Unit 4222-616 Administer medication to individuals and monitor the effects.

Outcome 1:
1.1:
Legislations:
- The Medicines Act (1968): This governs the use of medicines for human use and for veterinary use.
- Control of Substances Hazardous to Health regulations (COSHH): This is the law that requires employers to control substances that are hazardous to health.
- The Health and Safety at Work Act: This is the primary legislation covering occupational health and safety in Great Britain. The Health and Safety Executive are responsible for the enforcement of this act.
- The Misuse of Drugs (Safe Custody) Regulations 2001: This controls the import, export, supply and possession of dangerous or otherwise harmful drugs.
- Health and Social Care Act: This Act, the regulations and guidance are part of a wider regulatory framework that includes regulation of professionals such as Doctors, Nurses and Social Workers.
- The Misuse of Drugs Act 1971: This act creates three classes of controlled substances, A, B and C. It lays out the range of penalties for the illegal or unlicensed possession and possession with to supply, for each class.
- Date Protection Act: This covers any data that can be used to identify a living individual.
- Hazardous Waste Regulations: These replaced the Special Waste Regulations 1996 in England. They removed the requirement to pre-notify the Environment Agency before the movement of any hazardous waste and include a simpler method for tracking wastes once removed.
The online and hard copy handouts and policy procedures that my place of work have put in place. These cover the assessment of needs, requirements, the storage, administration, recording procedures and disposal of each individual’s medication.

Outcome 2:
2.1:
Antibiotics: Amoxicillin/Amoxicillin, Penicillin based antibiotics which fight infection in the body. For those allergic to Penicillin, Erythromycin may be used. Common side effects of antibiotics are Diarrhoea, nausea, vomiting. These are used to treat bacterial infections within the body such as Urine/bladder infections. If used for long periods of time, antibiotics can produce other side effects such as possible fungal infections (thrush, Joint pain, muscle weakness, severe blistering, yellowed skin and yellowing of the eyes (jaundice), dark coloured urine.
Analgesia: Paracetamol/Codeine. These medicines are used in the relief of pain. Possible side effects of Paracetamol are – swelling or rash (a possible indication of an allergic reaction), Low blood pressure (when given through an infusion), liver and kidney damage if higher than recommended dosage is taken. Codeine, which is also used in pain relief, is a morphine derivative and, more commonly used in dealing with higher levels of pain such as back pain, migraines and pain that is not controlled with Paracetamol alone. Side effects of Codeine can be: light headedness, dizziness, tiredness, nausea, vomiting. Codeine can become addictive when used over a prolonged period of time. As a result of addiction, the following can occur: Irritation of the stomach lining, liver damage and sleep disturbances.
Non-steroidal Anti-inflammatory Drugs (NSAIDs) are a group of drugs that may also be used in the treatment of pain although, they are also used in the treatment of swelling. The most common of these is Ibuprofen, which is available over the counter and is used in the treatment of mild to moderate pain, such as toothache, headaches and period pains. Ibuprofen can also be used in the treatment of mild pyrexia’s (Influenza for example.), ease pain and inflammation caused by conditions such as Rheumatic Diseases and Musculoskeletal disorders such as Rheumatoid Arthritis. Ibuprofen should be avoided by those with certain medical conditions, like those that suffer from stomach ulcers or a history of bad reactions to NSAIDs. It should be used with caution by older people and those with health conditions such as Asthma.

2.2:
Certain drugs require specific checks to be made prior to the administration of them. For example Insulin requires regular Blood Glucose tests (BMs) to be performed, so that the user can tailor the dosage to the body’s requirements. Warfarin requires the user to attend their GP weekly, to have a blood sample taken, so that levels can be checked and dosage tailored to the results by the GP.

2.3:
Common adverse reactions to medications can range from a mild allergic reaction to the more severe allergic reaction - anaphylactic shock. Symptoms for this can range from a mild itchy rash to the more severe: Swelling of the tongue/throat, difficulty breathing, which may stop altogether, leading to a total system wide collapse and death if not treated. Anaphylaxis is treated in the first instance with Adrenaline, delivered through an Intramuscular injection in the thigh. All allergies must be recorded on the MAR chart and be clearly visible. Other adverse reactions occur over a longer period of time, these may be kidney or liver damage which if left untreated, could be fatal.
When individuals suffer adverse an extreme reaction, my company’s policy is to first render first aid, contact the emergency services and then contact the local office and advise them of the situation. They then inform the local GP/pharmacist so that the appropriate action can be taken and medication is stopped. If the individual suffers only a mild adverse reaction, then the GP may decide that the positives of the medication, outweigh the reaction. This is then recorded on the MAR chart.

