OPUS Competency Assessment, Auditing & Managing Medicines Online Interactive Workbook

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Competency Assessment, Auditing and

Management of Medicines Incidents
An Advanced Course and

Resource Pack
0333 939 0053

ADVDL2009
info@opuspharmserve.com
www.opuspharmserve.com
©Copyright 2023 OPUS Pharmacy Services Ltd. All rights reserved.
Advanced Distance Learning Workbook
CONTENTS
ABBREVIATIONS USED IN THIS WORKBOOK��2
Introduction and Learning Outcomes��3
Section 1: Understanding Your Responsibilities�� 4
Understanding the Regulations��5
Safeguarding�� 10
Keeping Up to Date�� 11
Section 2: Medicines Management and Auditing�� 14
Identifying Good Practice�� 14
Achieving the Best Outcomes for People�� 20
Understanding Processes�� 31
Managing PRN Medicines�� 41
Effective Communication with Healthcare Professionals�� 46
Homecare Medicines Challenges�� 49
Auditing Medicines�� 51
Checking Medication Records�� 53
Summary�� 63
Section 3: Competency Assessment�� 64
Coaching�� 64
Assessing Competence�� 71
Assessing Competence�� 72
FAQs: Training and Competency Assessment�� 75
Suggested Activity:�� 77
Competence Case Studies�� 80
Section 4: Incident Management��83
What to do when a medicines incident has occurred�� 84
Case Study - Incident Management�� 84
Contributory Factors�� 85
Suggested Action Plan�� 88
Useful Resources��89
Self-Assessment Checklist��90
Putting your learning into action��91
Next step: Accessing Your Assessment�� 92
Support From OPUS��93
www.opuspharmserve.com info@opuspharmserve.com 1
© Copyright 2023 OPUS Pharmacy Services Ltd. All rights reserved.
ABBREVIATIONS USED IN THIS WORKBOOK

Here is a list of abbreviations that you will come across in this workbook.
CI Care Inspectorate (Scotland)
CIW Care Inspectorate Wales
CQC Care Quality Commission (England)
MAR Medication Administration Record
NICE National Institute for Health and Care Excellence
PRN 'pro re nata' - Latin for 'when required'
GP General Practitioner (the person's doctor)
CPN Community Psychiatric Nurse
2 www.opuspharmserve.com info@opuspharmserve.com
INTRODUCTION AND LEARNING

OUTCOMES
Welcome to the OPUS Advanced Distance Learning Course and Resource Pack.
This material is designed to support you to establish and evidence good medicines
management practices in your care service.
Learning Outcomes
On completion of this pack, you will be able to:
; Describe the characteristics of an excellent service
; Discuss aspects of poor medicines practice
; Describe how to deal with a wide variety of medicines management and audit issues
; Demonstrate how to complete a competency assessment in your care setting
; Explain the incident management process
; Produce an action plan to improve medicines handling in your service
SECTION ONE
UNDERSTANDING YOUR RESPONSIBILITIES

The Care Quality Commission (CQC) is the regulator of health and adult social care in
England. In Scotland the regulator is the Care Inspectorate, in Wales it is the Care Inspectorate
Wales (CIW) and in Northern Ireland it is the Regulation and Quality Improvement Authority
(RQIA). The regulator’s role is to make sure that people receive care that meets fundamental
standards of quality.
In 2015 in England, CQC introduced a set of fundamental standards

which focus on the following 5 elements:
? Is it safe?
? Is it caring?
? Is it effective?
? Is it responsive to people’s
needs?
? Is it well-led?
You should consider these 5 elements in the way you manage medicines.
Understanding the Regulations
In England, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014 is one of the main standards regarding medicines.
Regulation 12 is about Safe Care and Treatment.
Regulation 12 states that you must make sure:
Care is provided in a safe way
There is proper and safe use of medicines
There are sufficient quantities of medicines, to ensure the safety of the person and
to meet their needs
You consult nationally recognised guidance
The full details - see Regulation 12 of the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2014 (cqc.org.uk/guidance-providers/regulations-enforcement/
regulation-12-safe-care-treatment).
?
What does this mean? Think about what you should do to ensure “care is provided in a
safe way”, with regards to medicines.
We have given you some examples below but note down some ideas of your own. E.g.:
Policy and procedures – make sure they are up to date and easy to understand
Transfer of care – have a process in place for sharing accurate information about a
person’s medicines when they move from one care setting to another
Prioritise continuity of care – use a core team of care workers so the person
becomes familiar with them (homecare)
Carers are effectively trained and competency checked.
By the end of this course, you will be able to add to your answers above.
Click here for suggested answers
We will look at competency assessment, auditing and incident management in more detail
later in the workbook.
Think about what the "proper and safe use of medicines" means.
How will you ensure this is achieved in your organisation? Make some notes below.
Will fill in later
By the end of this workbook, you will be able to add to your answers above.
Your organisation should always have "sufficient quantities of medicines

available to ensure the safety of the person and to meet their needs."
Look at the case study below:
“It is 8am and the care worker goes to find Antonio Da Silva’s medicines. She discovers that
there are none left”.
Think of all the possible reasons why this may have happened and note them in the box below.
We will look at incident management in more detail later in the workbook.
"Consulting nationally recognised guidance" means referring to current best

practice guidance e.g. NICE guidance.
Look at the table below to see some TOP TIPS from the NICE guidance.
TOP TIPS
Ensure care is person-centred
Support people to make informed decisions
Share information
Have policies and procedures for the safe and effective use of medicines
Have a clear process for safeguarding
For detailed information on these topics, take a look at the current NICE guidance
nice.org.uk/guidance e.g. Managing Medicines for People Receiving Social Care in the
Community (NG67) and Managing Medicines in Care Homes (SC1).
You can find links to nationally recognised guidance in the “Useful Resources” section of this
workbook on page 89.
In addition to working within Regulation 12, The Health and Social Care Act 2008 has other
regulations that relate to the handling of medicines.
Make sure you are familiar with all of them.
Person-centred care Safeguarding

Regulation 9 Regulation 13
Meeting nutritional and

Dignity and respect and hydration needs
Need for consent Good governance

Safe care & treatment Duty of candour

If you are working within the relevant regulations in Scotland, Wales or Northern Ireland, the
same basic principles apply.
Safeguarding
Safeguarding is described as “keeping people safe”.
What do you think may be classed as a safeguarding issue with medicines?
NICE guidance states that safeguarding issues with medicines include:
Deliberate withholding of a medicine without a valid reason
Incorrect use of a medicine for reasons other than the benefit of the person
Deliberate attempt to harm through the use of a medicine
Accidental harm caused by incorrect administration or medication error
Local safeguarding arrangements vary; be aware of your local requirements!
TIP! Make sure these are stated clearly in your medicines policy.
Keeping Up to Date
It is important to keep up to date as procedures and guidelines change. It is also important

that you build a culture that encourages staff to follow the correct procedures.
The Care Certificate Standards give guidance on the skills, knowledge and behaviours your
staff need, to provide safe and high quality care and support with medicines.
Standard 13 of the Care Certificate Standards relates to Health and Safety. It requires care
workers to understand medication and healthcare tasks, and be able to:
5 describe the agreed ways of working in relation to medication
5 describe the agreed ways of working in relation to healthcare tasks
5 list the tasks relating to medication and healthcare procedures that they are NOT
allowed to carry out until they are competent
List the tasks that staff are NOT allowed to carry out until they have been assessed as being
competent.
Answers
Answers to page 6 – What should you do to ensure care is provided in a safe way?
Here are some more suggestions:
Î Make sure you have detailed care plans in place

