The safe use of medication during the COVID-19 pandemic

Introduction

As a social care worker, you are responsible for keeping up to date with your organisation’s policy and procedures regarding the safe use of medication.

This includes making sure, before you carry out any medication support, that you have undertaken appropriate training. By doing this you ensure the safety of the people you support.

When supporting people with medication, there are a number of ways you may be involved depending on the care setting, your role and level of responsibility.

You should always work within the expected parameters of your role and capability and know that you are supported by your employer to do so.

If you are at any time unsure with any aspects regarding medication you should speak with your supervisor or manager at the earliest opportunity so that there is a clear understanding of what is expected of you and what steps to take. There may be different expectations regarding your care role if you are supporting someone in their own home.

This resource offers support, information and resources for social care workers who have the responsibility to carry out one or more of the following types of support.

Prompt – remind someone to take their medication using their preferred communication method.
Assist – help someone who manages their own medication with physical tasks like opening bottles, at their request.
Administer medication - prepare the right medication, at the right time and support a person to take it in the right way in line with their care or support plan and advice from the prescriber or pharmacist.

Safety is vital when dealing with medicines, this resource does not replace existing guidance or specific medication training from your employer.

It should be used alongside your organisation’s policies and procedures; and relevant local and national guidance. We have designed it as a quick guide and hope it will be useful to you as a new worker, or as someone who is supporting the learning of others.

You may also find it helpful to refer to our other COVID-19 Learning Zone guides including infection prevention and control (including personal protective equipment, PPE) and adult support and protection.

Prompt and assist Supporting people in line with good practice including promoting choice and control

An underlying principle of supporting people with medication is that the medication should be given to maintain or improve the quality of life for the person.

A person is supported with a glass of water and tablets in her own hand

This section is about prompting and assisting people with their medication. It is important to acknowledge the support role you have in prompting, assisting and empowering people to take medication.

Your work setting may affect how much you support people with their medication. If you work with people in their own homes, they will normally be responsible for storing their medication. While some people in residential care may also choose to take responsibility for storing and administering their medication, it is likely the care provider will be responsible for more aspects of medicines management (including ordering, storing, administering and monitoring medicines).

When supporting people with medication you may come into close contact with them. COVID-19 is spread directly through close contact with an infected person (within two metres) and indirectly through touching a surface, object or the hand of an infected person. Infection prevention and control precautions are of critical importance when supporting people with medication; to reduce the spread of the virus and keep ourselves, as workers, and the people and families we support safe. For further guidance please see our Key measures for infection prevention and control resource in particular the personal protective equipment (PPE) section.

Click on each category to learn more.

These are unprecedented times. As social service workers we are coming face to face with many challenges, both through our own experiences and through the experiences of people we provide support for.

It is important to be honest with ourselves about the challenges we face and the renewed importance of ensuring we deliver care, compassionately and with kindness keeping the person at the centre of everything we do.

The Health and Social Care Standards set out what we should expect when using health, social care or social work services in Scotland. They ensure individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld. Watch the video below to learn more.

Health and Social Care Standards

At the core of self-directed support is the principle that people are given the opportunity to take control of their lives and the support that they may need to do this. One important aspect of this is being empowered to make decisions about medication.

Assessing the type of support someone will have in their care plan will cover a person’s understanding of their medicines, as well as motivation and physical ability to take them. It should also look at any help needed with ordering and collecting prescriptions. An assessment of a person’s capabilities may show that they do not need any help from you or may need a reminder to take their medicine. The pharmacist can also provide tools to promote and support someone’s independence, such as easy open bottles.

When you support an individual with medication, you are accountable for your actions, so you need to be very clear that the reasons for giving medication is to meet their needs.

Prompting of medication is reminding 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.

The decision about whether a person requires prompting with medication should be discussed regularly during person centred conversations and recorded within their care plan.

If you are expected to prompt a person to take medicines, the details should be within their care and support plan

If you have any concerns or think a person may need more support please speak with your line manager or the person’s keyworker who can arrange a follow up discussion with the individual, and their family and carers as appropriate.

