Medication Management Procedure

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TOPIC	Medication Management Procedure
AREA	Service Delivery	TYPE	Procedure

Purpose

Mobility is committed to the safe and effective use of medications by consumers living at home, in accordance with applicable laws and regulations. By identifying their medication needs, goals, and preferences, consumers shall be assisted in administering and managing their medications. Mobility is committed to the Quality Use of Medicines, to enhance the wellbeing of consumers.

Mobility will continue to build on established strengths, champion innovative solutions, and seek out new and sustainable ways to provide superior outcomes for the care and services provided by our aged care team.

Scope

This medication management procedure and work instructions applies to Registered Nurses (RN) working within their scope of practice to provide medication administration to home care package consumers.

Definitions

Care Plan	An individual support plan that outlines the measures a support worker must follow to provide support to a consumer
Dosage Administration Aid	Device or packaging system where one or more medicines in solid oral dosage form can be organised according to the time of administration, for example webster pack.
Health Care Plan	A document created by a physician or other allied health professional to provide information about the thorough management of specific health problems.
Medical Practitioner	An approved medical specialist (doctor) as defines by the medical board of Australia or dental practitioner who is registered to practise in Australia.
Medical Procedure	A course of action used in the delivery of health care with the intent of achieving a desired outcome
Medication	A drug or other preparation for the treatment or prevention of disease
Medication Errors	All medication errors or near misses are to be reported to mobility. Errors could include Documentation error, incorrect dose, incorrect medication, incorrect route, incorrect time, given without order, missing medication, medication not given, medication not taken
Medication Prompting	The prompting of medication is reminder a person of the time and asking if they have or are going to take their medicines. The person is still in control of their medicines and may decide not to take them or to take them later. Prompting can be useful when a person knows what medicines to take and how to take them but may simply forget the time.
Personal Care Worker	A sole trader who is trained and informed about current government laws and legislation, applicable standards, and organisational policies and procedures. 1. Assist customers with all elements of daily living, provides personal care and can provide medication prompting. 2. Assists consumers in conserving their environment
Pharmacist	A person who is professionally qualified to prepare and dispense medication
PRN medication	Means that the administration of medication is not scheduled. Instead, the prescription is taken as needed as prescribed by a Medical Practitioner.
Registered Nurse (RN)-	A person who meets the requirements of and is registered under Health Practitioner Regulation national Law in Australia and has a current AHPRA registration.
Schedule 8 Medications	Prescription medications that have a recognised therapeutic need but also a higher risk of misuse, abuse, and dependence.
Schedule 4 Medications	Substances (prescription-only medicines) that have common therapeutic uses, but are also liable to abuse, misuse and diversion, warranting more stringent controls on possession and supply.

Roles and Responsibilities

Registered Nurse (RN)

Administering medications according to relevant legislation and mobility management procedure.
Administering medication using at minimum the Six Rights in medication management (right consumer, drug, dosage, route, time and right to refuse).
Administration of medication from a valid medication order, i.e., that has been ordered by a Medical Practitioner or Dentist
Administering of Scheduled 8 medications, intramuscular, intravenous, and subcutaneous medications.
Ordering medications from the pharmacist in some circumstances.
Understanding the pharmacokinetics and pharmacodynamics of medications that are being administered.
Advising on the safe and appropriate storage of medication/s including all forms of Schedule 8 medications and injections.
Investigating and reporting medication incidents to mobility
Reporting any medication side effects or adverse reactions.
Consulting with the Medical Practitioner and or Pharmacy to report medication side effects, contraindications and adverse reactions and mobility.
Signing medication signing sheets/medication charts immediately following the administration of medications.
Ensuring that medication is stored safely in a consumer’s home or stored in a locked storage place if provided when not in use
Checking pharmacy delivery against the consumer’s prescribed medication list where applicable.
Being willing to maintain contemporary knowledge and skills in relation to pharmacology and health assessment.

Procedure

Types of Management

Medication Prompting

Refer to Medication Personal Care Worker Work Instruction

Administration of Medication

If consumers have been assessed as unable to administer or manage their medication, the Care Plan must contain clear instructions about the physical assistance and supervisory role Carelynx RN’s will take in the administration of medications.

