Staff administering medicines
All staff groups administering medicines must undergo training relevant to their role and be subject to robust governance procedures.
Clinical Governance framework
Organisations have a legal duty of care and are responsible for ensuring a Medicines Policy is in place and that the staff they employ are properly trained and competent to undertake only those responsibilities specified in agreed job descriptions.
Legal mechanisms to supply and administer medicines
Legal mechanisms to supply and administer medicines to individuals must be included in the employing organisation’s overall clinical governance framework.
Where the administration of medicines is being undertaken by staff, any suitably trained and competent member of staff in health or social care may administer medicines that an authorised prescriber has prescribed for an individual.
All registered health professionals, including doctors and nurses, have a duty of care and are professionally and legally accountable for the care they provide, including those tasks they delegate to non-registered staff.
Further information on delegation and accountability is available from the Royal College of Nursing.
Appropriately trained non-registered staff can legally administer medicines but those delegating the duty must ensure that these staff are competent to do so safely. Non-registered staff are also accountable for their own practice.
Further information is available from the Department of Health on the administration of medicines in care homes.
Method of supply to administer
Medicines that have been dispensed or supplied to a named individual can only be administered to that named individual. This principle applies to registered and non-registered staff at all levels.
Stock medicines can only be administered to an individual under the care of the organisation where an appropriate prescription or legal authority to administer the medicine exists.
Administration of prescribed medicines
A prescription is an authorisation against which a supply of medication is made (usually by a pharmacist). It can also be used as a direction to administer a medication to an individual.
A prescription must comply with all legal requirements for prescriptions and controlled drugs (where applicable).
A prescription can be one of the following:
- A Patient Specific Direction (PSD)
- An FP10 prescription form
Authority to Administer
A direction to administer is a written instruction from a prescriber that indicates the intent for a medicine to be given to an individual by a suitably trained and competent person.
A direction to administer may take the form of:
- a Patient Specific Direction (PSD)
- an FP10 prescription form
A direction to administer should normally include:
- the individual’s details
- prescriber details
- medication details (e.g. name, strength, dose, frequency, duration)
The label of dispensed medicines may be used as a source of medication details.
The direction to administer needs either:
- the physical signature of the prescriber, or
- an electronic signature of the prescriber, with assurance that this has been added by the prescriber themselves, such as transferred via secure email (e.g. nhs.net)
If the prescriber is not known to the recipient, the appropriate regulatory register should be used to validate the authority.
Directions to administer for Schedule 2 and 3 Controlled Drugs (CDs) are possible. These can be sent electronically via email as there is no legal requirement for these to have physical signatures because supply will have already been made.
Labelled ‘As Required’
Where the label does not specify a dose (e.g. medication administered via a syringe driver), a direction to administer is required.
There is no legal requirement in this circumstance for a Patient Specific Direction (PSD); however, it is good practice to have it in place in order to ensure medicines are administered safely. A letter or entry in the individual’s clinical record would be an example of a PSD in this circumstance.
Medication Administration Record
A Medication Administration Record (MAR) is a document that records the administration of a medicine. It is predominantly used by social care staff for this purpose.
The MAR forms part of an accurate, complete and contemporaneous record of the administration of medicines.
There is no legal requirement for the MAR to be physically signed by the prescriber. An emailed version e.g. from a community pharmacy, can be printed and accepted for use.
Administration of Medicines under Exemptions
Anyone can administer a medicine listed in Human Medicine Regulations Schedule 19 in an emergency.
It is considered good practice to have a local policy or procedure to support practitioners working under an exemption to the Human Medicines Regulations e.g., local anaphylaxis policy.
Exemptions under Human Medicines Regulations Schedule 17 cannot be delegated to another person to administer.
Administration of medicines supplied under a PGD
If a person has a non-parenteral/injectable medicine in their possession that has been supplied under a PGD, another person can administer it, assuming they are appropriately trained/competent.
Administration of an injectable medicine must not be delegated under a PGD.