This film shows the correct procedure when prompting a person to take medication.

How to prompt with medicines

The person's care and support plan will show if they are able to retain control of their medicines, but need assistance with certain tasks.

It is important to remember that care and support plans need to be reviewed and monitored regularly to make sure they continue to meet the needs of the supported person.

Assisting with medicines can include:

ordering repeat prescriptions from the GP’s surgery
picking up prescriptions from the GP’s surgery
collecting dispensed medicines from the pharmacy
bringing packs of medicines to a person at their request so they can take the medicines
opening bottles or packaging, including multi-compartment compliance aids at the request and direction of the person who is going to take the medicine
reading labels and checking the time at the request of the person who is going to take the medicine
ensuring the individual has a drink to take with their medication.

It is very important not to handle any medicines. You need to prepare them by a ‘clean’ technique.

This may include:

washing your hands first
pushing a tablet or capsule out of the blister directly into a clean medicine pot.

Some medicines may be harmful to the worker if they have direct contact with the skin. You should avoid touching medication in general, although if you have to you should wear gloves.

Here are two videos to help you assist people with medication.

Washing hands with liquid soap and warm water

Washing your hands correctly will help you assist with medication safely.

How to assist with medicines

If you assist a person with their medication it is very important to follow the correct procedure.

Administer medication Preparing the right medication, at the right time and supporting a person to take it in the right way

Not all social service workers will administer medication. If this is not part of your role you should focus on the prompt and support section above.

Many social service workers administer medication, such as tablets and capsules, and will have appropriate training for this arranged or provided by their employer.

This section covers good practice and is an additional source of support for you to refer to during the COVID-19 outbreak, however it will not replace the training that you must receive so that you can feel confident carrying out this type of support.

How to administer medicines

We can never underestimate the importance of administering medication.

This film shows how to administer medicines correctly.

Click on each category below to learn more.

When administering medication, remember the six Rs below.

Right person.
Right medicine.
Right route.
Right time.
Right dose.
Person’s right to refuse.

Sometimes a person needs medicines administered which social care workers are not normally trained to give. However, when social care workers receive additional training to give such medicines, the worker needs to consider:

the person’s consent given to the social care worker giving this treatment
that they agree and are trained to do this role
clear roles and responsibilities are agreed by all those involved in providing care.

When administering medication you should follow advice from the pharmacist. You should never administer medication covertly to someone (such as disguising it within their food or drink without their knowledge) if they have capacity to make decisions about medicines.

However, covert medication may be an agreed approach if a person has been assessed as not having capacity to make a decision about whether or not to take particular medication, and if it has been specifically agreed by professionals and recorded in their care plan. This can be covered by a letter from a GP stating that there are medical reasons for medication to be given in this way. You must have appropriate training to carry out covert medication.

The Mental Welfare Commission has a good practice guide on covert medication. It gives guidance on the law (including how this relates to capacity to make decisions, and the protection of individuals) and the safe use of covert medication in practice (for example can a medication be safely disguised?)

If you are responsible for administering medication you will hold knowledge of a range of additional considerations.

Housing support worker wearing a mask and washing her hands in a kitchen

The SSSC’s SafeMed resource was designed as a useful reference guide.

You can use the following sections as needed to refresh your knowledge.

Types of medication legal categories of medication
Medication form and routes
Labelling of medication
Adverse reactions
Side effects
Contraindications
Recording requirements
Physiological measurements (including monitoring, evaluation and reviewing process)
Recognising when medication may be required
Disposal of medication

COVID-19 is spread directly through close contact with an infected person (within two metres) and indirectly through touching a surface, object or the hand of an infected person.

Infection prevention and control precautions are of critical importance to reduce the spread of the virus and keep ourselves, as workers, and the people and families we support safe.