Î Medicines reconciliation - you should co-ordinate an accurate listing of all the
person’s medicines when they transfer into the care service
Î Discuss potential benefits of telecare to complement a person’s homecare
package, if appropriate
Î Closely monitor risks associated with missed or late visits and take prompt action
(homecare)
You will find more suggestions in the appropriate NICE guidance.
Return to question on page 6
Answers to page 7 – How will you ensure the proper and safe use of medicines is achieved in
your organisation?
Î Have a clear medicines policy with procedures

Î Have trained, competent staff
Î Have accurate up to date records
Î Have clear procedures for raising concerns, errors and incidents
Î Share information appropriately
You should be able to add more suggestions of your own by the end of this course.
Answers to page 7 – Case Study - Think of all the possible reasons this may have happened
Î Medicines not reordered

Î Medicines not received by the service e.g. pharmacy did not send
Î Medicines put in the wrong place
Î Medicines given to someone else by mistake
Î Medicines may have been discontinued
Î Medicines were out of date so someone sent them back to the pharmacy
Answers to page 11 – List the tasks that staff are NOT allowed to carry out until they are
competent.
Î Staff cannot administer any medicines – tablets, liquids, patches, inhalers etc
Î Staff cannot apply any creams, ointments, gels
Î Staff cannot witness the administration of Controlled Drugs
Î Staff cannot give over-the-counter medicines
Î Staff cannot prompt medication
Î Staff cannot order medicines
Î Staff cannot take telephone messages about medicines
Please note that this list is not exhaustive.
In addition to the Care Certificate, staff must receive approved medicines training to enable
them to administer medicines safely. A list of courses can be found on page 93.
SECTION TWO
MEDICINES MANAGEMENT AND AUDITING

Identifying Good Practice
All care organisations want to meet the standard of care required. To exceed the standard for
medicines and to provide an excellent service, consider the following:
How to get an outstanding rating for medicines management
Ensure you have:
Good procedures in place for medicines handling and administration
Accurate record keeping
A robust medicines policy which is accessible to all staff
Regular review of medicines by the person's GP
Well organised and audited management of medicines
Detailed person-centred care plans
Medicines training, refresher training and competency assessment
Medicines advice from the pharmacist or GP
Detailed, outcome-focussed protocols for PRN medicines
Good working relationships with other healthcare professionals
Good communication with the people you support, their family and others involved in
their care
Add any other ideas you can think of in the space below:
? What constitutes poor practice?
You have seen some of the things that could help you to get an outstanding rating as a care
service provider. Now think about what would be seen as poor practice.
Look at the scenarios below to see some examples of poor practice.
A person was prescribed a new dose

A person who was prescribed
of warfarin and the correct new dose
ibuprofen for pain relief in arthritis
was stated in the anticoagulant
was given the medicine by a care
record book that included the
worker. The care worker did not
blood test results. Staff ensured
read the label properly and gave the
the new dose was entered onto the
medicine without food.
medication administration record
The person suffered stomach pains but forgot to request a new supply of
and indigestion. warfarin from the GP. The person did
not receive the medicine for 2 days.
A resident with severe cellulitis was

A care worker administered
prescribed an antibiotic on Thursday
paracetamol to a person one morning
evening. Due to poor procedures
but did not note down the time of
in the care service, combined with
administration. The second dose was
poor support from the pharmacy and
given at lunchtime by another care
the local GP practice, this was not
worker who assumed the first dose
obtained until the following Tuesday
had been given at 8am but in fact it
afternoon. As a result, the condition
had been given at 10am.
worsened.
The person received an overdose of
The person had to be admitted to
paracetamol.
hospital.
Poor recording in a care home resulted in one person being given their morning dose of
insulin twice. The person had a hypoglycaemic episode.
Think about how the incidents on the previous page could be avoided,
and write your answers in the box below.
Having a good process in place to ensure medication is ordered in advance.

Carers reviewing care plans and following instructions closely.
Using the 5Rs of administration.
Answer to activity on page 16
Being familiar with the person's support plan
Reading the medicine label carefully before every administration
Reading the MAR carefully, including the back of the MAR before every administration
Checking medicines stock regularly and re-ordering when needed
Establishing a good relationship with the pharmacy and GP surgeries supporting the
care service
Recognising which medicines are urgent and making sure they are obtained on time
? What constitutes poor practice?
Now write down all your thoughts and ideas about what would constitute poor practice
leading to poor outcomes for the person.
Medicines not being ordered and collected in advance.

Carers not reading care plans.
Ineffective information or out of date information in care plans.
Carers not regularly checked for competency.
Inadequate supervision.
Inadequate instructions for PRN medication.
Medication poorly stored.
Answers to activity on page 18
Examples of POOR PRACTICE that result in poor outcomes for the person:
Poor systems for obtaining medicines resulting in people not getting medicines when
! they need them
! Not considering the individual needs of the person
! Poor management of Controlled Drugs
! Poor management of PRN (when required) medicines
! Medicines not available or out of stock for long periods
! Poor procedures for administration and record keeping
! Secondary dispensing
! Medicines stored inappropriately or at the wrong temperature
! Wrong medicines given to people
! Poor recording of received, administered and disposed of medicines
Poor communication in the care setting e.g. dose changes, discontinued medicines,
! side effects
This list is not exhaustive and you may well have thought of other examples that are not on
the list.
Achieving the Best Outcomes for People
Now think about how you would deal with a variety of situations in your care setting. For each
situation tick the appropriate box(es) to show how you would respond, taking into account the
independence, choices and outcomes for the person.
Situation 1: A person has medicines in a dossette box filled by her daughter. Do you:
Administer them as per the daughter’s instructions
Politely refuse to administer them and do nothing else
Explain to the person that you are only able to support them with medicines in
pharmacy-labelled containers. Contact the GP to request a new prescription
Ask the daughter to administer the dose until you have the medicines in the correct
container
Situation 2: A person’s son asks you to put his mother’s medicines in her porridge as she is
very confused and constantly refusing them and quite obviously needs them. He is prepared
to sign a statement to confirm his request. Do you:
Politely refuse and do nothing else
Put them in the porridge and ensure you have a copy of his statement
Decline and contact the GP. Explain the rules around covert administration and
request a best interest meeting.
Situation 3: The cupboard where the medicines are stored is very full and there are several
part-used, opened boxes of Fybogel® for a person. Do you:
Remove them and put them in a different place
Put the sachets together in one box as they are for the same person
Dispose of the boxes with only a few in
Leave them as they are
Situation 4: A person is prescribed Actonel® (Risedronate) for osteoporosis. They are

prescribed the medicine once a week, half an hour before food. They ask if they can have just
a cup of milky tea with the tablet as it upsets their stomach and taking it with tea soothes the
stomach. Do you:
Give them a small cup of tea
Politely refuse and explain why
Advise them to take it with their breakfast to minimise the effect on the stomach
Contact the GP to report that this medicine upsets the person's stomach and seek
resolution
Situation 5: A person has been on a course of antibiotics for a week (Amoxicillin 250mg
capsules three times a day). The GP decides to extend the course for another week. You
obtain the new supply from a different pharmacy so you need to handwrite on the MAR.
Do you:
Discontinue the first course and make a new entry
Leave the existing entry and continue to sign for another 7 days
Wait and see how someone else records it
Situation 6: A person is prescribed paracetamol in the evening, which is given by the care
worker. The person also requires another 2 tablets during the night. The care worker asks
what she should do as the person would like to administer the medicine themselves, but they
are a bit forgetful. What do you advise?
Leave them out next to the bed for the person to take in the night
Say you cannot do anything about it as care workers are not available during the night
In homecare, ask the family to sort it out as it is not your responsibility

