Administer Medication to Individuals, and Monitor the Effects Essay

The Medicines Act 1968 This act is an Act of Parliament of the United Kingdom and it governs the manufacture and supply of medicine. This act outlines three categories of medicines: †¢Prescription of medicines (POM). These are only available from a pharmacist if they are prescribed by an appropriate doctor. †¢Pharmacy medicines (P). These are available from a pharmacist without a prescription. †¢General Sales List (GSL). These are medicines which can be bought from any shop without a prescription. The Medicines Act 1968 controls the supply of drugs it covers. It does not outline any offence of simple possession as it is only an offence if the drug is also controlled under the Misuse of Drugs Act 1971. The Misuse of Drugs Act 1971 and amendments 1985, 2001 The 1971 Act outlines those activities which are illegal in relation to the drugs it controls (this is why certain drugs are called controlled). Such activities include: †¢Possession of a controlled drug unlawfully †¢Possession of a controlled drug with the intention of supplying the drug to another person †¢Supplying or offering to supply a controlled drug (this includes giving, selling, sharing, bartering etc.) †¢Allowing premises you occupy or manage to be used for unlawfully for the purpose of producing supplying controlled drugs Health & Safety at Work Act 1974 The Act lays down general principles for the management of health and safety at work, enabling the creation of specific requirements through regulations enacted as Statutory Instruments or through codes of practice. The objectives of the act are securing the health, safety and welfare of persons at work, protecting persons, other than persons at work, against risks to health or safety arising out of or in connection with the activities of persons at work and controlling the keeping and use of explosive or highly flammable or otherwise dangerous substances, and generally preventing the unlawful acquisition, possession and use of such substances. Control of Substances Hazardous to Health Regulations (COSHH) COSHH is the law that states general requirements on employers to protect employees and other persons from the hazards of substances at work by risk assessment, control of exposure, health surveillance and incident planning. 2.1 Common Types of Medication and their Effects and Potential Side Effects Antacids Used to aid the digestion such as burning acids and sometimes flatulence Side Effects: Milk-alkali syndrome is one of the worst side effects of antacid overuse. The excess of calcium accumulates in the blood and can lead to kidney failure. Other side effects could include a chalky taste, mild constipation, increased thirst, speckling or whitish discoloration of stools, stomach cramps. Analgesics These are commonly used to relieve pain such as a headache. Side Effects: Common side effects include nausea, vomiting, drowsiness, dry mouth, urinary retention, constipation, miosis (contraction of the pupil) and orthostatic hypotension (blood pressure lowers upon sudden standing). Less common side effects include confusion, hallucination, delirium, hives, itch, hypothermia, bradycardia (slow heart rate), tachycardia (rapid heart rate), raised intracranial pressure, muscle rigidity and flushing. Anti-histamines These are used to stop the side effects of an allergy Side Effects: Sedating antihistamines could may you feel sleepy although this may improve after taking them for a few days. Non-sedating antihistamines rarely cause drowsiness. Less common side effects, mainly from sedating antihistamines, include headaches, difficultly in passing urine, blurred vision, feeling sick or vomiting, and dry mouth. Laxatives These are used to aid bowel movement when constipated Side Effects: Wind and bloating can be caused by bulk-forming laxatives. Stimulant laxatives can cause abdominal pain and if used for long periods of time can result in a weakened or ‘lazy’ bowel. Osmotic laxatives can cause abdominal pain, bloating and wind. Stool softener laxatives can cause abdominal cramps, nausea and a skin rash. Anticoagulants These are used to aid blood thinning Side Effects: The most common side effects are itching, rashes, easy bruising, increased bleeding from injuries and purplish spots on the skin. The purplish spots are caused by small amounts of bleeding under the skin and bleeding from wounds can be difficult to stop. 2.2 Medications which Demand the Measurement of Physiological Measurements Anti-hypertensives to treat high blood pressure Blood pressure is a physiological measurement and would need specific measurement for the prescribing of anti-hypertensives Insulin for diabetics Blood glucose needs to be tested to ensure the blood glucose is not too high or too low to determine how much insulin is needed. Warfarin (a blood thinning drug) Warfarin requires the blood be checked regularly to monitor how effective the drug is, i.e. is the blood becoming too ‘thin’, which could cause an internal bleed or if the Warfarin dose is not effective enough leaving the patient at risk of blood clots. 