Domain 1 - Staff Training & Competency
1. The care home has a means to assess which elements of training are necessary for each care worker?
2. All care workers within the home have received level one training (induction).
NB: For care workers who will not be administering medication to residents this may be an awareness session. Highlighting the care workers role in a situation where medication is present.
3. All members of staff who administer medication to residents have completed accredited Level 2 (basic) training.
4. The training provides care workers with basic knowledge of how medicines are managed and how to recognise and deal with problems.
5. The training describes the principles behind all aspects of the home's policy on medicines handling and records.
6. There is a mechanism within the care home to assure care workers are confident in administering medication to residents.
7. There is a suitable mentor in the home to support staff through their medication training at each level.
8. The care home has a formal means to assess whether the care worker is sufficiently competent in medication administration before being allowed to give medicines.
9. There is an assessment process recorded in each care worker’s training file.
10. It is made clear to care workers that level 2 training does not enable them to administer medication using specialised techniques i.e. giving oxygen, insulin by injection or rectal diazepam.
11. Where a resident requires a medication which needs to be administered using a specialised technique there is a mechanism to support this.
12. Each care worker administering medication to residents understands the need to seek guidance and support if there is uncertainty e.g. if label states “apply to affected area” and the area is unknown to the care worker.
13. Each care worker understands the need for confidentiality, when and to whom information about an individual’s medication.
14. There is a support mechanism in the home to enable care workers to request additional training if they feel there is a need.
15. Where the care home employs nurses to provide care to residents, it is assured that their actions are within the auspices of the NMC Guidelines for Professional Practice.
16. Where the care home employs nurses to provide care to residents, it is assured that their actions are within the auspices of the NMC Guidelines for The Administration of Medicines.
17. Where the home employs nurses to provide care to residents there is a supervisory process to identify when a registered nurse is not meeting these standards.
Please provide a summary of observations/comments based on what has been found from this inspection.
Domain 2 - Individual Medication Records
1. The MAR chart clearly states each resident’s name and date of birth.
2. The MAR chart displays a recent photograph of each resident.
3. MAR charts clearly identify known allergies.
4. MAR charts clearly show the name(s) of the medicines.
5. MAR charts clearly show the route of administration of the medicines (e.g. oral, topical, IV etc.).
6. Medication Records clearly show the dose of medicine to be administered.
7. MAR charts clearly state the dose of medicine which has actually been administered. (This will apply to medicines with a variable dose).
8. MAR charts clearly show the time medication has been administered.
9. Medication records describe the indication for WHEN REQUIRED medicine.
10. MAR charts show the maximum frequency of WHEN REQUIRED medicine in twenty four hours.
11. WHEN REQUIRED medicines are being administered appropriately. (Also see Domain 9).
12. Medication Records clearly state reason for missed doses i.e. refusal of medication by residents using codes indicated on MAR.
13. Medication records indicate the site of application for creams and lotions etc.
14. The appropriate code is used for the non-administration of medication.
15. Explanations are given when the “other” code is used.
16. All hand-written entries for medication on MAR charts are checked for correctness and signed by a second person. (Preferably this applies to interim, acute medication and homely remedies only).
16. The home ensures that care workers check that the person has not already been given the medication by anyone else.
17. Medications no longer required are not shown as current on residents MAR charts.
18. The home obtains a MAR chart for each new medication supplied.
19. Where times of administration have been altered, reasons are recorded together with new times, which are signed and dated.
20. Doses changed by GPs are annotated on the MAR with reference to the GP, date and time recorded.
21. Medication times align with regular drugs rounds or vice versa.
22. The home ensures that administration is recorded on the MAR chart by the person preparing and administering the medication.
23. The application of creams, ointments and oral nutritional supplements are recorded on the MAR chart.
24. All staff involved in the process of medicines management have read the up to date medicines policy and have signed to agree to the procedures.
25. There is an up-to-date documented record of the printed names, signatures and initials of all staff that are authorised to administer medicines.
