Self administered medicines in care homes

It is important for people living in care homes to maintain their independence.

'Self administration' is when a person can take their own medicines.

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.