2.3 Common Adverse Reactions to Medication Adverse reactions to drugs are common and almost any drug can cause an adverse reaction. Mild adverse reactions include drowsiness, dry mouth, dizziness, skin rashes, constipation and diarrhoea. Sometimes, individuals starting treatment with new or unfamiliar drugs may experience a loss of appetite and weight. The individual’s doctor can be made aware of any mild adverse reactions. Serious adverse drug reactions can involve anything from bleeding ulcers to liver or kidney damage. Other more serious reactions include difficulty breathing, wheezing, fever and joint pain. With serious adverse reactions the individual’s doctor should be contacted. A serious drug reaction might produce anaphylactic shock which severely affects the body functions. Some of the most common symptoms include swelling of the eyes and lips and difficulty breathing, confusion and even fainting. In the case of anaphylactic shock emergency care must be sought immediately. 2.4 Different Routes of Medication Administration Epicutaneaous – this is application onto the skin and can be used for local effect for allergy testing or as a typical local anaesthesia. It can also be used as a systemic effect where the active substance is introduced to the body by spreading through the skin. Subcutaneous – this is where the medication is injected into the skin, .e.g. insulin for a diabetic. Nasal administration – this is where the route of administration is through the nose. Decongestant nasal sprays can be taken up along the respiratory tract through the nose or some substances can be inhaled e.g. inhalational anaesthetics. Intravenous – intravenous means ‘within a vein’. This is where medication or fluids are introduced to the body through a needle or tube inserted into a vein. Intramuscular – many vaccines, antibiotics and long-term psychoactive drugs are injection directly into a muscle. It is one of several alternative methods for the administration of medications Examples include Codeine, Morphine, Diazepam, Penicillin, Vitamin B12, Rabies and Influenza. Suppositories – A suppository is a drug delivery system that is inserted into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository), where it dissolves or melts inside the body to deliver the medicine. They are used to deliver medications for local effect and systemic effect. The general principle is that the suppository is inserted as a solid, and will dissolve or melt inside the body to be received by the many blood vessels that follow the larger intestine. 3.1 Types, Purposes and Functions of Materials and Equipment needed for the Administration of Medication Medication administration charts – these need to be used when administering medication so you know who needs the medication, how much and when. The medication charts must be signed after administering medication and be kept safe and secure. Disposal bags – disposal bags are used to return any medication not used to the pharmacists. These should be clearly labelled. Drugs trolley – this is needed to store all medication and must have a lock on it for when it is not in use. It should be large enough to hold all medication securely and to organise medication as appropriate. Medication pots – these can be used to measure out medication in liquid form for the person to drink from. These can also be used to transfer medication in tablet from the blister pack to the person taking the medication. Spoons – these can be used to deliver liquid medication and to transfer tablets from the medication pots to the mouth so that your fingers do not touch the tablet. Water jugs and drinking glasses – it is always a good idea to have water jugs and drinking glasses with you so tablets can be swallowed with the water or for a drink after taking liquid medication to clear away the taste or texture of the medication. Bottles and packets – All medication needs to be enclosed in clearly labelled bottles or packets to keep it protected and to ensure medication is identifiable and ensuring the medication gets to the correct person. 3.2 Medication administration charts must have the full name, age and date of birth of the person receiving the medication so that you can ensure that you are administering to the correct person. They must also have the dosage required and name of medication so that you can compare this to the bottle or packet of medication to ensure you have the correct medication and dosage and that you administer this as required. The medication administration chart should have the date of issue and date of expiry of the medication so that no medication is administered after its expiry date as this could cause adverse effects. 4.2 It is important for medication to be administered at the correct times. You should always check the medication administration chart to see when the medication has to be administered through the day and when the medication was last administered. If you don’t’ leave enough time between doses this could result in an overdose and adverse reactions. If you have left too long a time between doses the medication may become less effective as it has had time to wear off. Medications must be given within half an hour of the time that is listed on the medication administration chart. This means that you have half an hour before the medication is due, and half an hour after it is due to administer the medication in order to be on time with medication administration. This does not apply to PRN medications. 