Domain 3 - Homely Remedies
There is a list of homely remedies agreed with the GP on an individual patient basis.
Any creams/ointments should be used for individual residents only and not included the homely remedy list.
A list of homely remedies is maintained for purchases and returns.
The administration of homely remedies is recorded on the MAR.
The resident’s GP is informed if homely remedies are used for more than 24 hours. The MAR chart should confirm this.
The home has a protocol for non-prescribed medicines.
Domain 4 - Self-Medication
Residents have been offered the opportunity to self-medicate where appropriate.
A risk assessment has been completed for those residents who wish to self- medicate.
Residents have lockable storage for their medication.
The MAR states “self-medicating” against the medication to be self - administered.
Appropriate checking procedures for medication are in place and recorded.
Domain 5 - Administration Of Oxygen
Oxygen is administered at the prescribed concentration and flow-rate.
Oxygen masks are clean and dry.
Oxygen masks are covered when not in use.
Oxygen cylinders are in safety cradles or trolleys when in use.
“OXYGEN IN USE/NO SMOKING” signs are displayed on the resident’s door.
“OXYGEN STORED” sign is present on the treatment/clinical room door.
Oxygen not in use is stored securely in “NO SMOKING” areas and in safety cradles which are fastened to the wall.
Prescribed oxygen on is for a named resident only.
When patients no longer require oxygen, this is reported to the GP practice concerned.
An individual risk assessment is carried out for the safe use of Oxygen within the service.
Domain 6: Receipt, Storage & Disposal of Medicines
A record is maintained of all medication used by the home.
Quantities of resident’s medications are audited prior to ordering to ensure appropriate stock holding of medication, i.e. one month.
Medication received into the home is checked against the prescription forms and current MAR.
A method of exchanging information with pharmacy/dispensing practice is in place in case of missing/incorrect medication.
Any discrepancies are reported to the pharmacy/dispensing practice at the point of receipt.
A copy of all medications requested is kept at the home.
The quantity of each item of received into the home is recorded.
Changes to prescriptions made verbally by GPs are checked, dated and initialled by two responsible staff members.
Medicines for internal and external use are stored separately.
Medicines cupboards are clean and dry.
Medicine cupboard and storage room is locked when not in use.
Medicine trolleys are clean and dry.
Medicine trolleys are locked when not in use.
Medicine trolleys are secured to the wall.
Stock of homely remedies is correct.
Medicines requiring refrigeration are stored appropriately.
The medicines refrigerator is clean and dry.
The medicines refrigerator is lockable and/or in a secure room.
The minimum and maximum temperature of the medication refrigerator is checked and recorded daily.
The temperature of the medicines refrigerator is between 2 degrees C and 8 degrees C.
There is a procedure in place should the thermometer show that the fridge has not been between 2 degrees C and 8 degrees C.
Reagents are stored in a separate locked cupboard.
Reagents have lids securely in place.
Reagents are dated on opening.
Medicines are returned to the pharmacy/dispensing practice/waste carrier when past the expiry date.
Medicines returned to the pharmacy/dispensing practice/waste carrier when a course of treatment is discontinued.
Medicines are retained at the home for a period of 7 days following the death of a resident.
Medicines are disposed of correctly.
Staff are aware of hazardous/Cytotoxic/Cytostatic medication.
Hazardous/Cytotoxic/Cytostatic medication is disposed of appropriately. According to waste regulations.
Medicines returned to the pharmacy/dispensing practice/waste carrier are recorded.
Returned controlled drugs (i.e. those recorded in the CD register) are signed for by the person receiving them.
Miss-administered medicines, (e.g. dropped medicines), are disposed of in a pharmaceutical waste container and recorded.
Medicine pots are used in accordance with the manufacturer’s directions.
Oral medication syringes are used in accordance with the manufacturer’s directions.
Eye drops/ear drops/nasal drops are marked with the date of opening and stored correctly.