Consider the outcome, assess the risks and decide on the most appropriate course
of action
Situation 7: You are requested to prompt a person with their medicine.

How do you record this?
There is no need to make a record as you have only given a reminder but did not
administer any medicine
Make a record in the MAR, noting the date and time of the prompt
Situation 8: You administer a person’s medicines from a pharmacy-filled and labelled dosette
box. How would you record it?
Write “As per dosette box” with no further details

Write "As per dosette box" and make sure there is an accurate list of all medicines
contained within it
Itemise each medicine and sign for them individually
Don’t record it as the pharmacy has supplied it in a dosette box
Situation 9: A support worker reports that she has found a carrier bag of old medicines in a
person’s flat. What would your advice be?
Throw the medicines away
Inform the GP that the medicines have not been taken

Suggest to the person that they return the medicines to the pharmacy or ask a
relative/advocate to do so
Get the support worker to take the medicines back to the pharmacy
Situation 10: A person with a mild learning disability manages her own medicines. Recently
she has become unwell and is unable to take full responsibility for her medicines.
What can you do to support her?
Nothing as she manages her own medicines
Assess the support she needs
Temporarily administer medicines for her, advising her that it is only temporary
Permanently change her level of support
Situation 11: A person with diabetes who attends the day service by minibus brings her
insulin pen in for staff to assist her with her medicine. Which of these are important issues to
communicate to your staff to ensure the best outcome for the person?
Safe transport of the insulin pen
Storage of the insulin pen
Level of assistance needed
Record keeping
Training by a healthcare professional
Understanding of diabetes
Answers to questions on pages 20 - 23
Situation 1: A person has medicines in a dossette box filled by her daughter. Do you:
Administer them as per the daughter’s instructions
Politely refuse to administer them and do nothing else
Omit the medicine and request a new prescription

Explain to the person that you are only able to support them with medicines in
pharmacy-labelled containers. Contact the GP to request a new prescription
Ask the daughter to administer the dose until you have the medicines in the correct
container
Important:
The outcome for the person is that the person needs to receive their medicines at the correct
time and in the right way.
As you cannot verify what is in the dosette box, you will need to contact the GP for a new prescription,
which can then be dispensed by the pharmacy.
Situation 2: A person’s son asks you to put his mother’s medicines in her porridge as she is
very confused and constantly refusing them and quite obviously needs them. He is prepared
to sign a statement to confirm his request. Do you:
Politely refuse and do nothing else
Put them in the porridge and ensure you have a copy of his statement
Decline and contact the GP. Explain the rules around covert administration and
request a best interest meeting.
Important:
The outcome for the person firstly needs to be considered i.e. the independence and choices
of the person regarding their medicines administration need to be recognised. Does the person have
the capacity to make a decision?
Covert administration (disguising medicines in food or drink without the person's knowledge) is only
permitted if:
Î the person lacks capacity to make decisions about their medicines (a mental capacity
assessment needs be undertaken to confirm this) AND
Î it is in the person’s best interest
This will be decided by a best interest meeting involving health and social care professionals and
representatives of the person concerned.
Situation 3: The cupboard where the medicines are stored is very full and there are several
part-used, opened boxes of Fybogel® for a person. Do you:
Remove them and put them in a different place
Put the sachets together in one box as they are for the same person
Dispose of the boxes with only a few in
Leave them as they are
Important:
The outcome for the person firstly needs to be considered i.e. you need to ensure that the
person receives the correct medicine and the medicine is in date.
The contents of the opened boxes cannot be put together in one box as the expiry dates may vary.
It would be wasteful to dispose of the boxes with only a few in. It would be better to take the extra
boxes out of the cupboard and store them separately, as staff should administer from one box only
at a time. If the cupboard is very full and untidy, staff are much more likely to make an error when
selecting medicines. All staff should be made aware of where the extra boxes are stored.
Situation 4: A person is prescribed Actonel® (Risedronate) for osteoporosis. They are

prescribed the medicine once a week, half an hour before food. They ask if they can have just
a cup of milky tea with the tablet as it upsets their stomach and taking it with tea soothes the
stomach. Do you:
Give them a small cup of tea
Politely refuse and explain why
Advise them to take it with their breakfast to minimise the effect on the stomach
Contact the GP to report that this medicine upsets the person's stomach and seek
resolution
Important:
The outcome for the person firstly needs to be considered i.e. you need to ensure the person
receives the full benefit from the medicine with minimal side effects. Even the amount of milk in
a cup of tea will affect the absorption of this medicine so it should be taken just with water to get
the full benefit. It should not be taken with food as this will affect its absorption also. It is essential
that the full directions are followed i.e. take with a whole glass of water and sit upright or stand
for 30 minutes after taking in order to prevent ulceration of the oesophagus. If these instructions
cannot be followed, then the GP must be contacted and an alternative medicine can be found. This
demonstrates the need to train staff to read the label and any accompanying information carefully.
Situation 5: A person has been on a course of antibiotics for a week (Amoxicillin 250mg
capsules three times a day). The GP decides to extend the course for another week. You
obtain the new supply from a different pharmacy so you need to handwrite on the MAR.
Do you:
Discontinue the first course and make a new entry
Leave the existing entry and continue to sign for another 7 days
Wait and see how someone else records it
Important:
The outcome for the person needs to be considered i.e. you need to ensure the person receives
continuous treatment with the right medicine in the right dose. It is probably best to discontinue the
existing entry and start a new entry. All staff must be aware of the procedure you are going to adopt.
Mistakes have been made by some staff continuing to record on the existing entry and some staff
adding a new entry resulting in the medicine being given twice. This is particularly important if the
items are on separate MARs or separated by a number of other items.
Make sure your procedure is clear and unambiguous.
Situation 6: A person is prescribed paracetamol in the evening which is given by the care
worker. The person also requires another 2 tablets during the night. The care worker asks
what she should do as the person would like to administer them herself but is a bit forgetful.
What do you advise?
Leave them out next to the bed for the person to take in the night
Say you cannot do anything about it as care workers are not available during the
night
In homecare, ask the family to sort it out as it is not your responsibility
Consider the outcome, assess the risks and decide on the most appropriate course
of action
Important:
The outcome for the person firstly needs to be considered i.e. to ensure the person receives
effective pain relief and is kept safe. You need to assess the risks.
What are the risks if the tablets are left out?
Î The person is forgetful so may wake after a few hours and take them before they should
Î The tablets may be taken by someone else
Î The person may drop them or lose them
Î The person may hoard them and take them in one go
You also need to check your policy regarding whether medicines can be left out for the person to
take later. Once the risks have been assessed and you have decided on the most appropriate course
of action in the particular situation, you should document it with full details in the care plan and
reassess as appropriate.
Situation 7: You are requested to prompt a person with their medicine.

