, and managers. Be prepared for the CQC inspector to accompany your staff and observe them administrating medication.

The inspectors may also ask to see a range of documents related to your medication management including:

  • Medicine administration records
  • Medicine review
  • Medicine training
  • … and medicine protocols

Outstanding services will look for creative ways to promote and support increased independence, as well as being at the forefront of medication management innovations.

Take a look at the recommendations, examples, and resources in our GO Online resource to help you to safely manage medicines.

CQC Focus

The CQC inspection will focus on the following key line of enquiry when looking at this topic. The additional prompt questions below may be explored as part of their inspection focus.

  • S4 -

    How does the provider ensure the proper and safe use of medicines?

  • S4.1 -

    Is the service’s role in relation to medicines clearly defined and described in relevant policies, procedures and training? Is current and relevant professional guidance about the management of medicines followed?

  • S4.2 -

    How does the service make sure that people receive their medicines (both prescribed and non-prescribed) as intended (including controlled drugs and ‘as required’ medicines), and that this is recorded appropriately?

  • S4.3 -

    How are medicines ordered, transported, stored, and disposed of safely and securely in ways that meet current and relevant legislation and guidance?

  • S4.4 -

    Are there clear procedures for giving medicines covertly, in line with the Mental Capacity Act 2005?

  • S4.5 -

    How does the service make sure that people’s behaviour is not controlled by excessive or inappropriate use of medicines?

  • S4.6 -

    How do staff assess the level of support a person needs to take their medicines safely, particularly where there are difficulties in communicating, when medicines are being administered covertly, and when undertaking risk enablement assessments designed to promote self-administration?

  • S4.7 -

    How does the service engage with healthcare professionals in relation to reviews of medicines at appropriate intervals?

  • S4.8 -

    How do staff make sure that accurate, up-to-date information about people’s medicines is available when people move between care settings? How do medicines remain available to people when they do so?

  • S4.M -

    The following questions are specific to CQC monitoring process.  Some prompts will only be asked where relevant to a service type:

    • How have you ensured that the right medicines in the right doses and quantities are available to people, at all times?
    • How have you ensured medicines are stored and transported safely? For example, how are they delivered to the home, any returns?
    • How have you ensured any errors are noted, addressed and learned from? Have you any examples?
    • How have you ensured people who administer their own medicines can continue to do so safely?
    • How do you ensure staff are competent to administer medicines safely? Have staff been asked to complete delegated duties in relation to medicines and was training provided?
    • How have you managed any challenges when working with your local healthcare professionals, including community pharmacies?

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