Medication Management Policy and Procedure

Kyeema Support Services Inc. (Kyeema) acknowledges a duty of care to ensure that medication is administered as directed by the participant’s doctor.

This procedure supports Kyeema Support Services to apply Standard 4.3: Provisions of Supports Environment – Management of Medication.

This policy and related procedures are to be followed by all staff responsible for the administration of medication in the form of tablets, capsules, drops, ointments, lotions and sprays.

Medications are chemical substances used to treat medical conditions. When taken in prescribed or recommended doses, they are intended to benefit the person using them. As some medication may have unwanted side effects or bad reactions, a qualified doctor should generally prescribe medication.

Prescribed medication must be given exactly as instructed by the prescribing doctor or pharmacist. If staff have any concerns about the amount or type of medication a participant has been prescribed or have any suggestions concerning alternative approaches, they should direct these to their supervisor (Manager or Team Leader) as it is important for the participant’s rights and wellbeing that they are involved in decision-making where possible.

The supervisor may then discuss these issues with the participant or nominee and the participant’s doctor with consent and as appropriate.

• Provide instructions for staff who are responsible for the management and administration of medication.

• Ensure that legal and departmental requirements are met with regard to medication administration, recording and storage.

For the purposes of this practice instruction, the following definitions have been provided.

This term refers to the House Supervisor, Supports Manager or Team Leader, or equivalent position level.

This term refers to the person who is a staff member’s immediate manager and to whom that staff member has direct accountability, such as Supports Manager and Team Leaders.

This term refers to staff who can be contacted outside normal business hours for the purposes of providing approval, advice and support, particularly in emergencies or crisis situations.

This term refers to the delegated person who has the authority and responsibility of approving the use of restraint and seclusion under the provisions at section 139 and 190 of the Disability Act 2006.

This term refers to a short excursion for leisure or recreation purposes that does not involve overnight stays.

Certain terms and abbreviations are used in relation to the administration of medication. Among those most commonly used are:

Administer	to give (medication)
b.d./b.i.d	twice a day
contra-indications	conditions under that a medication should not be taken as it is known to lead to ill-effects.
Dosette	container divided into sections for tablets/capsules
mane / o.m.	in the morning
nocte / o.n.	at night
oral	taken by mouth
over-the-counter medication	medication that can be purchased without a prescription
p.r.n.	as required (from Latin “Pro Re Nata”)
q.i.d.	four times a day
side effects	undesirable or unwanted actions of a medication
statim / stat	at once
suspension	medication partly dissolved in a liquid base suspended medication
t.d.s. / t.i.d.	three times a day
topical	on the skin
Webster Pak	blister packs that divide solid medication, such as tablets and capsules, into prescribed doses to be taken at specific times over a period of a week

Consent from the participant for the administration of medication is the responsibility of the treating health professional and should take into account the person’s capacity to make decisions in their own interests.

There will be times that a carer or nominee may need to support the decision-making capacity of the participant, and in some cases provide substitute consent for him/her.

Staff who are trained in the administration of medication can administer the following medications:

− Tablets and capsules from a dossette box, Webster Pak or original container.

Staff trained in administration of medication are also responsible for carrying out proper recording procedures, ensuring safe storage of medication, monitoring desired effects and possible side effects, and safe disposal of out-dated medication.

Staff administering medication should be aware of the basic purpose of the medication and, where this information is available, major side effects of the medication given to participants.

The staff administering medication to a participant must promptly record the administration in the participant’s medication administration record. Different record sheets are used for different purposes;

CCF-03 is photocopied onto pink paper and is used when the medication is in a dosette or Webster Pack

CCF-08 is blue and is used for medication in original containers including topical, injected or inhaled medications

Staff must immediately report any unusual changes in the participant’s physical condition and/or behaviour to the Manager/Team Leader or to the on-call contact person.

• Staff must try to avoid distraction at the administration of medication and not attend to any other task at the time of administration.