How do you record this?
Do not record as you have only given a verbal reminder and not administered
Make a record on the MAR, noting the date and time of the prompt
Important:
The outcome for the person firstly needs to be considered i.e. the person needs to be
supported by you to take their medicines at the correct time and in the right way. A prompt is a
verbal reminder given to a person who usually self-administers their medication. If you notice that
the frequency of prompts is increasing, you need to refer to the prescriber, as their condition may
have changed and their needs may need to be reassessed.
If you think that the person is not taking their medicines despite being prompted, refer to the
prescriber.
Verbal prompts are forms of medicines support, therefore they need to be recorded on the person's
MAR. Make sure to include the date and time when recording prompts.
Refer to your organisation's medicines policy on recording verbal prompts.
Situation 8: You administer a person’s medicines from a pharmacy-filled and labelled dosette
box. How would you record it?
Write “As per dosette box” with no further details

Write "As per dosette box" and make sure there is an accurate list of all medicines
contained within it
Itemise each medicine and sign for them individually
Don’t record it as the pharmacy has supplied it in a dosette box
Important:
The outcome for the person firstly needs to be considered i.e. you need to ensure the person
has received their prescribed medicines at the times they need them and in the right way. It is
necessary to know which medicines have been administered. Medicines can be identified by the
supplementary label provided by the pharmacy which will describe what each medicine looks like. If
this information is insufficient to identify the medicine, then consider whether individually labelled
containers would be more appropriate than dosette boxes. Care staff must be aware of what they are
administering.
Important:
Dosette boxes or multi-compartment compliance aids should only be supplied to people who
need them to retain their independence, following a review by a healthcare professional.
Situation 9: A support worker reports that she has found a carrier bag of old medicines in a
person’s flat. What would your advice be?
Throw the medicines away
Inform the GP that the medicines have not been taken

Suggest to the person that they return the medicines to the pharmacy or ask a
relative/advocate to do so
Get the support worker to take the medicines back to the pharmacy
Important:
The outcome for the person firstly needs to be considered i.e. you need to support the person
in order to keep them safe and make sure they do not take expired or inappropriate medicines. You
could suggest to the person that they return the medicines to the pharmacy. If they are unable to
do so, ask a relative / advocate to remove or return the medicines to the pharmacy. You will need
to consult your organisation’s policy to check if a support worker can be requested to remove the
medicines. If this is permitted, then the relevant paperwork must be completed, and the person's
consent must be documented. It is also important to inform the GP that the medicines have not been
taken.
Situation 10: A person with a mild learning disability manages her own medicines. Recently
she has become unwell and is unable to take full responsibility for her medicines.
What can you do to support her:
Nothing as she manages her own medicines
Assess the support she needs
Temporarily administer medicines for her, advising her that it is only temporary
Permanently change her level of support
Important:
The outcome for the person firstly needs to be considered i.e. you need to ensure the
person receives the right medicines in the right way. It is important for this person to retain her
independence. However at the moment she requires additional support. You should assess the
support that she needs and, for the time being, administer medicines to her. You should keep
a medication administration record for this and make sure staff are trained and competent to
administer her medicines. You also need to think about storage issues. Explain to the person that the
new arrangements are only temporary, whilst she is unwell.
Situation 11: A person with diabetes who attends the day service by minibus
brings her insulin pen in for staff to assist her with her medicine.
Which of these are important issues to communicate to your staff to ensure the best outcome
for the person:
Safe transport of the insulin pen
Storage of the insulin pen
Level of assistance needed
Record keeping
Training by a healthcare professional
Understanding of diabetes
Important:
The outcome for the person firstly needs to be considered i.e. to ensure the person receives
the correct medicine at the times she needs it and in the right way. In addition, other people using the
service need to be kept safe.
All of the above are important issues.
Understanding Processes
It is important that all staff understand the processes by which medicines are managed. The
following case studies have all resulted in problems with medicines management.
Case Study 1: Controlled Drugs
A person prescribed a 50 microgram fentanyl patch requests additional pain relief. The GP
increases the dose by prescribing a 25 microgram patch to be administered as well as the 50mcg
patch.
What possible errors could occur when the patches are administered and recorded?
To ensure the person receives the required dose, there are various actions to take. You will
need to:
Î Ensure the MAR contains entries for both strengths
Î Ensure stock of the new 25 microgram patches is ordered and received
Î Ensure an entry is made in the Controlled Drugs register on receipt of the new patches
Î Ensure the days when the patch is due to be changed are highlighted
Î Ensure staff are briefed on the new dose
Case Study 2: Warfarin
A person is prescribed warfarin 2mg on Mondays and Fridays and 1.5mg on the other days of the
week.
Show how you would record this on the MAR to ensure the correct dose is given.
Name: George Brown D.O.B: 1/5/1940
1/5/1920
Address: Room 101 Allergies: None known
Start Date: 26/2/20XX End Date: 26/3/20XX Start Day: Monday

Doctor: Dr A Smith
Commencing Week 1 Week 2 Week 3 Week 4
Medication Profile Time/Dose
08.00
28 Warfarin 1mg Tablets
12.00
To be taken as directed
17.00 X
22:00
GP Sig.
Commenced 10/10/20XX Route Oral recd. quantity by
08.00
12.00
17.00 X
22:00
GP Sig.
08.00
28 Warfarin 0.5mg Tablets
12.00
17.00 X
22:00
GP Sig.
What
GP Sig. are the likely sources of error? Note down your answers below.
Commenced Route recd. quantity by
GP Sig.
A = Refused B = Nausea or vomiting C = Hospitalised D = Social leave
F = Other (define)...........................................................................................................................................................................................................................................................................
NR = Offered but not required - see note overleaf
Case Study 3: Self-administration
Brian is an 81 year old gentleman and is on digoxin, furosemide and ferrous sulfate and E45®
cream for dry skin. Brian wishes to self-administer but is becoming increasingly forgetful and
finds it difficult to manipulate the tablet bottles and gets frustrated. He becomes quite agitated
when care staff try to administer his medicines for him as he wishes to retain his independence.
What can you do to ensure the outcomes are met for Brian?
Case Study 4: Hospital Discharge
A care worker visits a person who has been discharged from hospital. She notices a new bag of
medicines that have been dispensed by the hospital pharmacy. These medicines are not on the
existing MAR.
What are the issues here? What would you do? Note down your answers below.
Case Study 5: Dressings
A person has a wound dressing applied by a District Nurse. The District Nurse requests the care
worker to change the dressing every 2 days and replace it if it comes off.
Case Study 6: Antibiotics in homecare
A person is prescribed antibiotics four times a day for a week. The person only has 3 visits during
the day. The care worker phones in to tell you this and asks what they should do.
Answers to activity on pages 31 - 36
Case Study 1: Controlled Drugs