5.3 If there were any immediate problems with administration of medication I would report the mistake or error to my Manager or Senior Team Leader straight away. The GP of the resident or pharmacy would be consulted and if they advised to call emergency services this would be done. The individual would be accompanied to hospital by a member of staff. An internal investigation would take place which may include the local council or health authority, or the health and safety executive and the appropriate actions would be put in place. 5.5 It is necessary to confirm that the individual actually takes the medication and does not pass the medication to others to ensure that the individual is taking the correct prescribed dose for the medication to work. The medication may be an essential drug to the individual’s health and if not taken could endanger their life, for example, medication for diabetes or heart medication. If the medication is passed on to another individual this could endanger their health as they could be allergic to the medication or if they end up taking a medication not prescribed for them, e.g. Digoxin, which lowers the heart rate, when not needed, this could endanger their life if they have other health problems which could be affected. Once the resident has taken the medication I must then sign the medication administration chart to confirm I have administered the medication and the resident has taken it. 5.7 As my place of work is a residential care home which offers personal care they are included in an exemption under the Controlled Waste Regulations 1992 and our waste, classed as ‘household’, is not subject to the Special Waste Regulations 1996. Whereas under the Controlled Waste Regulations 1992 clinical waste, excluding domestic properties, and clinical waste from care homes providing nursing care is classified as ‘industrial’ waste and is subject to the Special Waste Regulations 1996. The Special Waste Regulations 1996 classifies all prescription medication as special waste and must be handed over to a suitably authorised waste management facility and a retail pharmacy is not very likely to be authorised. As my place of work is not subject to the Special Waste Regulations 1996 we can return any out of date or part used medication to the pharmacy who arrange and deliver our medication to us. We can also return out of date or part used controlled drugs to the pharmacy. Any out of date and part used medications must be documented in medicines returns book. The returned drugs must be counted and itemised in the returns book. The pharmacist must sign the returns book when collecting the medications. When returning medication, the Boots returned medication book should be used as a receipt. When returning medication the ‘Returned’ section of the medication administration chart must be completed Administer medication to individuals, and monitor the effects Essay Outcome 1 Understand legislation, policy and procedures relevant to the administration of medication 1. In the workplace there is a generic Medication Management Policy and Procedures for Adult Services (Issue 10, 2012) document. This is kept to hand in a locked cupboard, readily available to read. It requires that all Healthcare Staff are given mandatory training and refreshers are provided. Legislation which surrounds the administration of medication includes The Medicines Act 1968, The Misuse of Drugs Act 1971, The Data Protection Act 1998, The Care Standards Act 2000 and The Health and Social Care Act 2001 Outcome 2 Know about common types of medication and their use 1. describe common types of medication including their effects and potential side effects Below are outlined 3 types of common medications. Analgesics: i.e. Codeine, used for pain relief, side effects can be light-headedness, dizziness, nausea, vomiting, shortness of breath, and sedation. Codeine can also cause allergic reactions, symptoms of which include constipation, abdominal pain, rash and itching. See more:  Manifest Destiny essay Antibiotics: i.e. Amoxicillin, a penicillin based antibiotic which fights bacteria in your body. It can only be taken if you are not allergic to Penicillin and do not have asthma, liver or kidney disease, or a history of diarrhoea caused by antibiotics. It is used to treat many different types of infections, such as ear infections, bladder infections, pneumonia, and salmonella however it can cause side effects including sores inside your mouth, fever, swollen glands, joint pain, muscle weakness, severe blistering, peeling, and red skin rash, yellowed skin, yellowing of the eyes, dark colored urine, confusion or weakness, easy bruising, and vaginal itching. Anti-hypertensive: i.e. Lisonopril used for lowering blood pressure, it is also effective in the treatment of congestive heart failure, and to improve survival after a heart attack. Not to be used by people with liver or kidney disease, diabetes, rheumatoid arthritis. Side effects can include feeling faint, restricted urination, stomach swelling, and flu like symptoms, heart palpitations, chest pains, skin rash, depressed mood, vomiting and diarrhoea. 