• Staff must collect the folder containing the participant’s completed Medication Form CCF-09 (or Doctor’s Treatment sheet) the required Medication Administration recording sheets, the medication to be given, and any other equipment that may be needed, for example a graduated medicine cup for pouring liquid medication, a pen for recording the administration.

• If staff are unsure about any aspect of the medication, they should consult their Manager/Team Leader. If there is no suitable person available, staff should seek advice from the prescribing doctor or pharmacist as soon as is practically possible. This advice is to be documented, and should include the name of the person spoken to at the doctor’s clinic or the pharmacy.

• Staff must wash their hands and ensure that the work area/table and any equipment to be used are clean. Gloves must be worn to cover cuts, sores and other skin breaks when applying ointment, creams and lotions

• For further information about infection control, refer to the Infection Control Procedures in Kyeema Support Services Inc.’s resources library.

• Staff must follow all instructions for the administration of the medication. These instructions may be on the label of the original container, on the back of the Webster Pak/dosette and on the participant’s Treatment Sheet (Form 1A) and Doctor’s Medication Notes (Form 1B). An example of an instruction is “to be taken with food”.

• Before and during administering the medication, staff must check the following against the participant’s Medication Form or Treatment Sheet:

• Staff must ensure the medication is given as close as possible to the scheduled time. If the medication is given orally, the staff member administering the medication must remain with the participant until satisfied that the participant has swallowed the dose.

• Staff must record and sign for all medication given to the participant on the participant’s medication administration record sheet CCF-03 or CCF-08. The staff member who administered the medication must record this at the time the medication was administered.

• To make sure the medication administration record is easy to read, a blue or black pen should be used to complete the administration sheets.

• White-Out or similar must never be used on the medication administration record at any time. If staff make a mistake on the administration sheets, it should be crossed out and the correct entry made next to it.

• Staff must observe the participant for possible side effects and if they occur report these promptly to their Manager/Team Leader.

Chemical restraint is the use of a chemical substance to control or subdue a participant’s behaviour. Tranquilizers and sedatives are the usual type of medications prescribed for this purpose.

Chemical restraint is a Regulated Restrictive Practice and as such its use and reporting is subject to regulation under Part 7 of the Disability Act 2006 and reporting requirements to the NDIS Quality and Safeguards Commission.

Where a participant has a diagnosed psychiatric condition, any medication the participant may be taking is classified as chemical restraint when it is primarily used for the purpose of behavioural management rather than for the treatment of the defining symptoms of the mental illness. It is the prescribing physician who determines whether the medication is for treatment of symptoms or control of behaviour.

The use of regular or PRN chemical restraint must be documented in a Behaviour Support Plan, created by a specialist behaviour support practitioner, that is lodged with the NDIS Quality and Safeguards Commission and must have the prior approval of Kyeema’s delegated Authorised Program Officer (APO). For more information see Behaviour Support and Restrictive Practices Policy and Procedure

The use of the chemical restraint must be reviewed at least every four months for participants in permanent care, and every twelve months for respite participants.

The relevant Authorised Program Officer must ensure that the administration of chemical restraint, including self-administrated chemical restraint, is recorded on the monthly report that is forwarded to the NDIS Quality and Safeguards Commission.

Where a staff member administers the chemical restraint to a participant, the staff member has to sign the appropriate medication administration record sheet to record the administration.

Staff may only administer PRN chemical restraint when other positive support strategies described in the participant’s Behaviour Support Plan have been unsuccessfully implemented.

Staff must only administer PRN chemical restraint in circumstances identified by the prescribing doctor and authorised by the NDIS Quality and Safeguards Commission. If PRN medication is given in the absence of an authorised Behaviour Support Plan, it must be reported to the NDIS Quality and Safeguards Commission as an unauthorised administration.

When possible, permission to administer the medication should be sought from the relevant Authorised Program Officer (APO), before administering the chemical restraint. If this is not possible at the time, contact should be made with the APO or other management as soon as practicable after the chemical restraint has been administered.

Conditions of use of PRN medications are to be recorded by the participant or nominee on Kyeema’s Medication Form CCF-09.