Housing support worker wearing a mask and washing her hands in a kitchen

If you are managing a person’s medication it is likely you will be handling original packaging. It is good practice to use a clean technique which includes washing your hands before and after, and not handling the medicines. You may also be required to wear gloves.

During COVID-19 you need to be particularly alert to this. Performing regular and thorough hand hygiene is the single most important thing you can do to reduce the transmission of any infection, including COVID-19, in any care setting.

Some medicines may be harmful if you have direct contact with them. If you are applying medicines to the skin it is important to use gloves both for your own protection and also to prevent cross-infection. These medicines are directly absorbed through the skin.

If supporting people with medication into different parts of their body (including ear, nose, eye, rectum or onto skin) you will need to get close them to carry out this support and you will require additional training. Even if the person you are supporting is not showing symptoms of COVID-19, you should wear a face mask, gloves and apron to reduce possible transmission of virus from or to the person you are supporting.

For further guidance please see our Key measures for infection prevention and control resource in particular the personal protective equipment (PPE) section.

Documentation

Each organisation’s documentation used in the safe administration of medication should be person-centred. Documentation may vary depending upon an organisation's own policies and procedures.

However, there are some documents that should always be part of the procedures for administering medication.

The two main documents are described below. Their names may vary slightly so we have used the most common ones.

The medicine administration recording (MAR) chart is used to record the name of the medication, dosage, times when it is to be administered, how it should be taken as well as a record of administration. Each person has their own recording chart.

The care plan (or personal plan) may tell you what medication the person is taking, what conditions or symptoms this is for and how it should be taken (as directed by the prescriber or pharmacist). The care plan will have further detail about the person’s unique background and preferences. Adhering to a person’s care plan will help you administer medication in a way that promotes their wellbeing and respects the choices they make. Choices can include, for example:

how they wish to be supported
how they can be actively involved
any preferred routines.

Errors

In such complex systems, errors cannot be eliminated completely. Each of these errors should be regarded as an opportunity to learn and to improve in order to increase the safety of our care system for everyone. Good practice in the handling of errors involves organisations developing a learning culture. Organisations will report certain medication errors to the Care Inspectorate. Reporting to other bodies such as the GP or NHS24 is also usually required.

If you make an error with medication, as soon as you realise the mistake, it is very important that you report this in line with your organisations policies and procedures. You may feel anxious but you must be open and honest about the error to make sure that any negative effects on the wellbeing of the individual can be minimised. Your employer has a responsibility to ensure you receive appropriate support through observation and training.

You can learn more by reading the Care Inspectorate's guidance about medication, personal plans, review, monitoring and record keeping in residential care services.

COVID-19 additional guidance Useful information for employers and workers about the safe use of medicines during the pandemic

Your care home’s medication documentation will specify who in the organisation has the responsibility for ordering repeat and non-emergency acute medication. Care homes see sight of the prescriptions before they are dispensed by the community pharmacy to ensure the prescriptions agree with what the home has ordered before the medicines are dispensed. The community pharmacy service often transport these prescriptions from the GP surgery to the care home and pick them up again when they have been checked.

During the COVID-19 pandemic, there are additional pressures on GP and pharmacy services which may mean that some pharmacies cannot perform this transporting role and prescriptions may be automatically transferred from GP to pharmacy to save time and reduce opportunity for infection spread.

In these circumstances homes are advised to ensure they keep a record of what they have ordered from the GP and check this against the medicines and chart received from the pharmacy. For more information read the National Institute for Health and Care Excellence guidance. Alternatively, homes may choose to transport the prescriptions themselves.

This medicine management film below explains the journey of a prescription.

The journey of a prescription

This advice is for care homes and services which are residential in nature.

Providers have responsibility to ensure medicines prescribed for a resident are not used by other residents.

However, the COVID-19 pandemic has raised challenges with accessing palliative care medicines, including controlled drugs. The reason for this may be the fragility of medicine supply chain (locally or nationally) or because the condition of people who need care may deteriorate rapidly out of hours when a prescription cannot be dispensed.