2.2 Identify medication which demands the measurement of specific physiological measurements. Answer Drugs like insulin (blood has to be taken from a pinprick so that glucose can be measured before the insulin can be given); warfarin to thin the blood – again blood levels must be checked regularly; digoxin to slow and steady the heart (pulse should be checked prior to administration and advice taken if the pulse dips below 60 beats per minute) Administer medication to individuals, and monitor the effects Essay Outcome 1 Understand legislation, policy and procedures relevant to administration of medication. 1. The current legislation, guideline policies and protocols relevant to the administration of medication are. Medicines Act 1968 & amendments. Categorises how medicines are provided and sold. Misuse of Drugs act 1971 (Controlled Drugs) and amendments. Health and Safety at Work Act 1974. 5 elements of risk assessment. COSHH. Storage and who has access. Health and social Care Act 2008. Receipt, storage and administration. Access to Health Records Act 1990. Access to your own records. Data Protection Act 1998. Confidentiality. Hold relevant records for7 years. Hazardous Waste Regulations 2005. Sharps, controlled drugs, unused medication. Outcome 2 Know about common types of medication and their use 1. Describe common types of medication including their effects and potential side effects. Antibiotic – To treat infection. Can be specific or broad spectrum. Amoxicillin. Penicillin. Oxycycline. Trimethoprim. Common side effects rashes, headaches, anaphylactic shock, GID Gastro intestinal disturbance i.e. sickness. Analgesic – Pain relief: paracetamol Common side effects: long term side effects include liver damage. Anti-histamine – To treat allergies such as hay fever, reaction to insect bites. Piriton. Antacid – To combat excess acid. To calm stomach. Gaviscon. Rennies. Settlers. Peptobismol, omeprazole. Common side effects: GID, dry mouth, insomnia, drowsiness, rash Anti-coagulant – To thin blood and avoid unwanted clotting. Warfarin, Heparin. Common side effects: haemorrhage, hypersensitivity, rash, alopecia jaundice. Psychotropic medicine – To alter state of mind. Loperimide. Risperidone. Chlorpromazine. Common side effects: rashes, GID, paradoxal effects, extrapymidial side effects rolling of the tongue, drooping of the face, parkinson’s Symptom,  Laxative – To soften stool and encourage bowel movements. – Sennocot. Lactulose. Movacol. Common side effects: GID, a tonic bowel   Diuretic – To treat water retention and encourage urine flow through kidneys. Frusemide, Bendrofluazide. Common side effects: mild GID, hypotension, electrolyte Anticonvulsant- To control seizure activity for epilepsy. Sodium valproate, Diazepam. Midazolam. Common side effects wait gain and loss, abnormal sensation in limbs GID, rashes, dizziness, amnesia, and headache. Cytotoxic medicines – Cancer treatments. Chemotherapy. Highly toxic. Vincristin Common side effects: hair loss, constipation, low blood counts, abdominal cramps, weight loss, nausea and vomiting, loss of appetite 2. Insulin used in the treatment of Diabetes requires finger prick blood testi ng for sugar levels. Warfarin Used to thin blood or prevent unwanted clotting. Fluid Retention. Fluid output measurements. Blood pressure may need to be taken for certain medication that moderates BP or heart function. 3. Describe the common adverse reactions to medication, how each can be recognised and the appropriate actions required. Unexpected adverse reaction can potentially happen from any medication that an individual is taking. Someone can have an adverse reaction to penicillin i.e. anaphylactic shock, the signs for this can be the person has problems swallowing or the lips or face ballooning, a skin rash and the individual may also stop breathing, leading to total system collapse and if not treated with adrenalin death may occur. This is why it is important that all information about an individual’s medical records must be up to date and in their care plans, also in their MAR Chart. You don’t come cross anaphylactic shock often, but you still have to be aware. Other severe adverse reactions that could include a fever and skin blistering; these usually occur within an hour of the medications being administered. Sometimes adverse reactions can develop over a few weeks, they may cause damage to the kidneys or liver. If adverse reactions are not treated they could be fatal. When individuals experience adverse reactions to medicines my workplace policy is to inform the GP and explaining in detail the adverse reactions, the staff member will then inform the individual/ team. GP advise and guidance will then determine if the medication is to be stopped. If the reactions are so serious then an  ambulance should be called my responsibility is that I have duty to continue to observe the individual and monitor their vitals, speaking to them and looking at any changes, so as to ensure that the individual is not deteriorating. All adverse reactions and following advice given, must be recorded in full in the individual’s clinical note and refer enced in their daily report also MAR’s chart. 4. Outcome 3 Understand procedures and techniques for the administration of medication. 