The level of support a consumer requires varies and will regularly need to be reviewed throughout their time receiving care.

All medication to be administered by mobility must be prescribed by the consumers health practitioner and within its original packaging or a Dose Administration Aid.

An up-to-date pharmacy/health practitioner’s list of the consumers current medications must be kept with the medications to be administered. This list must be updated with each medication change the consumer experiences.

Registered Nurses are to follow their accredited training in medication management in relation to the rules for safe administration of medication.

Prior to administering medication, Mobility must prepare the consumer by communicating and discussing the procedure, encouraging participation where possible. Mobility must also establish the consumers preference relating to medication administration, complete all personal hygiene steps and prepare all resources required.

Mobility administering medication must ensure:

the right medication is being administered
the medication is being administered to the right person
the right dose is being administered
the medication is being administered at the right time
the right route and administration method is being used as prescribed
the right documentation is being completed; and
Registered Nurses administering medication must also ensure the consumers right to refuse their medication, ensuring to document this clearly within the journal notes or workplace incident report.

Registered Nurses administering medication should as far as possible understand:

the reason the consumer is taking each medication.
how the medication is to be stored and administered.
the possible side effects of the medication and interactions with other medications; and
how to utilise their first aid equipment and strategies if required.
medication change the consumer experiences.

Registered Nurses must not administer medication to consumers if:

the above processes have not been followed.
the medication is past its use by date or has been damaged.
the consumer is asleep, unconscious, drowsy, vomiting or having a seizure or other immediate health concern.

Evaluation

Evaluation of the effectiveness of the medication is part of medication administration. Workers and contractors must record in the consumer record if the medication has been effective and if not, any actions taken to address the presenting issue i.e., escalate to their supervisor.
For analgesia (pain relief): it is important to record in the notes and escalate to their supervisor or health practitioner if a consumer continues to comment or displays signs of experiencing pain to ensure it can be addressed promptly.
Choking is a major cause of preventable deaths for vulnerable consumers. Certain medications administered can increase this risk. Additional care must be taken if there is a risk of a client choking on a medication (refer to the Swallowing and Chocking Procedure).

Medication Review

Home Medication Review (HMR)* is conducted to identify and prevent medication-related problems through a team approach, involving the consumer’s Medical Practitioner and preferred community pharmacy. It may also involve other relevant members of the health care team, such as nurses in community practice or carers. This review is covered under Medicare.

*Home Medication Review (HMR)* is also known as a Domiciliary Medication Management Review (DMMR). For ease of reading the term HMR is adopted in this procedure.

The process utilises the specific knowledge and expertise of each of the health care professionals involved. In collaboration with the Medical Practitioner, a pharmacist comprehensively reviews the client’s medication regimen in a home visit. After discussion of the pharmacist’s report and findings, the Medical Practitioner and consumer agree on a medication management plan.

When to request an HMR

A trigger for a request for a HMR is polypharmacy which is often defined as the use of five or more medications, or two or more psychotropic medications, at the same time. Either situation can increase the risk of medication-related adverse effects and impact the health outcomes of consumers.

Choking is a major cause of death of people in vulnerable consumers. Certain medications including psychotropics can increase the risk of choking by affecting alertness and muscle relaxation. Other areas of concern are existing swallowing problems, reoccurring chest infections, mobility limitations, GORD, poor oral health, a diagnosis of cerebral palsy epilepsy or Down syndrome.

RN Workers and contractors should report any concerns to the consumer and Medical Practitioner where a HMR may be required for an individual consumer.

The referral to the Pharmacist must be completed by the Medical Practitioner. Once the review is completed and the report made available mobility must comply with any recommendations that are endorsed by the treating Medical Practitioner and agreed by the consumer.

Reporting

In the event of a medication error:

The Consumer’s GP is to be advised by the Care Manager or the consumers nominee/ Authorized
Care Manager are to notify the Nominee/ Authorized Representative
All medication incidents must be investigated by the Clinical and Risk Specialist (CRS) or Carelynx RN as a priority within one working day or the next working day if occurring over the weekend or Public Holiday.
The CRS is to be advised of all medication incidents and concerns.
The CRS among other things will determine if any external authority reporting is required and progress, as necessary.

Version	Date	Change
1.0	21/7/22	New