Repurposing medicines is the term used to describe a situation where a medicine prescribed for one resident is administered to another resident, to allow immediate treatment where access to medicine is not possible via normal routes in a timely manner.

In a recent joint statement with partners, the SSSC recognised that the prime concern for everyone is the health, safety and wellbeing of people experiencing care. As such, if there is no other option available, the SSSC acknowledge that repurposing medicines may be an ethical and moral step that needs to be considered.

Repurposing medicines is not a decision to be taken lightly. Each care home must undertake a risk assessment and develop a robust repurposing of medication governance process. The Care Inspectorate and NHS Scotland have issued Guidance for repurposing Prescription Only Medicines (POMs) in care homes and hospices (PDF).

Front page of guidance for repurposing medicines

Care Inspectorate guidance on repurposing POMs

If a situation arises where sharing medicines between care home residents is in the best interests of an individual, care home staff and prescribers are asked to assess the risks and benefits in line with the principles outlined within the guidance. It should be seen as a last resort to provide access to palliative medication. Such decisions should be taken within a local governance framework that includes undertaking a risk assessment and a decision record made.

In the last weeks or days of life ‘just in case’ (JIC) anticipatory medication for end of life symptom control can ensure treatment, if required, without unnecessary delay. JIC boxes include the most important medicines which may be required to manage predictable and distressing symptoms or in the event that the person cannot manage necessary oral medications.

The medications available in the JIC box are prescribed for named people. Some of these medicines are controlled drugs (CD) and should be stored in a safe, secure (locked) and appropriate place.

For more information read the Scottish Palliative Care Guidelines

As the COVID-19 crisis developed, concerns were raised about the potential wastage from a JIC box approach alone, coupled with pressures on prescribers and other front line staff. In response the Scottish Government has developed a framework for palliative care medicines supply during the COVID outbreak. Read section 3.2 of the Coronavirus (COVID-19): palliative care toolkit.

As a result of the COVID-19 situation, some people who would normally receive opioid substitution therapy (eg methadone) on a daily (often supervised) basis from their pharmacy may be given a larger supply to take away with them.

A risk assessment of each situation should be carried out if any individuals are vulnerable as consequence of being in receipt of a larger supply.

The safest option may be that the service holds the medicine securely in their own central location rather than the individual holding the medicine. The medicine must be signed into the secure central storage area with an appropriate audit trail. If the care service has no administration of medicine responsibilities for the individual, they can sign a daily amount over to the individual at their request for them to self-administer.

The individual could act as a second signatory for this if needed and appropriate.

If a care service has been asked to collect medicines on behalf of a service user then the person may provide authorisation for them to collect on their behalf from the pharmacy.

Review of medicine management procedures (PDF)

This guidance is for Care Inspectorate staff to help them review care at home medication policies and procedures.

Social Care (Self-directed Support) (Scotland) Act 2013

This is intended to change the way that care and support is delivered, collectively making the principles of choice and control central to care and support, and giving individuals full opportunity to take control of their support and their lives.

Prompting, assisting and administration of medication in a care setting: guidance for professionals (PDF)

Any care service provision should be based on the desired outcomes of the person who uses the service. This national guidance defines medication roles and will help services develop local medication policies.

Self Directed Support Scotland (SDSS) COVID-19 advice

SDSS provides advice and support on Self-directed Support (SDS), including guidance on Scottish Government COVID-19 guidance on Option 1 and 2 for Local Authorities and Health and Social Care Partnerships.

Scottish Government and COSLA guidance on self-directed support options 1 and 2 for use during the COVID-19 pandemic

This guidance is for Local Authority and Health and Social Care Partnership staff who assess, approve and administer social work and social care and support (including carer support), and approve Self-directed Support (SDS) budgets.

National Institute for Health and Care Excellence (NICE) Managing medicines in care homes

This guideline covers good practice for managing medicines in care homes. It aims to promote the safe and effective use of medicines in care homes by advising on processes for prescribing, handling and administering medicines.