Which of the following is a way that may help clients with self-administered medications

People have the right to choose to manage their own medicines. Staff should consider a person's choice and whether there is a risk to them or others.

NICE guidance

NICE guidance SC1 says that staff should assume a person can self administer (unless a risk assessment indicates otherwise). When people are receiving short term respite, or intermediate care, they need to keep their skills. This includes keeping the skills they need to take their own medicines when they return home.

Process

You should have a policy in place for self administration of medicines. Your process for self administration of medicines (including controlled drugs) should include:

• an individual risk assessment
• obtaining or ordering medicines
• storing medicines
• keeping records
• supporting people to take their medicines if necessary
• monitoring adherence
• disposing of unwanted medicines

Individual risk assessment

Self administration can vary from person to person. Care home staff should find out how much support a person needs to take and look after their individual medicines. This should be risk assessed.

Risk assessment should consider:

• the person’s choice
• if self administration will be a risk to the themselves or other people
• if they can take the correct dose of their own medicines at the right time and in the right way. For example, do they have the mental capacity or manual dexterity? This can vary for different medicines. For example, some people may be able to take tablets but need support with eye drops
• how often you will need to repeat or review the assessment. Base this on the person’s need (for example, during an acute illness)
• how the medicines will be stored
• the responsibilities of the care home staff. Write these in the person’s care plan. Include an effective way of monitoring adherence.

The care home manager should coordinate the risk assessment. They should decide who to involve. Assess the risk individually for each person. Involve the person and their family members or carers if they wish. Involve care home staff with the training and skills for the assessment.

Involve other health and social care practitioners as appropriate. For example, the GP and pharmacist can offer help and advice. They could identify how to adjust medicines to make them easier to self administer.

Support to self administer

Support could include:

• reasonable adjustments such as:
  • alarms
  • multi-compartment compliance aids
  • large print labels
  • colour coded labels
  • easy to open containers
• reminders such as:
  • reminder charts
  • alarms
• help measuring liquids
• devices to help with inhalers or eye drops
• providing the person with suitable information about their medicine. This includes explaining how to take it and any potential side effects.

Storing medicines

How to store medicines for self administration will be identified in the person’s care plan. For example, you might store the medicines in a lockable cupboard or drawer in their room. The storage place must not be accessible to other people. People should be able to access any medicines when needed. This includes controlled drugs.

Keeping records

You must keep records when:

• you provide support for a person to take their medicines. This includes reminding a person to take a medicine
• you supply medicines (including controlled drugs) for self administration.

Where a person self administers a medicine, this should be recorded on the MAR. Individual doses taken by the person do not need to be recorded.

You have known Miss Kelly for over three years, as you have been caring for her and her sister. The two of you have a special connection, so it is particularly distressing to you when you watch her slowly, over time, deteriorate because of her arthritis and heart condition.

You have always aided with bathing, meal preparation, and light chores, but she has taken care of her own medications. You know she takes a few pills in the morning, and you have been careful during her bath not to dislodge the medication patch she wears for her heart condition.

It seems that lately Miss Kelly has gotten much weaker, and she struggles to get her medication bottles open and then break the tablets in two. She confides that she isn’t always sure that she’s opening the right medication bottle because her vision is blurrier than it used to be.

Most worrisome is that fact that she occasionally has trouble swallowing her pills, and even gets choked sometimes. Additionally, she has a new diagnosis of asthma and now uses an inhaler.

You report your observations to your supervisor, and changes are made in the care plan to include medication self-administration assistance.

You haven’t helped Miss Kelly with her medications before, and you aren’t sure exactly of what “assisting” with her medications really means. Questions flood your mind:

• Am I supposed to decide when to give her medications to her?
• Am I supposed to know what each medication is for?
• What should I do with a pill so she won’t choke on it?
• Are there things I need to check before I help her take her medications?
• Do I need to wear gloves when helping with her medications?
• How do I use a medication patch? Where does it go? What do I do with the old one?
• How do I help her with an inhaler? Doesn’t she just breathe into the mouthpiece?
• Am I allowed to help her with all of her medications? If not, which ones?
• Are there things I should watch for after she takes her medications?
• Do I have to document that I helped her take them since I really didn’t give them to her?