2.4:
Injection – Medicines such as Insulin is injection into the subcutaneous tissue of the abdomen. Others are delivered through intra-muscular injection such as vaccinations, adrenaline etc.
Topical – These are medicines that come in creams and ointments and are absorbed through the skin.
Instillation – This medicine comes in the forms of drops and ointments and can be used via the eyes, nose or ears. Drops and ointments are used for eye infections, drops for ears and nasal spray and ointment for the nose.
Oral – This medicine can come in the form of tablets, capsules or liquids and is taken by mouth. There is also a special type of medication called sub-lingual, and this is when a tablet is placed under the tongue.
Transdermal – This is medicine that is delivered through the skin via adhesive patches on the skin. Some examples of these are: nicotine patches, HRT patches and some painkillers can also be delivered in this way, like fentanyl.
Inhalation – This is when medicine is breathed in and enters the respiratory system to ease certain infections/conditions. An example of an inhaled medicine would be Salbutamol, which is delivered via an Inhaler and is used in the relief of an asthma attack.
Intravenous – This is when the medication goes straight into the vein and is absorbed quickly into the bloodstream.
Vaginal/Rectal – Suppositories are given via the rectum and Pessaries are given via the Vagina. Both are absorbed very quickly into the bloodstream.
Outcome 3:
3.1:
Equipment required may vary for each form of medication and may include the following: Medicine pots, spoons, syringes, Nebulising machines, wipes, drinking glasses and MAR Charts. Hands must be washed and gloves worn at all times, when administering any medication by any route.
Inhalers – Inhalers are used by those with breathing difficulties and are either worked by the individual or set to activate automatically, when the individual breathes in. Nebulisers are also used to aid with breathing difficulties. The liquid solution is placed in to the chamber of the nebuliser mask and the mask is connected to Oxygen. The Oxygen is then turned on and flows through the mask, turning the liquid in to a mist, which is then inhaled by the individual. This is then recorded in the MAR chart.
Intravenous – Medication given in this way, requires gloves, a needle, syringe, a sterile wipe (to clean the area), a sharps box to place the used needle in, and a container to hold all of these. Some forms of intravenous medication, require a bag of fluid (of various sizes), plus a giving set that attaches to a cannula, that is placed in the vein. Only registered Nurses and doctors are allowed to administer medicine in this way. All details should be recorded in the MAR chart.
Subcutaneous and Intramuscular – Medications given via these routes, also requires gloves, a needle, syringe, a sterile wipe (to clean the area), a sharps box and a container to put them all in. Gloves should be worn as always and details recorded in the MAR chart. Only those with specialist training are to administer the subcutaneous medications. The Intramuscular injections should only be given by a trained nurse or doctor, unless it is the adrenaline injections given in Anaphylaxis. These can be given by anyone that has received the required training.
Topical – These come in the form of creams, gels and ointments and instructions for use should be followed carefully so as to avoid any adverse effects i.e. Steroid creams if applied too thickly can cause thinning of the skin in the affected area. When applying any form of topical medication, gloves should always be worn, as it can be absorbed quickly into the skin. Details are recorded in the MAR chart.
Instillation – This medicine comes in the forms of drops, ointments, sprays or ointments and be applied via the eyes, ears or nose. When applying drops/ointment (chloramphenicol for example), to the eyes, extra care should be taken to avoid the pipette/dropper/nozzle coming into contact with the eye surface. If it touches the surface, the applicator is immediately contaminated and GP should be informed, and another issued. Gloves are to be worn at all times and all prescription information. This is to be recorded in the MAR chart.

Outcome 4:
4.2:
Explain the appropriate timing of medication e.g. check that the individual has not taken any medication recently. Always check the individual’s Medication sheet or records. This will have a detailed reviewed of what medication has been taken and when it was administered.

Outcome 5:
5.3:
If the patient refuses the medication, my company’s policy is to first notify them and then depending on the type of medication refused, contact the patient’s local GP and request advice. For example if the medication to be administered is Paracetamol and is on the prescription chart as PRN or as required, then I would make a note in the MAR chart and record it in the notes but take no further action. If it was an anti-coagulant or anti-hypertensive, Insulin etc. then I would contact the office for advice and possibly the GP, as well as ensuring that it was recorded in the patients MAR chart and records. If it was an emergency medication such as Adrenaline for anaphylaxis shock, then I would contact the emergency services and the GP, then whilst waiting for the ambulance to attend, inform the office and advise them of the actions, I have taken. I would then ensure that this is recorded in the patients MAR charts and records.

5.5:
When dealing with controlled medicines it is necessary to ensure that it is taken by the client, because otherwise, in some instances it may be sold/given to others which is against the controlled medicines act and may result in a police investigation. In other instances, when medication is not taken correctly, it may result in the worsening of the client’s condition and may result in a hospital admission.

5.7:
For the disposal of controlled drugs in care/nursing homes: - If a supplied for a named person: denature the CDs using a kit designed for this purpose and then consigned to a licensed waste disposal company.
- If supplied as a ‘stock’ for the care/nursing home: an authorised person must witness the disposal.
For all other social care settings, the CDs should be returned to the pharmacist or dispensing doctor, at the earliest opportunity for safe denaturing and disposal. When CDs are returned for disposal, a record should be made in the CD record book and if possible, best practise would be to obtain the receiving pharmacist/doctors signature.
Other prescribed medications do not require such specialised disposal but best practise is to always return the unwanted medication to the pharmacist for safe disposal. Medicines should never be disposed of down sinks, toilets or refuse area's as they may then become environmental hazards.