Authority to administer a chemical restraint medication is via a Behaviour Support Plan approved by the NDIS Quality and Safeguards Commission.

Staff record the administration of PRN medication used for PRN chemical restraint on the ‘PRN Medication Record Sheet’ CCF-04.

Staff must record the administration of short-term prescription medication, such as antibiotics, on the ‘Dose Administration Container Record Sheet’ CCF-03, if the medication is contained in a Webster Pak, or on the ‘Original Container Record Sheet CCF-08, if the medication is in its original packaging or container, or is a topical or inhaled medication.

Dose administration containers such as dosettes and Webster Packs divide solid medication, such as tablets and capsules, into prescribed doses to be taken at specific times during the day and week. Wherever possible, services should use dose administration containers in preference to bottles and packets.

The supplying pharmacist or the carer records the following information on the back of each dose administration container:

The Manager, Team Leader or delegated person must ensure photo identification is attached to each participant’s dose administration container.

Dose administration containers should be used to hold prescribed medication in solid form, such as tablets or capsules. Dosettes must be of good quality so that the parts do not separate and cause tablets to drop out or get mixed up.

A Pharmacist must carry out filling of Webster Packs. Parents/Carers may fill or alter compacts of dosettes.

Apart from administration of medication, staff must not under any circumstances alter the contents of a dose administration container. This includes adding or taking out any tablets or capsules.

• The staff member receiving the filled dose administration container must check that the number of tablets or capsules (if these can be easily counted) match the number identified on the back of the container.

• Where staff find a mistake with the number of tablets or capsules in a dose administration container, they must contact the carer so they can return the container to the dispensing pharmacist as soon as possible. Webster Packs must be returned to the dispensing pharmacist if they are damaged or the medication has become contaminated in any way, so that replacements can be obtained. Dosettes must be returned to the carers in this situation.

• As some medication may become ineffective if it is exposed to the air, staff must not remove any original wrappings (for example – foil) until just before giving the medication.

• Medication administered from dose administration containers must be recorded on the Dose Administration Container Record Sheet CCF-03

• Staff must keep dose administration containers clean. Any contamination of the contents of the dose administration container may affect the potency of the medication.

It is possible that in handling a dose administration container or original container, the container could be accidentally dropped, resulting in either a partial or total loss of contents.

Dropped or spilt medication must not be placed back into the participant’s dose administration container or original medication container.

Dropped or spilt medication must not be administered to the participant except in the case where a solid medication dose is dropped onto a clean surface, is not contaminated in any way and remains in view of the person dispensing it.

• Staff must wrap the spilt medication in foil, and place in an envelope. It must be marked ‘for return to pharmacy’.

• Depending on the circumstances (such as contents of a container only partially spilt), staff may give a subsequent dose of medication, providing it is identical to the one that was spilt. Staff must be certain that the dose given is exactly the same as that that was spilt, otherwise it must not be given to the participant. If staff are, in any way, uncertain about what action to take, they should immediately contact the Manager/Team Leader or on-call person for advice.

• Staff must make arrangements for the participant’s prescription (if possible), the dropped medication (where possible) and the medication container to be returned to the pharmacist or carer to have the medication replaced.

• Staff must complete an Incident Report according to Kyeema’s incident reporting guidelines.

Incorrect administration occurs when a participant is given the wrong medication (intended for another participant), is given a scheduled dose at the wrong time or not at all, or is given more or less than the prescribed dose of medication.

When discovered, medication errors are to be immediately reported to a team leader or to the Kyeema On Call staff, who may take any of the actions below.

If a manager, team leader or On Call staff are not immediately available and a participant has been given an incorrect medication or an incorrect dose, treat it as an emergency and do not wait for the extra help, take the below action and also monitor the participant carefully.

• Contact the participant’s doctor or pharmacist for information and instructions. The Poisons Information Centre (phone 13 11 26, any time of day) should be contacted if the participant’s doctor or pharmacist is unavailable.

