1. Purpose
Supporting someone with their medicines in their own home is different from giving medicines in a care home. The person, or their family, may manage most of it themselves, and the Service supports only the parts they need help with. This policy sets out how the Service decides what support each person needs, how workers prompt, assist or administer medicines safely, and how the Service records it and learns from any error.
The Service must verify this policy against current NICE guidance and its own local pharmacy and prescriber arrangements before adoption.
2. Sources to verify before adoption
- NICE NG67, Managing medicines for adults receiving social care in the community: https://www.nice.org.uk/guidance/ng67
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Mental Capacity Act 2005 (consent and best interests, including covert administration): https://www.legislation.gov.uk/ukpga/2005/9/contents
- The Service's local arrangements with the person's GP practice and community pharmacy
3. Scope
This policy applies to:
- every person the Service supports with medicines in their own home
- prescribed medicines, medicines bought without a prescription, and creams, drops, inhalers and similar
- the workers who support medicines, and the senior staff who assess need and check competence
4. The three levels of medicines support
The Service uses the levels of support set out in NICE NG67 and records which level applies to each medicine for each person. The level can differ from one medicine to another for the same person.
- Prompting and reminding. The person manages their own medicines. The worker reminds them it is time to take them. The person decides and acts.
- Assisting. The person directs their own medicines but needs practical help, for example opening a bottle, popping a tablet from a blister pack, or passing a glass of water.
- Administering. The worker gives the medicine to the person, including selecting it, preparing it and recording it.
The level of support is agreed with the person, recorded in the care plan and the medicines record, and reviewed when the person's needs change.
5. Starting from what the person can do
The Service starts from the principle that a person manages their own medicines unless an assessment shows they need help. The Service does not take over more than the person needs.
- The level of support is based on an assessment, the person's wishes and, where relevant, their mental capacity to make decisions about their medicines.
- Where a person manages their own medicines, the Service records that and does not interfere with it.
- Consent is sought before the Service gives any medicine. Where a person may lack the capacity to consent, the Service follows the Mental Capacity Act and section 11 below.
6. The medicines record in the home
Where the Service administers or assists with medicines, it keeps an accurate medicines administration record (a MAR) in the person's home:
- the MAR lists each medicine, the dose, the form and when it is to be given
- the worker records each time a medicine is given, or the reason it was not (for example the person refused, was asleep or was out)
- the worker signs each entry
- the MAR is kept where the next worker can find it, and is legible and up to date
Where a person only needs prompting and manages their own medicines, the Service records that level of support rather than keeping a full MAR.
7. Time-critical medicines
Some medicines must be taken close to a set time to work safely, for example medicines for Parkinson's disease, insulin, and some medicines for the heart or for epilepsy. The Service:
- identifies time-critical medicines in the care plan and the medicines record
- plans visits so these medicines can be given on time
- treats a visit that includes a time-critical medicine as a critical visit under the missed and late visits policy
8. When-required (PRN) medicines
For medicines taken only when needed, such as pain relief, the Service follows a clear plan for each one:
- what the medicine is for and the signs that it is needed
- the dose, how often it can be given and the maximum in a day
- how the person shows or says they need it, including where the person cannot ask in words
- the worker records each time a when-required medicine is given and the reason
9. Storage, ordering, collection and disposal in the home
Medicines in a person's home belong to the person and are stored in their home. The Service:
- supports safe storage, taking account of children or others in the home where relevant
- records who is responsible for ordering and collecting medicines, whether that is the person, a family member or the Service
- follows an agreed route for returning unwanted or out-of-date medicines to a pharmacy, and records what was returned where the Service handles it
10. Controlled drugs in the home
Where a person is prescribed a controlled drug, the Service:
- records the support it provides with that medicine
- counts and records the quantity where it administers the controlled drug, and checks the balance
- reports any discrepancy or concern without delay
The Service confirms its controlled-drug arrangements against current guidance before adoption.
11. Covert medicines and the Mental Capacity Act
Giving medicine to a person without their knowledge, for example hidden in food, is covert administration. It is only ever considered where a person lacks the capacity to decide about that medicine. Before any covert administration the Service ensures:
- a capacity assessment has been completed for the decision about that medicine
- a best-interests decision has been made and recorded, involving the prescriber, the pharmacist, the family or representative, and the Service
- the method is agreed with the pharmacist, because hiding a medicine can change how it works
- the arrangement is recorded, reviewed and stopped as soon as it is no longer needed
A worker never decides to give a medicine covertly on their own.
12. Medicines errors and learning
- A worker reports any medicines error, near miss or concern the same working day, including a missed dose, a wrong dose, the wrong medicine or a recording gap.
- The Service checks whether the person has come to harm and gets medical help where needed.
- The error is logged and runs through to a recorded outcome with any actions completed.
- The Service reviews medicines errors together to find patterns and improve practice, rather than treating each as a single worker's mistake.
13. Staff competency
A worker supports medicines only after training and a check that they can do it safely. The Service:
- trains workers in safe medicines support before they support medicines alone
- checks competence in practice, not only in the classroom, and repeats the check on a stated cadence
- records who is competent for which level of support, and removes a worker from medicines tasks if a concern arises until it is resolved
14. Audit cadence
The Service checks, on a stated cadence, that:
- each person has a recorded level of support for each medicine, agreed with them
- medicines records in homes are accurate, signed and up to date
- time-critical and when-required medicines are managed per the plan
- medicines errors are reported, recorded and learned from
- workers supporting medicines are trained and competent
The Registered Manager reviews the results and records the improvement actions that follow.