1. Explain the different types, purpose and function of both materials and equipment that may be needed for the administration of medication via different routes. Type; Syringe The purpose; To administer medication such as insulin into the blood stream. The function; Enables subcutaneous/ intermuscular administration in correct and measured dosage into the blood stream. Type; Spacer The purpose; To add to an inhaler The function; To enable correct dosage of inhaled medication when patient is not able to use the inhaler on its own Type; Medication pot The purpose; To contain medication when being dispensed with non-touch technique The function; To enable people to take medication cleanly and safely without contamination and in some cases to promote active participation and inclusion/independence 2. What information must be included on a prescription? Doctor’s name and signature Date of issue Patient’s name and address Patient’s date of birth Name and dosage of medication Quantity and form of medication. e.g. 30 tablets Strength of medication How many times a day Duration of treatment Method and route of administration Hospital number Outcome 4 Be able to prepare for the administration of medication 1.  wash your hands  gather your equipment required i.e. medication pots, spoons, water, gloves, mar sheets, aseptic wipes aseptic equipment if required   establish who the medication is for   ensure the environment is suitable for the safe administration of medication sharp box if required 2. Establish on the mar sheet that no medication has been given recently and that it is time to give medication as per mar sheet instructions. To ensure the spacing between medication is appropriate and as per guidance. Ensure dosage is spaced evenly as per therapeutic range and ensure therapeutic range is achieved. 3. Consent is through implied consent or objective consent and if consent is not achieved then it will have to go best interested decision. All s/u that I support will have a risk assessment in place that identifies individual’s capacity issues. Furthermore individual s/u have a PDP that specifies how an individual receives their medication. This will say the process if the s/u declines to receive their medication. If the s/u declines to take their medication then it is my responsibility to insure I have within the best of my abilities attempted to explain and divulge the information that is within the realms of the individuals understanding. This is to develop a knowledge and therefore capacity to make informed decisions. If unsuccessful then I’m to contact the GP to seek advice and refer for a best interest decision. Any issues around consent must be recorded and be communicated to the individuals who are significant in the administration of medication to that person. 4. Outcome 5 Be able to administer and monitor individual’s medication 5.3 I always pay attention to ensuring I maintain individuals’ dignity, choices and preferences. Sometimes individuals refuse their medication, this is  their right to as I cannot legally and according to our medication policy administer their medication without their consent. I listen to why they are refusing sometimes because they can’t understand why they need to have their medication, other times because they can’t swallow tablets. I explain what their medication is for and their eï ¬â‚¬ects and also give them information about how medication is available in liquid form which they would ï ¬ nd easier to swallow. If the client refuses their medication I have to record it on their MAR and in their support plan and client notes and get advice from the GP or 111 then inform my Manager. This may involve a medication review to see what else can be oï ¬â‚¬ered. Sometimes when individuals leave the home or stop taking their medication because it is not agreeing with them then the home is left with out-of-date and part-used medications. Under the care home standards, the hazardous waste regulations and the medication policy it is a requirement for all medications to be disposed of safely. At work we have a medication returns book where the medication that is to be disposed of is entered in here, then packaged up and placed in the medication cupboard securely until the pharmacy collect this this usually happens when the new medication is delivered these are signed for and recorded. 5.5 To make sure that the individual is taking their prescribed medication and that their condition does not deteriorate. It is our workplace policy to check that medication is taken by the individual. If the individual passes it to others, this could result in other individuals overdosing, taking medication that is not prescribed for them, and this can cause them to feel ill or can be fatal. If medications not taken and left out then others might misuse this too which is abuse and neglect. If I was working in mental health settings I would also be aware of Individuals distributing certain medication that has a value. 5.7How do you dispose of out of date or part used medication ensuring that you comply with legal and organisational requirements? All unused or out of date medication should be disposed of via the pharmacy, placed in clear individual bags clearly labelled with details of the medication, dose, name of s/u and stored in an appropriate manner i.e. locked box in a locked room. Record must be kept in the s/u notes and also a returns book. Records should  be signed by person initiating the disposal if these returns are collected, or by the person taking medication for disposal if taken to pharmacy. Records must be signed by the pharmacist or their representative on receipt of the medication. Medication should not be put down the toilet or drain or put into household waste.