There are a number of medicines administration related enquiries that you may be asked to help with when working with patients and staff in care homes. These include –
- Simplifying complex dosage regimes
- Alternative formulations for patients who are not able to swallow tablets/capsules
- Principles and best practice in relation to covert administration of medicines
- Use of hand written medication administration record (MAR) charts
We have signposted to some key resources to help you deal with the most common queries –
1. Simplifying complex dosage regimens
Specialist Pharmacy Service (SPS): Practical steps to amending medication dosage regimens in care homes during COVID-19
Version 1. Produced May 2020
- This document gives advice on factors to consider when changing medication dosage regimens of care home residents to reduce the frequency of administration during COVID-19.
- It is aimed at registered healthcare professionals supporting care homes. The objectives are both to protect residents from unnecessary contacts during medication rounds, and to assist with staff capacity.
2. Swallowing issues
Key resources for answering questions about alternative formulations of medicines include –
- Drug Administration via Enteral Feeding Tubes is accessible on Medicines Complete through a free Open Athens account. Instructions for how to register for this and access the resource can be found here.
The SPS website has a number of useful Medicines Q&As on this topic including –
- Which medicines require extra care when switching between liquid and tablet/capsule formulations?
- What are the considerations when crushing tablets or opening capsules in a care home setting?
There are also two resources on the SPS website that provide more background on the management of dysphagia and the need to consider alternative formulations –
Last updated June 2018
- This webinar covers what is dysphagia and how pharmacists can utilise SLT recommendations for fluids consistency and food textures to amended oral formulations to allow for appropriate and safer medication administration
Care Quality Commission: Dysphagia and thickeners
Last updated 27th January 2020
- A brief summary of the key points to consider when someone has difficulty swallowing and thickening agents are being considered.
- Key questions to consider when reviewing patients with dysphagia are considered
Care Quality Commission: Enteral feeding and medicines administration
Last updated 14th July 2020
- A brief overview of the issues around the administration of medicines via enteral feeding tubes as well as a summary of the different enteral feeding tubes used
3. Principles and best practice in relation to covert administration of medicines
Two excellent resources on this topic are –
Care Quality Commission: Covert administration of medicines
Last updated 23rd October 2020
- This resource provides best practice principles and examples in relation to covert administration including circumstances where covert administration may be or may not be appropriate and how to ensure that these actions remain in the best interests of the person
- The guidance also highlights pharmaceutical considerations; e.g. that administering medicines in food or drink can alter their therapeutic properties and effects crushing a tablet or opening a capsule before administration may make its use off-license.
Last updated Nov 2017, currently being updated
- Covert administration of medicines is a complex issue and involves disguising the administration of a medicine (e.g. in food or drink) to a patient lacking the capacity to consent to treatment.
- This Medicines Q&A discusses some of the legal issues that need to be considered before medicines are given covertly.
- It also addresses some of the pharmaceutical issues (e.g. absorption, incompatibility, interactions) and patient factors (e.g. acceptability) that need to be considered when deciding whether to administer medicines in this way.
4. Use of hand written medication administration record (MAR) charts
The Care Quality Commission: Handwritten medicine administration records (MARs)
Last updated 28th April 2020
- This resource provides advice for circumstances when a written MAR chart may be required to maintain a good record of medicines administration
- It links to NICE guidance for managing medicines in care homes and also managing medicines for adults receiving care in the community
Administration update 21/1/2021
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