• Follow all instructions given by the professional to whom the matter was referred. This may include observing and reporting any adverse effects. Report the matter by writing an Incident Report and forwarding it to the appropriate manager

The staff member responsible for the incorrect dose must also write a report in the participant’s shift notes. The report must include:

− The name of the doctor, pharmacist or person at the Poisons Information Centre who was contacted.

If it is clear that a participant has missed a dose of medication, staff must record the code M for ‘missed dose’ on the appropriate medication administration record sheet.

The staff member must also make an entry regarding the incorrect administration in the communication book if in respite, or the participant electronic file if in a day activity, or in supported independent living. This should include information about the professional advice given and the subsequent action taken.

An incident report must also be filed for Kyeema internal records using CCF-65 Incident, Complaint, WHS Record Form.

Staff must not alter the contents of a participant’s dose administration container, if a dispensing error is found. Where necessary, the dose administration container must be returned to the pharmacy for refilling.

Staff on different shifts need to communicate essential information to each other to ensure appropriate services are provided to participants at all times. This communication should primarily occur at handover where direct handover occurs or through the communication book where direct handover does not occur.

• Check that all appropriate medication has been administered during the shift.

• Inform incoming staff of any changes to a participant’s medication made by the doctor and noted on the participant’s Treatment Sheet or Medication Form. Staff must make a record of these changes in the participant’s file and make a note in the Respite House communication book for incoming staff to familiarise themselves with these changes.

• Inform incoming staff of any participants exhibiting effects or side effects of medication, any action to be taken.

On Call will direct any action to be taken. Staff must make note in communication book for incoming staff to “read documentation in participant file”.

This procedure is to ensure any stored medications are current, correct and in date. This will mainly apply to PRN medications. The following steps should be followed:

1. Medication check list to be filled out by medication officer or person nominated by officer.

4. Check that PRN medication corresponds with information on Medication form CCF-09

6. Check daily medication corresponds with information on Medication form CCF-09

8. Contact parent/carer to ensure new medication is sent in as soon as possible if medication is near use by date

Some medication is dispensed in original containers, such as bottles and packets, because it cannot be stored with other drugs or because its potency may be affected if it is removed from its original container.

Apart from administration of medication, staff must not under any circumstances alter the contents or original containers of medication as dispensed by the pharmacist.

• Staff must administer medication from original containers strictly according to the instructions on the label or according to the instructions provided by the doctor and transferred to Kyeema’s Medication Form CCF-09.

• If the participant treatment sheet states particular conditions for use of the medication, staff should record this information in the ‘Conditions’ section on the ‘Original Container Including Topical, Liquid, Inhaled and Injected CCF-08 Medication Administration Record Sheet under the name of the particular medication. Alternatively, staff may request that the pharmacist print this information on the label of the original container.

• Staff must ensure that original containers are kept clean so that instructions are not obscured and expiry dates can be checked.

• Routine medication administered from the original container must be recorded on the ‘Original Container Including Topical, Liquid, Inhaled and Injected CCF-08 Medication Administration Record. However, if the medication is prescribed pro re nata (PRN) or stat, the administration must be recorded on the CCF-04 PRN Stat Medication Administration Record Sheet Staff must return empty or finished containers to the dispensing pharmacist, or to the participant’s carer/family.

Drops, ointments and lotions can be prescribed by a doctor to be applied to particular areas of the body.

Sprays are medications usually prescribed by the doctor to treat conditions of the nose, sinuses, trachea (windpipe) and lungs.

All the above are to be administered as directed by the doctor or pharmacist, and only for the participant for whom they were prescribed. An exception to this is Ventolin, as the Asthma Foundation advises that in an emergency another person’s Ventolin can be used, although not their spacer.

Staff must explain the procedure clearly to the participant, and elicit the participant’s consent during the administration.

• Staff must follow any special administration instructions, such as directions about the minimum time before an application is repeated. Infection control procedures must also be followed at all times.

Some medications are able to be absorbed into the body directly through the skin. This is useful as a way to ensure that the medication is administered over a period of time at a fixed rate. Medications that may be absorbed through the skin include Anginine, a medication used to control chest pain caused by heart disease, hormone therapy and some medications for the prevention of travel or motion sickness.

