Leading Practice Guidelines

Medication Support

Type: Wellbeing

Guideline: Organizations that are responsible for medication support have systems and practice to ensure the safe and effective administration and management of medications. The organization provides education and support to people to be actively involved in decision making, management and administration of their medications as guided by their abilities and wishes.

What does this look like?

Organizations clearly communicate their role and scope of service related to medications to people and their family/support network prior to beginning service in order for the person to make an informed choice on whether the service will adequately support their unique health needs. For example, some transportation, day or employment support services may have limitations to their scope of support related to medication support.

The organization has policies and procedures that comply with all applicable Licensing requirements related to medication administration, documentation, storage and destruction. These should cover both prescribed and over the counter medication and treatments. The policies should also include:

• Maintenance of history of medication and immunizations;
• Processes to gain pharmacological review and advice on how medications may interact with one another and what common side effects could be expected. This should include an annual review of all medications (prescribed and over the counter);
• How side effects and health outcomes are monitored in order to assist health professionals to evaluate the effectiveness and impact of medications;
• Information and communication that will be provided to people served and their families/support network (as guided by the person) about medication options, purposes, side effects and changes. Each person is advised, as appropriate, about the side effects of prescribed medicines and is given access to information fact sheets provided with medicines. Each person is afforded the opportunity to consult the pharmacist or other appropriate independent healthcare professional about medicines prescribed as appropriate. Consent of the person and/or their Substitute Decision Maker should be the first step of providing medication support;
• How privacy will be respected and protected while provided medication support;
• Protocols related to handling or altering medications:Some individuals may need to have oral medications altered, for example, tablets broken or crushed to aid administration or mixed with food or liquids (e.g. for use with a feeding tube). The alteration is intended to assist administration and ensure that individuals receive necessary medications. Always check with a pharmacist first before altering the form of medications as this practice may have unsafe consequences.
  
  • Some medications cannot be altered because this may reduce effectiveness, create a greater risk of toxicity or other harm, an unacceptable presentation to the individual in terms of taste or texture, make it difficult to ensure appropriate dosage and risk to work health and safety. Cross-contamination of medications is also a risk.
  • If an individual is having difficulty taking their medications, or they require an alteration to the standard dosage form, the individual might need alternative formulations or different medications instead. Staff administering medications should check with a pharmacist about which oral dose medications can and cannot be altered in form and any special conditions relating to the alteration or administration of specific medications.
  • Some medications (e.g. antibiotics), are also not suitable for ingestion with yoghurt. Check with a pharmacist first if it is intended to use yoghurt to assist with ingestion.
  • Medications must be stored in the conditions indicated on the pharmacy label. (e.g. Refrigeration, etc.)
• Medication should not be hidden in food or liquid. Some people prefer or require medication to be placed in food to aid in swallowing however, this is done with their full knowledge and not designed to deceive;
• Process to ensure that medication supply is consistent and reliable including how to manage emergency after hours shortages;
• Reporting, follow up and review of all medication errors or incidents.

The organization provides staff with training and support to gain competence in all areas of medication support provided by the organization. These could include:

• Seven rights and three checks of Medication Administration
• Seven Rights:
  1. right person
  2. right medication
  3. right route
  4. right time
  5. right dose
  6. right reason
  7. right documentation
• Three Checks:
  1. When the medications are retrieved from storage area
  2. When the medications are prepared for administration
  3. When the medications are being presented to the person for administration
• Proper medication administration documentation
• How to monitor for side effects and sensitivities resulting from medications
• Purposes and common side effects of medication received by people served
• Proper storage, recording, documentation, handling and destruction of medication
• Emergency procedures for serious medication errors – key contact information (pharmacist, physician, poison control)

People served are provided education and support to gain skills needed to be as actively involved in their own medication decisions, management and administration.

How would you know this is happening? (Evidence)

What you see in systems:

• Comprehensive policies that articulate scope of service in the area of medication support and practices expected
• Training content and completion records
• Medication records
• Medication error data and quality review records

What you see in actions:

• Staff are knowledgeable and confident in their skills and competence to fulfill expectations around medication support.
• People served and their family/support network is aware of what they can expect from the organization related to medication support.
• People served are involved, informed and aware of their medications and the reasons they take them and have been actively involved in their health care decisions to the extent that they are able and wish to be.