If the answers to these questions are unclear, rest assured that you are not alone in your confusion. There is a lot to know when assisting with self-administration of medications!

Your Abilities

Before you can assist with the self-administration of medications, there are specific abilities that you must be able to perform. These abilities include:

• Read and understand a prescription label.
• Know what approved abbreviations your organization uses and use only those.
• Assist with oral (mouth), topical (skin), ophthalmic (eye), otic (ear) nasal (nose), and inhaled forms of medications.
• Measure liquid medications, break scored tablets, or crush tablets as directed.
• Recognize when to clarify an “as needed” prescription order.
• Recognize an order that requires judgment or discretion.
• Safely store medications.
• Complete a medication observation record or other required documentation.
• Recognize general signs of adverse reactions to medications and report such reactions.

In addition, you must be aware of and follow scope of practice guidelines and organizational policies and procedures. Be mindful of the fact that practice guidelines and regulations do vary from state to state and from organization to organization. Be sure you understand how state laws govern your practice, and check with your supervisor for clarification if you have questions.

Before You Begin

Before assisting someone with taking their medications, you must remember to:

• Ensure this task is within your scope of practice.
• Check the individual’s plan of care and your organization’s policies and procedures.
• Give medications within 1 hour of the scheduled dose or within 30 minutes if a time-critical medication.
• Administer medications immediately after preparing them.
• Encourage individuals to perform as much of the procedure as they are able.
• Review the basic rights for medication administration while holding the medications.
• Consult a drug reference to familiarize yourself with unknown medications.
• Discuss the purpose and side effects with the individual prior to administration.
• Follow all manufacturer’s guidelines for medication administration, including if medications need to be given at a different time than other medications.
• Compare the medication label to the medication administration record (MAR) 3 times.
• Check the expiration date for the medications the individual is taking.
• Gather all necessary supplies.
• Verify the individual’s identity using two identifiers.
• Explain the procedure and provide for privacy.
• Perform hand hygiene.

Other Considerations

Because some medications can cause problems with constipation and dehydration, providing adequate amounts of fluid is often essential.

Be sure to check the manufacturer’s guidelines for recommendations for fluid intake with certain medications and follow them. The same is true when giving medications that must be taken with food.

Remember that everyone has the right to privacy. It is your responsibility to make sure that all medications are administered in a private environment.

For example, before giving a medication in front of another person, make sure the individual taking the medication is comfortable with this.

You may need to ask visitors to leave the room or take the individual to a private location before assisting with the self-administration of medications.

Remember, those who are not able to communicate or have mental or cognitive impairments should also have their privacy and dignity protected.

Other considerations include:

• Follow organizational policy and procedure for the disposal of all medical waste.
• Administer each medication separately by using individual medication cups to hold each one apart from the others.
• Recognize that certain forms of medications must usually be given by nurses or licensed personnel, including those placed into a body cavity and those that are injected through the skin.
• Acknowledge that certain pre-medication administration procedures must usually be performed by nurses or licensed personnel, including assessment, blood glucose testing, and measurement of heart rate, pulse, respiratory rate, and blood pressure.

Be Mindful

There are many things you must be mindful of as you assist individuals with self-administration of medications.

They include abilities and knowledge that you must demonstrate before assisting with self-administration of medication, strategies you should use during the process, and things to watch for and report. Always be aware of and stay within your scope of practice, job description, and capabilities to ensure the safety of the people you care for.

Medication Training for Caregivers

If members of your organization are worried about providing medication to those you care for, consider providing additional training to your staff.

According to a 2017 study, “Medication errors occur frequently in home care and can threaten the safety of patients.”

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