Likely Sources of Error
Î Staff may have altered the 50 microgram dose to 75 microgram on the MAR instead
of making two separate entries i.e. one for the 50 microgram patch and one for the
25 microgram patch
Î Two patches of the same strength may be applied instead of one patch of each
strength
Î Patches may be changed on the wrong day due to incorrect interpretation of the MAR
Î New stock may not be obtained quickly enough so the person does not receive the
new dose
Î Staff may not have been informed of the new dose at handover

Name: George Brown 1/5/1940
D.O.B: 1/5/1920

Doctor: Dr A Smith
Medication Profile Time/Dose M T W Th F S S
08.00
12.00
17.00 X JM JM JM JM JM JM JM
O n e e a c h da y a n d t wo o n
Monday and Friday 22:00 2 1 1 1 2 1 1
JM AFM 26/2/20XX
GP Sig.
Commenced 10/10/20XX Route Oral recd. 26/2/20XX quantity 28 by JM
08.00
12.00
17.00 X
22:00
GP Sig.
08.00
28 Warfarin 0.5mg Tablets
12.00
17.00 X JM JM JM JM JM
O n e e a c h d a y e x c e p t M o n d ay
a n d F r i da y 22:00
JM AFM 26/2/20XX
GP Sig.
GP Sig.
Likely sources of error
Î Staff may administer the wrong strength
Î Staff may not give the up to date dose
Î The MAR may have become unclear and confusing with lots of dose changes
Case Study 3: Self-Administration
Brian wishes to retain his independence; therefore, a risk assessment should be undertaken
to ensure Brian's safety with medicines. As he is becoming more forgetful and as he has
difficulty opening the medicine containers, it may be worth suggesting to him that care staff
help by administering his oral medicines but he retains responsibility for administering his
E45® cream.
This partial self-administration will ensure he receives his oral medicines on time and
staff can support him to administer his own cream with a gentle reminder if necessary. His
independence will be retained and staff can discreetly monitor his progress.
A review date should be agreed with Brian to reassess the situation.
Your Notes...
Case Study 4: Hospital Discharge

The care worker should be advised not to give the medicines until it has been ascertained what
the current medication regime is.
Questions that should be asked include:
Î Is there a hospital discharge letter?
Î Is the medicine in the bag from a current stay in hospital (check the dates on the labels)?
Î Is the new medicine meant to be administered instead of the existing medicine or to be
given “as well as” the existing medicine?
Î Has there been any contact with the GP / hospital / out of hours service / family?
Once the medicines and instructions have been confirmed, a senior staff member should
write the new medicines and instructions onto the MAR. This entry should be checked and
countersigned by another member of staff at the earliest opportunity to ensure accuracy and to
ensure the safety of the person.
You must always evidence what actions you have taken to find out the information and ensure
everything you do is documented.
Case Study 5: Dressings

The administration of a medicated wound dressing is a task which would generally be
undertaken by a District Nurse. The District Nurse may wish to delegate this task to a care
worker. In this situation, the District Nurse retains overall responsibility and would need to train
the care worker and assess the care worker’s competence in performing the task. This is often
known as a "delegated" task. The training should be person specific and care worker-specific
and details of training and competence should be fully documented.
You need to check your medicines policy to check if you are covered to undertake delegated
tasks such as this.
Consider the outcome for the person; their wound should be managed in a way that promotes
healing and prevents it getting worse.
Here are a few examples of what promotes this outcome:
Î Applying and removing the dressing with the correct technique
Î Changing the dressing at appropriate intervals
Î Cleaning the wound with the right technique using the right products
Î Responding to changes in the wound and the person's condition (i.e. they may need a
different type of dressing)
Î Recognising the signs of infection
All of these points specific to the person being treated need to be included in the training given
to the care worker by the District Nurse. The care worker must demonstrate competence in these
areas before they undertake the task.
Case Study 6: Antibiotics in homecare
There are several options available that need to be considered:
Î Can the family come in and give the last dose?
Î Is the person able to manage the last dose themselves i.e. have the dose left out?
This will require risk assessment.
Î Can the prescriber be contacted to prescribe an alternative antibiotic three times a

day or a longer acting preparation?
Î Is it appropriate to contact social services and request an additional visit?
The issue is that if administration of the night-time dose is not resolved, the last dose of
antibiotic will get missed and the person will not get the full benefit from the course of
treatment.
You need to avoid:
Î Medicines being left out without risk assessment
Î Double dosing at the teatime call
Î The last dose being missed
You need to brief the care worker and explain why the last dose is important and how it will
be managed. Document every action you take.
Managing PRN Medicines
To ensure the best outcome for the person, it is important when administering medicines
prescribed “PRN” (when required) that a detailed person-centred protocol is drawn up.
An example of a PRN protocol is available for download from:
opuspharmserve.com/distance-learning-additional-resources/
Managing PRN Medicines: Case Study
Here is a medicine label for a PRN medicine:
Any chemist DISP CHKD

Address/Tel. No.
100 Paracetamol 500mg Tablets

TWO to be taken FOUR times a day when required
Do not take more than 2 at any one time. Do not take more than 8 in
24 hours. Contains paracetamol. Do not take anything else
containing paracetamol while taking this medicine. Talk to a doctor at
once if you take too much of this medicine, even if you feel well.
Mr John Brown 26/04/20XX
Keep out of reach and sight of children
Consider the 3 people below who have all been prescribed “Paracetamol 500mg Tablets” at a
dose of “Two tablets four times a day when required” for pain relief:
Alan Smith rarely has pain. Maria Lopez is unable to Esin Yilmaz has dementia.
Alan will ask for pain relief communicate. Assessment She is recovering from a
when he needs it. of pain is made using a broken arm. If you ask her
pain chart. whether she requires pain
relief, she says no. Her
support plan says that if
you take time with her, you
will notice that she cradles
her broken arm when she
is in pain. If you ask her
permission to gently touch
her arm and ask if her arm is
still hurting, she will say yes.
The PRN protocol for each of these three people will look very different. Look at the PRN
protocol excerpts on the following pages.
PRN protocol (excerpt) for Alan Smith:
HOW THE DECISION IS

Alan Smith has capacity and is able to make the decision
REACHED ABOUT HOW
himself. When he requires pain relief he will ask staff.
AND WHEN TO GIVE
ACTIONS TO TAKE BEFORE Check MAR to ensure the last dose was given at least 4
ADMINISTRATION hours ago.
ACTIONS TO TAKE AFTER Record the time the medicine was given on the MAR and
ADMINISTRATION who administered it.
EXPECTED OUTCOMES Pain relief.
FOLLOW UP Monitor and check if pain is relieved.
PRN protocol (excerpt) for Maria Lopez:
HOW THE DECISION IS Maria Lopez is unable to communicate verbally. Use

REACHED ABOUT HOW personalised pain chart (which describes how she
AND WHEN TO GIVE indicates pain) to assess level of pain.
Do pain assessment and record in care plan. Check MAR

