Supporting Self-Administration

A Worcester care home, praised by CQC for supporting a service user who was formerly a nurse to administer her own medicines, has been rated ‘outstanding’ following its inspection.

Inspectors noted how staff at Perry Manor used residents’ individual care plans to ensure that the care provided meets their particular needs and help them to feel valued. In the case of a resident with a past career as a nurse, this meant that staff enabled her to administer her own medicines and manage her own pain relief. The final report from CQC stated that “the resident was proud of her career as a nurse and felt staff had supported her to be in control of her own pain relief which was very important to her.”

Actions such as this show how relatively small changes, that personalise the way care is delivered, can transform a service user’s life and, as a consequence, improve the reputation of your home.

Rather than simply ‘taking over’ a task such as medication administration from a service user, looking at how they can be assisted to manage the task for themselves can help to boost self-esteem and give back some control over their lives. Read on to find out more about supporting safe self-medication and how you could enable more of your service users to manage this task independently.

Self-Medication

Both the National Institute for Health and Care Excellence (NICE) and the CQC provide detailed guidance on the subject of self-administration of medication in care homes.

The NICE guidance actively encourages self-medication, unless there are clear reasons why staff should take over this task, stating “It is important for people living in care homes to maintain their independence, and that they have as much involvement in taking their medicines as they wish and are safely able to.”

So often, the default position for care homes is the exact opposite of the approach recommended by NICE, but the CQC’s guidance document, based on the NICE recommendations, helps to outline the steps a care home should take to support self-medication safely.

Support Your Service Users to Administer Their Own Medicines: 5 Steps to Safe Self-Medication 

1.Have a clear process: You must have a policy in place for self-administration of medicines. (including controlled drugs) which should include:

  • Individual risk assessment.
  • Obtaining or ordering medicines.
  • Storing medicines.
  • Keeping records.
  • Reminding or prompting people to take their medicines, if necessary.
  • Monitoring adherence.
  • Disposing of unwanted medicines.

2. Risk assess: Your staff should assess the risk for each person based on their individual abilities to establish whether it would be safe for them to self-administer and, if so, how much support would be needed. The risk assessment should consider:

  • The person’s choice.
  • If self-administration will be a risk to the themselves or other people.
  • If they can take the correct dose of their own medicines at the right time and in the right way.
  • How often you will need to repeat or review the assessment.
  • How you will store the medicines.
  • The responsibilities of the care home staff.

3. Provide appropriate support: It’s important to remember that self-administration should be regarded as an ‘all or nothing’ task. In some cases, service users may be able to manage some items e.g. inhalers, but not others. Types of support could include large print labels, colour coding of containers, dosette boxes or discreet prompting.

4. Store medications safely: All medicines must be stored securely and in a way that ensures they are not at risk of degrading e.g. eye drops that require temperature-controlled storage. A lockable drawer or cupboard should be a minimum requirement for any service user choosing to self-medicate.

5. Keep accurate records: You don’t need to record each dose of medication on a MAR chart if a person self-administers their medication, simply that they’re self-medicating. However, you must keep a record of all medication supplied to the person and any occasion where you remind or support the person to take their medicine.

If you want to find out more about the risks and benefits associated with self administration of medication, subscribe to Care Quality Matters now. Every issue is packed with advice and guidance, supported by online resources, templates and checklists to help you provide the best possible standards of care.

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