The medication is administered by applying adhesive patches containing the medication to the skin.

• Staff administering a transdermal patch to a participant must note the type of patch, the date and the time the medication was administered.

• Transdermal patches can only be administered on the advice of the participant’s doctor. Transdermal patches containing prescription medication can only be administered if prescribed by the participant’s doctor. This information is to be recorded on Kyeema’s Medication Form CCF-09.

• Staff must ensure that the participant’s skin is clean and dry before the patch is applied.

• Staff must wear disposable gloves when applying patches, to prevent accidental absorption of the medication through their skin.

• If the transdermal patch is a PRN medication, and the participant does not appear relieved by the medication or appears unwell, then the staff must contact the participant’s doctor immediately.

• Staff must ensure that transdermal patches are safely stored as instructed by the manufacturer.

• Staff accompanying a participant on an outing must be aware of, and able to clearly follow, the instructions for administration of medication.

• Before an outing takes place, the supervisor should check that non-Kyeema. personnel, families and staff who may be accompanying the participant are able to follow the instructions for administration.

• The staff member on duty at the time of the outing must ensure that non-Kyeema personnel accompanying the participant sign for the medication when it is taken out of the house/centre and sign it back in if the medication was not used, as may be the case with PRN medication. If medication is taken on an outing, it must be noted and signed for in the communication book at the house or the medication folder at the day placement site.

• Medication administered on an outing by Kyeema staff must be recorded by those staff on a participant’s medication administration record (CCF-03, or CCF-08) on return from the outing. If medication is administered by non-Kyeema personnel, information regarding the medication given and the time it was administered should be reported back to staff. Staff must then note this information in the medication administration record with the code ‘O’ to indicate that the medication was administered on an outing by non-Kyeema personnel. This is to be noted in the respite communication book if participant in respite.

• When medication is taken out of the house, the most senior staff member on duty must ensure that the medication:

Checking the quantity of tablets or capsules in a dose administration container is important to ensure that errors in the filling of Webster Packs, or errors in administration are identified as early as possible.

Prior to administering a scheduled dose of medication, staff must always compare the quantity of a participant’s medication to that stated on the dose administration container.

• If a discrepancy is found in the quantity of a participant’s medication compared to that stated on the dose administration container, staff should attempt to establish the reason for the discrepancy.

• Staff must check the CCF-03 Dose Administration Container Record to determine whether a dose was missed and possible reasons for this or an overdose was given or incorrect medication was administered.

• If incorrect medication has been administered, staff must follow the procedure for incorrect administration of medication in the section “Problems with Medication” on Kyeema’s Quality Management System.

• If an error has been made in the filling of the Webster Pack, staff must contact the carer so they can return the container to the dispensing pharmacist as soon as possible. Webster Packs must be returned to the dispensing pharmacist if they are damaged or the medication has become contaminated in any way, so that replacements can be obtained. Dosettes must be returned to the carers in this situation.

• If staff are, in any way, uncertain about what action to take, they should immediately contact the Program Manager/Team Leader, on-call staff person or Executive Officer for advice.

Intermittent medication refers to medication that is administered at regular intervals, although less frequently than daily.

The infrequent nature of administration of intermittent medication increases the risk of a missed dose or overdose occurring. Strict attention to accurate and up-to-date record keeping and communication between staff is required.

Refers to types of medication that can be purchased without a prescription. These include analgesics (paracetamol, aspirin and so on), cough and cold remedies, laxatives, antacids, worm treatments, anti-diarrhoeals amongst a range of other medications.

Kyeema’s policy on administering non-prescription medications is the same as for prescription medications. Medication Form CCF- 09 must be completed and then the relevant medication Administration Sheet is to be filled out when the medication is administered.

Staff must seek medical assistance if the participant’s symptoms persist. Continuing symptoms may indicate a bad reaction or the onset of an illness for that more appropriate treatment may be necessary.

Herbal, Vitamins and Health Supplements are not medications and as such are not subject to the medication requirements in the Medication Policy. The following forms are to be used:

A medication may be ordered to be given statim (that means ‘at once’) or it may be ordered to be given as a once-only dose.