ACTIONS TO TAKE BEFORE to ensure last dose was given at least 4 hours ago.
ADMINISTRATION
Record refusal/non-administration on medication record.
ACTIONS TO TAKE AFTER Record the time paracetamol was given on the MAR and
ADMINISTRATION who administered it. Monitor her for signs of pain.
Monitor frequently and assess at least every 4 hours (or

FOLLOW UP
more frequently if necessary).
PRN protocol (excerpt) for Esin Yilmaz:
Esin Yilmaz has dementia. She may say no when asked a

direct question about requiring pain relief. If you take time
HOW THE DECISION IS with her, you will notice that she cradles her broken arm
REACHED ABOUT HOW when she is in pain. If you ask her permission, touch her
AND WHEN TO GIVE arm gently and ask if her arm still hurts, she may wince
and say yes. If you have confirmed that she is in pain,
administer paracetamol.
Assess pain as above.
ACTIONS TO TAKE BEFORE Check MAR to ensure last dose was given at least 4 hours
ADMINISTRATION ago. Record on the MAR when paracetamol is offered but
not given.
Record the time the paracetamol were administered on
ACTIONS TO TAKE AFTER
the MAR and who administered it. Monitor her for signs of
ADMINISTRATION
pain.
Monitor frequently and assess at least every 4 hours (or

FOLLOW UP
more frequently if necessary).
You can see the difference in PRN protocols for three different people prescribed the same
medicine.
This illustrates the need for a person-centred protocol to ensure the individual needs of the
person are met and staff are aware of the actions to take.
Effective Communication with Healthcare Professionals
The key to effective working is good communication. This will provide the best outcome for
the person. Without good communication, things can go wrong. Below are 4 examples where
things did go wrong.
? What went wrong?
For each of the following examples, write down what you think may have gone wrong and
what lessons can be learnt.
A District Nurse went into a care home. She

asked the person if they would like a flu vaccine
and the person agreed. The District Nurse
administered the vaccine.
A Community Psychiatric Nurse (CPN) went

into a care home to administer a depot injection
to a person. The injection was supplied by the
CPN who administered the injection. They did
not leave any record of the administration as
they carried their own records and felt that was
sufficient.
A District Nurse went into a care home to

administer insulin. She altered the dose but did
not leave a clear record of the new dose.
A Macmillan nurse altered the dose of a painkiller

on a MAR in pencil, but the change wasn’t clear.
Tramadol 150mg daily was changed to Tramadol
50mg three times a day.
A District Nurse went into a care home. She What went wrong?
asked the person if they would like a flu
The person had dementia and had forgotten
vaccine and the person agreed. The District
she had already had a flu jab, so agreed when
Nurse administered the vaccine.
asked.
Lessons learnt:
A procedure is needed for visiting healthcare

professionals. This should include:
• ensuring the District Nurse or healthcare

professional signs in when they enter the
home and report to the Duty Manager
• requesting the District Nurse or healthcare

professional reports to the Manager or
senior person, any potential changes to
medicines before they are implemented
• ensuring any actions by the District Nurse

or healthcare professional are documented,
e.g. on the MAR.
A Community Psychiatric Nurse (CPN) went What went wrong?

into a care home to administer a depot
There was no record in the care home of the
injection to a person. The injection was
depot injection being administered and staff
supplied by the CPN who administered the
were unaware that it had been given.
injection. They did not leave any record of
the administration as they carried their own Lessons learnt:
records and felt that was sufficient.
It is essential that a care home maintains a
complete record of all medicines administered
to people to ensure the persons’ safety. There
is a potential otherwise for the medicines to be
given again by mistake if the care home has
no record.
A District Nurse went into a care home to What went wrong?

administer insulin. She altered the dose but
Staff continued to administer the old dose.
did not leave a clear record of the new dose.
Lessons learnt:
It is important to put in place a procedure for

visiting healthcare professionals. See previous
page.
A Macmillan nurse altered the dose of What went wrong?

a painkiller on a MAR in pencil, but the
The person received the wrong dose. The dose
change wasn’t clear. Tramadol 150mg daily
given by the care worker in error, was 150mg
was changed to Tramadol 50mg three times
three times a day.
a day.
Lessons learnt:
• Dosage alterations should always be made

in pen, and they should be clear and legible
• Old instructions should be crossed out with

a single line so they can still be read
• Good communication is essential between

a visiting healthcare professional and care
home staff
Homecare Medicines Challenges
There are many challenges in managing medicines in a homecare setting. You will find below
some of the common issues and possible ways of dealing with them.
Issue Possible ways of dealing with it
! You are unsure of

which medicines
to give following
Produce a procedure and flow chart for getting up
to date information e.g. via hospital discharge letter,
advice from GP, duty doctor or NHS 111 if necessary.
hospital discharge Communicate this to staff.
All staff should be briefed on the medicines policy and

Being asked to
!
understand how to work within it. Staff should feel able
undertake tasks
and confident to feed back to their line manager if they
not covered in your
are being asked to undertake a task which they know is
policy
not covered by the policy.
Administering Feed back to the manager (and social services if
! medicines when
the care plan says
“prompt”
necessary) and ensure the person's medicine support
needs are reassessed. Document the assessment and
the support required and inform staff.
!
Difficult relationship Good communication is essential to provide the best
with GP or District outcome for a person. Consider arranging a meeting
Nurse with personnel at the surgery e.g. Practice Manager.
Explain why you are not able to comply with their
!
Family ask you to do
requests - they may not understand legislation issues.
things contrary to
Consider the outcome for the person and ways in which
your policy
you can support the person to achieve the best outcome.
Set up a procedure for each agency to write in a shared
!
More than one
record. The primary agency will have responsibility to
agency involved with
ensure a collaborative approach and to ensure actions
the person's care
are taken as necessary.
Issue Possible ways of dealing with it
Care workers can feed back very useful and important

Care workers feed information from the person. If care workers feed
! back information but back information and it is not acted upon, they will
no action is taken so not continue to feed back important issues. Regular
they feel isolated communication is crucial to preventing problems with
medicines management.
Family and Good communication between parties is essential here.
! neighbours getting
involved with the
medicines
Care workers should be asked to feed back if they think
anyone else is getting involved with a person’s medicines.
The safety of the person is key.
If you are required to handwrite a MAR, this should ideally

Handwritten
!
be done by a senior staff member. Details should be
medication
copied directly from the pharmacy label, doctor’s letter or
administration
prescriber’s authorisation. The handwritten entry should
records
be checked for accuracy by a second member of staff.
Auditing Medicines
Definition: An audit is an evaluation of a person, organisation, system, process,
enterprise, project or product.
Importance of Auditing
It is essential to audit the medicines procedures in your care service to ensure:
9 Procedures are being followed correctly by staff
9 People are receiving their medicines at the times they need them and in the right way
Audits should be planned and carried out regularly, documented and can be used as evidence
of your compliance.
Audit forms are available for download from opuspharmserve.com/distance-learning-

additional-resources/. You can use these whenever you carry out an audit to make sure you
cover all the necessary aspects of medicines handling in your organisation.
Action: How to use the Audit Tool