Creams are labelled with the resident’s name on the container rather than the box.
Eye treatments are labelled with the resident’s name on the container rather than the box where this is feasible.
Inhalers are labelled with the resident’s name on the container rather than the box.
Keys for the medication cupboards/storage room are only handled by authorised staff and a record of these staff kept.
There is a written procedure for missing keys.
Domain 7 - Administration Of Controlled Drugs
Controlled drugs (including those provided in a MDS) are stored in an appropriate locked cupboard.
Movement of controlled drugs is recorded in the controlled drugs register.
There is an individual page in the register for each resident and their controlled drug.
The record of administration includes date and time of medication.
The record of administration includes dosage and route of medication.
The record of administration includes the remaining stock balance.
The record of administration includes signatures of two responsible staff members (one as a witness).
The actual stock of controlled drugs tallies with the amount recorded in the controlled drugs register.
There is a procedure in place for the disposal of controlled drugs.
Controlled drugs are being disposed of according to current controlled drug regulations.
Staff are aware of procedures for reporting controlled drug incidents and how the reporting mechanism links with CQC and the role of the Accountable Officer.
An up-to-date British National Formulary/Mims is available (i.e. the current or previous year).
Domain 8 - Communication Relating To Medication Administration
When a resident is admitted to hospital a copy of the current MAR chart is supplied to the hospital.
Medication is checked following discharge from hospital and any query is raised at the earliest opportunity.
Where a medication has changed, the resident is involved in the change process.
There are named staff responsible for medication within the home that the GP surgeries, pharmacies etc are aware of.
Staff at the home identify colleagues at the GP practice, pharmacy etc to whom they can address correspondence.
For each new resident a list of current medication from the GP is obtained and assessed.
Medication is checked and assessed when a new resident moves into the home and any query is raised at the earliest opportunity.
Changes made to medication by a GP or hospital admission are communicated to the supplying pharmacy/dispensing practice.
Changes made to medication following a GP visit are annotated on the MAR chart and followed up by the GP practice in writing.
When Shropdoc or other out-of-hours service is contacted are all details of the resident readily to hand?
When a resident is transferred to another care setting a copy of the current MAR chart is supplied to that setting.
Provisions are made to report frequent refusals to the prescriber.
The home ensures that care workers are able to recognise and report possible side effects.
The home ensures that care workers understand the procedure for reporting refusals.
The home ensures that care workers understand the procedure for reporting medication errors.
Domain 9 - When required Medication
The home has a medication policy and procedure covering the administration of “when required” when required medication.
Care plans provide detailed information on medication prescribed as “when required”, i.e. when and why it is required.
“When required” medication is offered at times to meet the needs of the person as outlined in the care plan
Accurate record of “when required” administration made including the time it has been administered.
The expiry dates for “when required” medication are checked on a regular basis.
If “when required” medication is given regularly a request is made to the GP to review it.
“When required” medicines are held in suitable quantities.
Information is readily available for staff to know how to administer the medication.
The policy ensures that staff know when to give the medication i.e. what symptoms to look out for, or ask the person if they need it.
The maximum amount to be given in a day or the time to leave between doses recorded.
A record of the outcome following the administration of a “when required” medication made.
If after the specified time the medication is not producing the intended outcome this is communicated to the prescriber.
The information on why the medication has been prescribed and how to give it is sought from the prescriber, the supplying pharmacist or other healthcare professionals involved in the treatment of the person.
Consideration is given to the resident’s capacity to refuse the medication.
Staff are provided with information on the needs of the person e.g. if signs of pain are expressed in a non-verbal way.
Medication that is still in use and in date is carried over from one month to the next and not disposed of.
A record of the quantity carried over is recorded on the new MAR so there is an accurate record of the quantity in stock and to help when performing audits.
“When required” medication is supplied in an original box rather than a monitored dosage system (MDS).
Specialised training is sought/provided for specific medication where indicated, for example the administration of midazolam buccal or rectal diazepam.