Prescription medication to be administered at once or as a once-only dose must be ordered by a doctor and the PRN Kyeema medication form used, as it is an “as needed” medication.

The doctor must fill in the relevant medication details on a Treatment Sheet when prescribing either statim or once-only doses. This information is conveyed to Kyeema staff and Kyeema’s Medication Form CCF-09 is filled out.

If medication is prescribed as a statim dose or alternatively prescribed as a once-only dose, staff must record the administration of this medication on the ‘PRN Medication Administration Record Sheet’ CCF-04

A prescription may be given over the telephone by the participant’s doctor to a pharmacist in an emergency situation, where it is difficult for the participant to visit the doctor and where no prior prescription exists.

Telephone orders should only occur in emergency situations. This policy relates to Kyeema’s overnight accommodation services, or excursions.

Medications are mostly supplied by the family but in the event of a person in the respite house being taken to the doctor by a respite worker the following applies:

Staff must arrange to pick up the medication from the pharmacy without delay, once the doctor has given the order to the pharmacist.

The supervisor is responsible for ensuring that the doctor writes the details of the prescribed medication on the Participant Treatment Sheet and transferred to CCF-09 as soon as possible, confirming the telephone order. The doctor also provides a prescription to the supplying pharmacist for the medication ordered.

Staff must record the administration of any medication obtained by telephone order on the appropriate medication administration record sheet.

Staff must also record details, including time and date of administration, of any medication ordered over the phone in the participant’s file and in the shift report and/or communication book.

Staff must record a ‘C’ in the box next to the last dose initialled for administration on the medication administration record, when the course of a specific medication (for example, antibiotics) is completed.

PRN or ‘pro re nata’ medication is medication to be administered ‘as required’.

It is prescribed for recurring conditions such as hay fever, migraines and other headaches, in the treatment of epilepsy and sometimes as chemical restraint. (See Chemical Restraint section in this procedure)

Kyeema must be given written instructions regarding the exact circumstances under that PRN medication is to be administered. All staff must strictly follow these instructions.

• The prescribing Doctor completes a Treatment Sheet detailing the exact conditions for the use of the PRN. Details such as the name of the medication, the dose, route and conditions of administration are written on this form.

• Families or carers provide the treatment sheet or use this information to fill out Kyeema’s Medication Form CCF-09

• The information recorded on the participant’s Treatment Sheet/Doctor’s Medication Notes should include:

− Circumstances under which a dose should be administered and a safe interval between doses if a further dose is required.

− Circumstances in which the doctor should be notified, for example, when a maximum number of doses have been administered within a given period.

• The doctor may also provide procedures to follow if the medication does not have the desired effect.

• Staff must strictly follow the doctor’s instructions regarding the administration of PRN medication. If a staff member is unsure about any of the instructions given, the staff member must seek clarification from their line manager or the participant’s doctor as soon as possible.

• Approval for each administration of prescribed PRN medication must be sought from a senior worker or the on-call contact person

• Note 1: In emergency situations where medication is to be administered to a participant in the process of having an epileptic seizure, staff are not required to seek prior approval from their line manager before administering the medication.

• Note 2: The role of line managers who are contacted for approval is to ensure that staff have considered the participant’s circumstances prior to administering PRN medication and to confirm the doctor’s instructions with staff.

• Staff must record the administration of PRN medication on the CCF-04 PRN Medication Administration Record Sheet as well as in the shift report and/or communication book and in the participant’s file.

Asthma and other chronic obstructive airways problems such as emphysema are common conditions that require medication or moist air to be inhaled into the lungs. These treatments make breathing easier.

Puffers containing Ventolin are the only prescribed medication that may be given to another person in need, for whom it was not prescribed.

• The participant has an individualised Health Support Plan – Asthma (CCF-35) identifying triggers, symptoms and treatment, or it is understood the standardised Asthma Plan will be used as a default

• All the necessary medications are provided with full details regarding prescribed dose, times etc. noted on Medication Form CCF-09

• Medications and equipment are checked, maintained and replaced as recommended.