You may wish to undertake a complete audit or select specific sections of the audit
tool which are relevant to your organisation and to your needs at the time (risk-based
auditing).
Note: You can adapt our audit tool to meet the needs of your organisation.
You will see some examples of recording on Medication Administration Records (MAR) and
how to audit them below and on the following pages.
Example
Here is part of a medication record:

D.O.B: 1/5/1940

Doctor: Dr A Smith
08.00 1 JM JM
4 Alendronate Tablets 70mg
12.00
One to be taken each week
17.00
22:00
GP Sig.
There is an issue with this medication record. See if you can work out what has occurred,
before reading further.
George Brown should be taking an Alendronate tablet once a week. This means he should take
one every 7 days. The medication recordquantity
shows he bywas given a tablet six days after the previous
GP Sig.
Commenced Route recd.
dose. This does not provide the best outcome for him as the doses are too close together and
side effects may occur. As a manager or senior staff member you should discuss this matter
with the care worker concerned and think about how to prevent it happening again e.g. outline
the boxes on the medication record to indicate when the next dose is due.
GP Sig.
GP Sig.
GP Sig.
F = Other (define)...........................................................................................................................................................................................................................................................................
Checking Medication Records

Now look at two more excerpts from a medication record. See what issues you can find with
each one.

D.O.B: 1/5/1940

Doctor: Dr A Smith
100ml Morphine Sulfate Oral Solution 08.00 JM EJ

100ml Morphine Sulphate Oral Solution
10mg/5ml
10mg/5ml JM EJ
12.00
2.5ml - 5ml to be taken when required 17.00

Warning: This medicine may make you sleepy.
22:00
If this happens, do not drive or use tools or
machines. Do not drink alcohol
GP Sig.
Commenced 10/10/20XX Route Oral recd. 24/2/20XX quantity 1 00ml by JM
Issue:
GP Sig.

D.O.B: 1/5/1940

Doctor: Dr A Smith
GP Sig. Medication Profile Time/Dose
08.00 1 JM JM JM JM JM JM JM JM JM JM
112 Sinemet Plus Tablets
12.00 1 AF AF AF AF JM AF AF JM AF AF
ONE to be taken FOUR times a day
17.00 1 CL CL CL CL J M CL A F CL CL CL
22:00 1
GP Sig.
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 112 by JM
Issue:
GP Sig.
GP Sig.
F = Other (define)...........................................................................................................................................................................................................................................................................

GP Sig.
Commenced
www.opuspharmserve.com Route recd. quantity
info@opuspharmserve.com
by
53

D.O.B: 1/5/1940

Doctor: Dr A Smith
JM EJ
08.00 JM E J
100ml
100ml MorphineSulphate
Morphine Sulfate Oral
OralSolution
Solution 5ml 5ml
10mg/5ml
10mg/5ml 12.00
JM
JM EJ
E J
2,5ml 5ml
2.5ml - 5ml to be taken when required 17.00

Warning: This medicine may make you sleepy.
22:00
If this happens, do not drive or use tools or
machines. Do not drink alcohol
GP Sig.
Commenced 10/10/20XX Route oral recd. 24/2/20XX quantity 1 00ml by JM
Issue:
The dose of Morphine Sulfate is specified on the Medication Record as 2.5ml – 5ml. Since
this is a variable dose, the “actual” dose given should be recorded on the Medication Record
GP Sig.
each time e.g. at

Commenced the pointrecd.
Route shown by thequantity
arrow (close
by to your initials). You will need to refer to
the person’s PRN protocol for details.

1/5/1940
GP Sig.
Commenced Route Start Date: 26/2/20XX quantity
recd. Date: 26/3/20XX
End by Start Day: Monday
Doctor: Dr A Smith
08.00 1 JM JM JM JM JM JM JM JM JM JM
112 Sinemet Plus Tablets
12.00 1 AF AF AF AF JM AF AF JM AF AF
ONE to be taken FOUR times a day
17.00 1 CL CL CL CL J M CL A F CL CL CL
22:00 1
GP Sig.
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 112 by JM
Issue:
George Brown is prescribed one Sinemet Plus tablet four times a day. The MAR shows that
GP Sig.
he is only taking
Commenced Route a tablet three recd. times a day. quantity He should by be having a tablet before bed also. You
GP
will need to investigate
A Sig.
= Refused
Commenced Route
why
B = Nausea or vomiting
recd.
he has onlyquantity been receiving C = Hospitalised
by
a tablet threeDtimes =
a day rather than
Social leave
F = Other (define)...........................................................................................................................................................................................................................................................................
four times a day or whether staff have made a recording error.
GP Sig.
54
Commenced www.opuspharmserve.com
Route recd. quantity by info@opuspharmserve.com
Medication Records
Write down any issues with this medication record on the next page.

1/5/1920

Doctor: Dr A Smith
08.00 5 JM JM JM JM JM JM JM
100ml Amoxicillin 250mg/5ml SF Liquid
12.00 5 JM JM JM SL SL SL SL
ONE 5ml spoonful to be taken THREE times
a day for 5 days 17.00 5 AB AB AB AB AB AB
Take regularly and complete the course
22:00
Shake the bottle
GP Sig.
08.00
28 Sertraline 50mg Tablets
12.00
One to be taken at NIGHT
17.00
22:00 2 SL SL SL SL AB JM JM JM SL SL
GP Sig.
Commenced 10/10/X0XX Route oral recd. 24/2/20XX quantity 28 by JM
08.00 JM JM SL SL AB AB JM SL
500ml Lactulose Solution
12.00 F A F A
TWO 5ml spoonfuls to be taken when
required 17.00 F A
22:00 JM JM SL AB JM SL A
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 5 00ml by JM
08.00 JM
100 Paracetamol Tablets
12.00
ONE or TWO to be taken when required
17.00 JM
Not more than 8 in 24 hours
22:00
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 1 00 by JM
08.00 1
10 Trimethoprim 200mg Tablets
12.00
One to be taken TWICE a day
17.00 1
22:00
GP Sig.
Commenced 10/10/20XX Route recd. quantity by
F = Other (define)...........................................................................................................................................................................................................................................................................
Use the space below to make a note of any issues you find with the medication record on the
previous page.
Issues
Amoxicillin
Sertraline
Lactulose
Paracetamol
Trimethoprim

