1. Managing medication
Linda Nazarko
Nurse consultant
https://uk.linkedin.com/in/linda-nazarko-
1952a746

2. Aims and objectives
To be aware of:
 Legal and professional responsibilities
 The five rights of medication
 How systems and processes can
improve safety
 How to reduce the risk of errors
 High risk medications
 Resident’s difficulties with medication

3. Legal responsibilites
 Care Quality Commission
Standards (2010) (outcome
nine p104-109)
 Regulation thirteen of the
Health & Social Care Act.
 National Institute for Health
and Care Excellence (NICE)
(2014) guidance on
medication management in
care homes.

4. NICE StandardsRecommendation Comments
Residents involved in care and
treatment decision
Provide support to enable residents to make decisions.
Record on care plan and update regularly
Care homes must have a
written policy
Policy details of how the care home share information about
medicines, keeps records on medication, manage drug errors, list
and review medications, order receive, store, dispense and
dispose of medicines
Prescribers should assume
that people who live in care
homes are able to make
decisions about their own
medicines.
If a prescriber is concerned about a person's ability to make such
decisions, they should check whether the person is able to
understand why, for example, a new medicine is needed before
offering it.
Providers of health or social
care services should have
processes in place for sharing
accurate information about a
resident's medicines
This should include details of medicines that is recorded and
transferred when a resident moves from one care setting to
another e.g. from hospital to care home and care home to
hospital
Commissioners and health and
social care services should
ensure a robust process is in
place for identifying, reporting,
reviewing and learning from
medicines errors
Responsibility shared between health and social care.

5. Medication errors
 Older people vulnerable to adverse effects
medication
 Between 5-15% of older people admitted to
hospital because ill effects medication
 Around 40% of older people in nursing homes
may be prescribed medicines inappropriately

6. Stages at which errors occur
 Prescribing and monitoring
 Ordering
 Dispensing
 Administration

7. Prescribing & monitoring
 Medical history
 Good information from hospital
 Knowledge drug interactions
 Routine monitoring
 Minimise medication

8. Medication review
50% require a review & 47% of
reviewed medications
discontinued. Problems
identified:
Side effects
Not taking
Ineffective treatment
Unnecessary treatment
Inappropriate treatment
Treatment not indicated

9. Ordering
 Consider lead person(s) to check
stocks, order medication and ensure
reviews carried out
 Electronic prescribing coming

10. Dispensing
 Lack information
 Some research
-7% medication
mis-labelled
 Change working
practices reduce
errors

11. The five R’s of medication administration.
Right
resident
Right
medication
Right route Right dose Right time

12. Medication administration errors
 Nurse should follow
procedures
 If problems with
procedures report it
 If the system is
broken we need to fix
the system not shoot
the messenger

13. Ways to reduce risk of errors

14. High risk medications
 Warfarin, Insulin, antiplatelet drugs such
as aspirin and clopidogrel, and oral
hypoglycaemic drugs such as metformin
high risk adverse reactions (Budnitz et al,
2011). The risks increase as the number
of medications rise.
 Potential drug interaction risk when
patients are taking 2 to 3, 4 to 5, and 6 to
7 medications are 39%, 88.8%, and 100

15. Hypnotics
 Reduced
awareness
 Increased risk
falls, pressure
damage,
dehydration
 Not for long term
use

16. Diuretics
 Can affect renal
function
 Increase or
decrease
potassium
 Cause hypotension
 Increase risk falls
 Monitoring and
blood tests

17. Antipsychotics

18. Resident difficulties
 Large pills – hard
to swallow
 Dry mouth
 Swallowing
difficulties
 Adverse effects

19. Responding to difficulties

20. Key points
 Care home residents are vulnerable to
ADRS
 Home should have systems to enhance
safety
 Small changes can make a big
difference
 Work with person to overcome
difficulties

21. Thank you for listening
Any questions?