Medication Mock Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Ordering – How Medicines Are Ordered?

• Are repeat prescriptions obtained in a safe and efficient manner?

  Yes

  No

  N/A

• Is there an agreed method for requesting repeat prescription orders from the GP practice(s)?

  Yes

  No

  N/A

• Are there any ordering/stock problems?

  Yes

  No

  N/A

• Are medicines ordered in advance so Residentss do not miss any dosages of their medicines?

  Yes

  No

  N/A

• Are there any problems with the pharmacy or GP surgery?

  Yes

  No

  N/A

• Are records kept of medicines ordered?

  Yes

  No

  N/A

• Are records kept of medicines received?

  Yes

  No

  N/A

• Are discrepancies in the above raised with the community pharmacists and/or GP?

  Yes

  No

  N/A

• Are all medicines checked in correctly?

  Yes

  No

  N/A

• Are medicines clearly labelled by the Pharmacist?

  Yes

  No

  N/A

• If medicines are out of stock, is there a process for notifying the GP so an alternative can be prescribed if necessary?

  Yes

  No

  N/A

• Is there a process for ordering prescriptions in the middle of the ordering cycle, e.g. for acute medicines or new medicines?

  Yes

  No

  N/A

Storage - How Are Medicines Stored?

• Are medicines stored safely and securely in an appropriate designated area?

  Yes

  No

  N/A

• Are storage areas clean and organised?

  Yes

  No

  N/A

• Is the medicines cupboard kept locked when not in use?

  Yes

  No

  N/A

• Are keys kept as per policy?

  Yes

  No

  N/A

• Are excessive quantities of medication being stored?

  Yes

  No

  N/A

• Are expiry dates checked monthly – both prescribed and over the counter medicines?

  Yes

  No

  N/A

• Is there a record of expiry date checks?

  Yes

  No

  N/A

• Are external medications separated from internal medications where appropriate?

  Yes

  No

  N/A

• Are there arrangements in place for Residentss who self-medicate to safely store their own medication?

  Yes

  No

  N/A

• Is stock rotated appropriately?

  Yes

  No

  N/A

• Is there any evidence of borrowing/sharing of medication?

  Yes

  No

  N/A

• Are oxygen cylinders stored upright, in a well- ventilated area away from heat and flames?

  Yes

  No

  N/A

• Are 'No Smoking' signs displayed?

  Yes

  No

  N/A

Fridge Storage – How Are Fridge Items Stored?

• Are medicines requiring refrigeration stored appropriately in a secure area?

  Yes

  No

  N/A

• Are there any items stored in the fridge that shouldn’t be stored in it?

  Yes

  No

  N/A

• Are items requiring refrigeration put away as soon as they are received?

  Yes

  No

  N/A

• Is there a process for stock rotation where the Residents has more than one bottle/box of the same medicine?

  Yes

  No

  N/A

• Are there signs that state the fridge should not be switched off?

  Yes

  No

  N/A

• Do staff know not to overstock the fridge to make sure there is space for the air to circulate?

  Yes

  No

  N/A

• Do staff know to keep the fridge door open for as short a time as possible to keep a constant temperature?

  Yes

  No

  N/A

• Do staff check that products are not frozen before administering to a Residents?

  Yes

  No

  N/A

• Does the fridge have a maximum/ minimum thermometer?

  Yes

  No

  N/A

• Are all maximum/minimum fridge temperatures checked daily and the records kept?

  Yes

  No

  N/A

• Is action taken if the fridge temperatures are outside the normal range of 2-8 °C?

  Yes

  No

  N/A

• Is this action documented and retained?

  Yes

  No

  N/A

• Is the fridge cleaned and defrosted at least quarterly?

  Yes

  No

  N/A

• Do staff know what to do if the fridge breaks down?

  Yes

  No

  N/A

Controlled Drugs - How Are Controlled Drugs Managed?

• Are stock levels of controlled drugs appropriate?

  Yes

  No

  N/A

• Does the quantity in the CD register reflect the actual stock?

  Yes

  No

  N/A

• Is the administration of controlled drugs in line with current policy?

  Yes

  No

  N/A

• Are controlled drugs disposed of appropriately?

  Yes

  No

  N/A

Disposal - How is Medication Disposed of?

• Has medication been held for a sufficient time following a death?

  Yes

  No

  N/A

• Are any medicines destroyed in the home?

  Yes

  No

  N/A

• Is the returns record up to date?

  Yes

  No

  N/A

• Is medication for disposal separated from medicines in use?

  Yes

  No

  N/A

Homely Remedies- How Are Homely Remedies Managed?

• Does the audit trail of homely remedies tally?

  Yes

  No

  N/A

• Are all homely remedies in date?

  Yes

  No

  N/A

• Are homely remedies stored separately and securely?

  Yes

  No

  N/A

• Have any homely remedies been given for more than 2 days without contacting the GP?

  Yes

  No

  N/A

Self-Managed Medication - How Are Self-Managing Residentss Supported?

• Is there evidence that Residentss are encouraged and supported to selfmanage their medication?

  Yes

  No

  N/A

• Do current Residentss who self-manage have safe, lockable storage facilities for their medication?

  Yes

  No

  N/A

• Are risk assessments completed for current Residentss who self-manage?

  Yes

  No

  N/A

• Are verbal reminders/supervision/ monitoring given (and documented) for Residentss who require them?

  Yes

  No

  N/A

• Is discreet monitoring and reassessment being carried out?

  Yes

  No

  N/A

Obtaining Consent for Medication Administration?

• Is there a process for obtaining Residentss' consent if staff administer medication?

  Yes

  No

  N/A

Records - How Are Records Managed?

• Are all administrations of medicines recorded in the appropriate place, i.e. medicines chart, Residents's notes, CD register?