If the participant experiences symptoms of asthma, the staff member should check the Asthma Action Plan unless already familiar with the person’s plan. If the person is able to administer his or her own medication staff should supervise this.

Staff who are not trained or experienced in administering the asthma medication should seek the help of someone who is trained or experienced.

All administration of medication must be recorded to ensure that Kyeema is accountable for the medication given by its staff.

The prescribing Doctor completes a Participant Treatment Sheet. Details such as the name of the medication, the dose, route and frequency of administration are written on this form.

Families or carers use this information to fill out Kyeema’s Medication Administration Record Sheet CCF-08

Other forms as detailed in links below are to be used to record the details of the administration of dosetted medication, medication in original containers, PRN medication, non-prescribed medication, and medication given by injection (except for insulin that is recorded separately in an ‘Insulin Administration Record’ booklet.)

All medication administered to a participant must be recorded on the appropriate medication administration record sheet.

The staff member responsible for administering the medication must record that the medication has been given. This includes both prescribed and non-prescribed medications.

• When medication is prescribed, the Doctor will provide a prescription and should record the following information which must be passed on by a parent or carer to Kyeema:

• When a new medication administration record is commenced, staff must fill in the participant’s personal identification details at the top of each sheet. Where necessary, staff must also copy any details regarding the medication (such as name of medication, dose, route/area of application and so on) onto the appropriate medication administration record sheet from the participant’s.

• When administering medication to a participant, staff must record the administration of medication by initialling or signing the relevant record sheet at the time the medication is given.

• The staff member administering medication must fill in the time and date (if these have not been previously inserted) and initial the appropriate record sheet in the box provided or sign where a full signature is required. Blue or black pen should be used for this recording.

• Red pen should only be used on medication administration records for the following:

Ø Entering medication administered by a person other than Kyeema staff, such as a health professional.

Ø Making alterations to incorrect entries on the medication administration record.

• Staff must keep all current medication administration records in alphabetical order in a separate folder close to the place where the medication is stored.

• The Manager, Team Leader or delegated staff member must ensure that accurate, up-to-date medication administration records are maintained for each participant taking medication.

Side-effects are listed on the doctor/pharmacist medication record or on Medication Effects & Side-Effects CCF-78

If a participant is absent from the house (for example, on admission to a hospital), staff should mark a red line through the dates that the participant was absent from the house/centre on the participant’s medication administration record. An entry indicating the absence should also be made in the participant’s file, and the communication book.

Occasions may arise when a participant may refuse to take a prescribed medication.

Kyeema staff must not force a participant to take medication against the participant’s wishes except in emergency situations, for instance, when the administration of emergency chemical restraint is authorised and urgently required. In these cases, staff must only act in a reasonable manner in order to administer the medication.

Where it is known that a participant usually rejects medication when it is first offered, but agrees to take the medication on subsequent attempts to give it, staff should continue to encourage the person to take the medication. However, if a participant is clearly refusing medication and not displaying a usual pattern of behaviour, then staff should follow the procedure outlined below.

• If a participant refuses prescribed medication, the staff member responsible for medication administration should attempt to find out from the participant why the participant does not wish to take the medication, if this is possible.

• The staff member should explain to the participant the reasons for taking the medication as well as the implications of not taking it. Wherever possible, participants should be aware of the purposes and consequences of any medication administered to them.

• If a participant refuses medication, staff must not force the participant to take the medication. The staff member on duty must inform the participant’s carer if unavailable, and failing that the participant’s doctor.

• The staff member responsible for administering the medication must record the participant’s refusal on the medication administration record in the appropriate date/time slot and personally initial it. The ‘R’ code should be used to indicate that the medication was refused. Staff must also record the participants’ refusal, the contact with the doctor and any action taken in the participant’s file.

• Staff must observe the participant for any changes in behaviour or well-being and report these to their supervisor or on-call contact person who will decide whether further medical advice should be sought.

• The staff member responsible for medication administration must alert other staff at the house or day centre to the incident. Include this in handover information.

• If a participant consistently refuses medication, the Manager/Team Leader should alert the participant’s carer, who may arrange a consultation with the participant’s doctor to investigate alternative methods of treatment.

‘Self-Administration’ is the term used when participants are able to administer their own medication without any supervision or assistance from staff. Where participants are not fully independent and are learning the skill, they are not considered to be ‘self-administering’ their medication.

Where a participant is unable to self-administer medication but is considered capable of learning the skill, a developmental program should be prepared and documented in his/her Support Plan. The developmental program must specify the degree of assistance required and the steps by which the skill is to be taught.

The decision for a participant to self-administer is made by participants and carer and will be supported by Kyeema if it can be demonstrated that the following conditions can be met:

1. The participant wishes to self-administer medication and is capable of doing so.

2. The likely benefits of having the participant self-administer medication and whether these benefits outweigh the risks for the participant.

3. The likelihood of incorrect administration occurring and the risk of harm this may cause to the participants or others.

5. Staff must assess the participant’s ability to self-administer medication and document the outcome of this assessment in the participant’s File.

6. This information is to be transferred to the person’s Participant Information Form CCF-40 which is stored electronically in the file of each individual.

7. The Supervisor must ensure that any decisions made in relation to self-administration of medication, as well as the factors contributing to this decision, are recorded in the participant’s file.

8. Staff must record the actual administration of medication where they are responsible for supervising the participant taking the medication as part of that participant’s developmental program. Staff must record the code ‘S’ on the appropriate medication administration record to indicate that they supervised the participant administering medication to themselves.

9. Communication with the participant ensures that safe transportation and/or storage arrangements are in place for the medication to prevent it being damaged, lost or inappropriately consumed by others.

Specific health management refers to a range of specific procedures, recommended by a medical or health professional and that staff carry out as part of their support to participants with particular health needs.

Staff must be trained in the specific health management procedures referred to in this practice instruction by an appropriate medical or health professional before they can be performed.

Participants requiring specific health care management are to provide information from a doctor or therapist that will be used to create an individual Health Care Plan. These will be stored on the participant’s file.

All medication requires safe storage to prevent loss and to avoid accidental ingestion by participants.

Medication must be stored in a lockable cabinet such as a medicine cupboard, a drug trolley, a safe or a drug transportation box fixed to a particular location. A small lockable container must be used to store medication that is required to be kept in a fridge.

When deciding the most appropriate storage system to use for medication kept on any site, the following should be considered:

- The instructions for the storage of each medication, including the temperature at which it is to be stored.

Keys must be replaced as soon as possible if they do not work properly. Lost keys should be reported to the Manager/Team Leader as soon as possible.

The Manager/Team Leader must ensure that there is a spare set of keys to the medication trolley or cabinet available if needed.

Disposal of medication needs to be done in a safe manner and with consideration for the environment. It is recommended that it be taken back to the pharmacy.

Medication, including PRN medication, that is 12 months older than the date of issue displayed on the label of the original container, Webster pack or dosette is not to be administered.

Medication, including PRN medication, which is no longer required, or has reached its expiry date, must be returned to the supplying pharmacy or local hospital for safe disposal as soon as is practicable.

Medication that is expired and waiting to be disposed of is to be locked in the medication cupboard separately from the current medication.

- Expired medication, or medication no longer required, is to be labeled “Return to Pharmacist / Not For use” and stored in the locked medication cupboard separately from the current medication.

- The expired, or not required, medication is to be returned to the supplying pharmacy or local hospital for safe disposal as soon as practicable after it expires.

- The Program Manager/Team Leader or Medication Officer must ensure the checking of medications for expiry dates and must ensure that prescribed medication that is no longer needed by participants or has passed its expiry date is returned to the supplying pharmacy for safe disposal.

- The Program Manager/Team Leader or Medication Officer must note the disposal of medication in the medication folder or communication book.

- The Program Manager/Team Leader or Medication Officer must ensure that staff are aware of and adhere to the Disposal of Medication policy.