  Yes

  No

  N/A

• Is the administration of medicines recorded as soon as possible after the Residents has taken the medicine?

  Yes

  No

  N/A

• Are all omissions of medicines recorded in the appropriate place, i.e. MARs, Residents's notes.

  Yes

  No

  N/A

• Is there a process for verbal orders from a GP?

  Yes

  No

  N/A

Medication Administration – How Are Medicines Administered?

• Are medicines administered from original containers as received from the pharmacy, one Residents at a time?

  Yes

  No

  N/A

• Are labels printed clearly?

  Yes

  No

  N/A

• Are dosage instructions clear?

  Yes

  No

  N/A

• Have any labels been defaced or changed?

  Yes

  No

  N/A

• Are appropriate cautions and warnings clear?

  Yes

  No

  N/A

• Are all medicines labelled for individual Residentss (including medications for external use)?

  Yes

  No

  N/A

• If a monitored dosage system (MDS) is in use, are appropriate cautions and warnings clear and is there an appropriate dispensing date on the pack currently being used?

  Yes

  No

  N/A

• Is there a risk assessment for each Residents who self-medicates any of their medicines?

  Yes

  No

  N/A

• Are measures in place to identify Residentss to ensure that they receive the correct medicine?

  Yes

  No

  N/A

• Have all staff who are involved with prescribing and/or administering medicines read the suite of medication management policies at Aims Care Limited T/A Leighton House Nursing Home?

  Yes

  No

  N/A

• Is there a signatory list to demonstrate that staff have read and understood the policies?

  Yes

  No

  N/A

• Are allergies checked before a medicine is administered to a Residents?

  Yes

  No

  N/A

• Are medicines administered to Residentss from their original containers?

  Yes

  No

  N/A

• Is a drink offered when administering a Residents’s medicine?

  Yes

  No

  N/A

• Are medicines with short expiry dates, e.g. drops, some liquids, etc. dated when they are opened?

  Yes

  No

  N/A

• Are special instructions observed when administering medicines, e.g. before or after food, Residents needs to remain seated after medication?

  Yes

  No

  N/A

• Do Residentss have access to advice/training on their medicines, e.g. inhaler technique?

  Yes

  No

  N/A

• Is advice sought from a pharmacist or GP if staff need clarification on a Residents's medicine?

  Yes

  No

  N/A

• Do Residentss on repeat medicines receive an annual medication review from their GP?

  Yes

  No

  N/A

• Where a Residents has difficulties swallowing and there is no liquid preparation available, is the advice of a GP or pharmacist sought before crushing tablets or opening capsules?

  Yes

  No

  N/A

• If a Residents regularly refuses a medicine, is this raised with their GP?

  Yes

  No

  N/A

• If Monitored Dosage Systems (MDS) are used, is there a process within the home for highlighting medicines that cannot be put in these systems, i.e. medicines susceptible to moisture, e.g. effervescent<br>tablets, liquid medicines, creams, drops, etc.?

  Yes

  No

  N/A

How Are MARs Completed?

• Is the writing on the MAR legible?

  Yes

  No

  N/A

• Are all entries on the MAR in ink/printed?

  Yes

  No

  N/A

• Are handwritten entries on a MAR, cross referenced to the Residents’s notes?

  Yes

  No

  N/A

• Are all Residentss' details completed on the front of each MAR?

  Yes

  No

  N/A

• Is the number of MARs in use completed on the front of each MAR?

  Yes

  No

  N/A

• Are all boxes on the MAR signed for regular medicines?

  Yes

  No

  N/A

• Is it clear from the MAR that medication has been given to the Residents?

  Yes

  No

  N/A

• Does the person who gives the medicine sign the MAR?

  Yes

  No

  N/A

• Is there a central list of signatures/initials for staff involved in medication administration?

  Yes

  No

  N/A

• Do the levels of administration support required in the Care Plans tally with the MAR?

  Yes

  No

  N/A

• Are the directions for the administration of a medicine clear on the MAR?

  Yes

  No

  N/A

• Do directions on the MAR match the pharmacy label for that medicine?

  Yes

  No

  N/A

• Are all doses and times clearly stated on the MAR?

  Yes

  No

  N/A

• Is it clear from the directions on the MAR the number of medicines that should be given?

  Yes

  No

  N/A

• If the directions are, for example, ‘1 or 2 tablets…’ is it clear on the MAR if 1 tablet or 2 tablets have been given?

  Yes

  No

  N/A

• Is it clear when medicines have not been given/have been refused, etc.?

  Yes

  No

  N/A

• Are medicines given at the correct time?

  Yes

  No

  N/A

• Are the correct codes being used on the MAR?

  Yes

  No

  N/A

• If a prescriber stops a medicine, is this crossed off the chart, dated and signed by an appropriate person?

  Yes

  No

  N/A

• Are charts correctly stored to maintain confidentiality?

  Yes

  No

  N/A

Warfarin – How is Warfarin Managed?

• Is the International Normalised Ratio (INR) result sheet and yellow book stored with the MAR?

  Yes

  No

  N/A

• Are all the details in the general information section of the yellow book?

  Yes

  No

  N/A

• Do all the doses on the MAR match the doses specified in the yellow book, or the INR results sheet, for the audit period?

  Yes

  No

  N/A

• Is the current dose marked clearly in milligrams on the MAR (not the number of tablets)?

  Yes

  No

  N/A

• Warfarin tablets should not be broken in half. Has it been necessary to break any tablets in half in order to administer the prescribed dose?

  Yes

  No

  N/A

• Is the date of the next INR blood test noted on the MAR and/or in a diary?

  Yes

  No

  N/A

• Yes

  No

  N/A