D.O.B: 1/5/1940

Doctor: Dr A Smith
08.00 5 JM JM JM JM JM JM JM
100ml Amoxicillin 250mg/5ml SF Liquid
12.00 5 JM JM JM SL SL SL SL
ONE 5ml spoonful to be taken THREE times
a day for 5 days 17.00 5 AB AB AB AB AB AB
22:00
Shake the bottle
GP Sig.
08.00
28 Sertraline 50mg Tablets
12.00
One to be taken at NIGHT
17.00
22:00 2 SL SL SL SL AB JM JM JM SL SL
GP Sig.
Commenced 10/10/X0XX Route oral recd. 24/2/20XX quantity 28 by JM
08.00 JM JM SL SL AB AB JM SL
500ml Lactulose Solution
12.00 F A F A
TWO 5ml spoonfuls to be taken when
required 17.00 F A
22:00 JM JM SL AB JM SL A
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 5 00ml by JM
08.00 JM
100 Paracetamol Tablets
12.00
ONE or TWO to be taken when required
17.00 JM
Not more than 8 in 24 hours
22:00
GP Sig.
Commenced 10/10/20XX Route recd. 24/2/20XX quantity 1 00 by JM
08.00 1
10 Trimethoprim 200mg Tablets
12.00
One to be taken TWICE a day
17.00 1
22:00
GP Sig.
F = Other (define)...........................................................................................................................................................................................................................................................................
See notes on page 58 for explanations
Issues
Amoxicillin
The dosage instructions state that the amoxicillin should be given for 5 days. The MAR shows
that it has been administered for 7 days. Also note the times of administration. Antibiotics
need to be given at regular intervals.
Sertraline
The MAR has been printed incorrectly. The dosage instructions indicate that one tablet
should be taken but the MAR shows 2 tablets beside the time of 22.00. This is confusing and
should be rectified.
Lactulose
There is no consistency in how it is recorded when George Brown does not take the
lactulose. Some staff have left it blank, some have put A for refused and some have put F for
other. It is important to be consistent. Also, the exact time of administration has not been
recorded. Refer to the PRN protocol and the care plan for details.
Note: Lactulose takes 2 days to work. If it is prescribed “PRN” (when required), it should be
given “when required” for a period of time to enable it to work in the best way.
Paracetamol
The dosage instructions indicate that George Brown should take one or two tablets so the
actual dose (one or two) needs to be recorded. Refer to the PRN protocol. The exact time of
administration should also be recorded.
Trimethoprim
Nothing has been recorded for Trimethoprim – no doses being administered and no stock
being signed in. If the course has already been completed then the entry should be removed
from the MAR or marked as discontinued.
Checking Medication Records
Here is another complete MAR for the same person. Write down any issues you find on the
next page.

Doctor: Dr A Smith
Medication Profile Time/Dose M T W Th F S S M T W Th F S S
08:00 X SL SL SL SL SL
10 Scopoderm TTS Patches
12:00
ONE to be applied every 72 hours
17:00
For External Use Only
22:00
GP Sig.
08:00 X SL JW JW SL JW K H K H SL K H K H SL K H K H
10ml Novorapid Insulin 100iu/ml
10iu 12:00 X JM JM JM JM OT OT OT SW SW SW SW SW SW
20 units to be given in the
17:00
MORNING and at LUNCHTIME
Changed by Dr Smith 22:00
GP Sig.
08:00 X SL JW JW JW SL JW K H K H SL K H K H SL K H
4g Chloramphenicol Eye Ointment
12:00
Apply TWICE daily
17:00
Discard 28 days after opening
22:00 X F F ZL ZL ZL F JW F F JW JW JW JW
GP Sig.
168 Co-codamol Tablets 08:00 2 SL JW JW SL JW K H K H SL K H K H SL K H K H
TWO to be taken THREE times a day 12:00 2 JM JM JM OP OP OP OP SW SW SW SW SW SW
Do not take more than 2 at any one time. Do not take more than 8 in 17:00 2 ZL ZL ZL ZL ZL ZL BH BH BH ZL ZL K H SW
containing paracetamol while taking this medicine. Talk to a doctor
at once if you take too much of this medicine, even if you feel well.
22:00
Warning: This medicine may make you sleepy. If this happens, do
not drive or use tools or machines. Do not drink alcohol.
GP Sig.
F = Other (define) Sleeping
Use the space below to make a note of any issues you find with the medication record on the
previous page.
Problems
Scopoderm
Novorapid®
Chloramphenicol
Co-codamol


Doctor: Dr A Smith
Medication Profile Time/Dose M T W Th F S S M T W Th F S S
08:00 X SL SL SL SL SL
10 Scopoderm TTS Patches
12:00
ONE to be applied every 72 hours
17:00
For External Use Only
22:00
GP Sig.
08:00 X SL JW JW SL JW K H K H SL K H K H SL K H K H
10ml Novorapid Insulin 100iu/ml
10iu 12:00 X JM JM JM JM OT OT OT SW SW SW SW SW SW
20 units to be given in the
17:00
MORNING and at LUNCHTIME
Changed by Dr Smith 22:00
GP Sig.
08:00 X SL JW JW JW SL JW K H K H SL K H K H SL K H
4g Chloramphenicol Eye Ointment
12:00
Apply TWICE daily
17:00
Discard 28 days after opening
22:00 X F F ZL ZL ZL F JW F F JW JW JW JW
GP Sig.
168 Co-codamol Tablets 08:00 2 SL JW JW SL JW K H K H SL K H K H SL K H K H
TWO to be taken THREE times a day 12:00 2 JM JM JM OP OP OP OP SW SW SW SW SW SW
Do not take more than 2 at any one time. Do not take more than 8 in 17:00 2 ZL ZL ZL ZL ZL ZL BH BH BH ZL ZL K H SW
containing paracetamol while taking this medicine. Talk to a doctor
at once if you take too much of this medicine, even if you feel well.
22:00
Warning: This medicine may make you sleepy. If this happens, do
not drive or use tools or machines. Do not drink alcohol.
GP Sig.
F = Other (define) Sleeping
See notes on page 62 for further explanation
Issues
Scopoderm
The patch has not been applied consistently every 72 hours (every 3 days). There is a larger
gap between doses on one occasion indicated by the arrow.
Novorapid®
The dose has been changed by the prescriber but there is no indication of when the dose
was changed. The new dose should be written in full - 10 units.
Chloramphenicol
The second dose is not always given at night as the person is asleep (marked as F Other).
You need to consult the prescriber or Pharmacist, because the person is not getting their full
dose of antibiotic eye ointment. The prescriber may ask you to change the timing of the dose
or may prescribe an alternative.
Co-codamol
This person also takes paracetamol when required (see previous MAR on page 58). You need
to take care to avoid an overdose. The combined maximum adult dose of paracetamol and
co-codamol combined is 2 tablets every 4 hours up to a maximum of 8 tablets in 24 hours.
Also think about the timings of the co-codamol doses; could they be spaced more evenly
over a 24 hour period?
Summary
This is the end of the section on medicines management and auditing.
You should now be able to:
; Describe characteristics of excellent medicines management
; Describe characteristics of poor practice in medicines management
; Respond appropriately to a variety of medicines issues
; Recognise and take steps to prevent incidents arising in your care setting
; Identify recording and administration errors on MARs
; Ensure the best outcomes are achieved for people through efficient management and
auditing of medicines
Your Notes...
SECTION THREE
COMPETENCY ASSESSMENT
Coaching and Mentoring
Before looking at competency assessment, it is important to consider the way you

communicate with and support your staff.
Coaching and mentoring are skills which are essential if you are involved with competency
assessment of staff and successful handling of medicines errors and incidents.
Definitions
Mentoring is a relationship between an experienced person and a less
experienced person for the purpose of helping the one with less experience.
Coaching means unlocking a person’s potential to maximise their

performance by “helping them learn” and supporting them rather than
teaching them.
Coaching
With the definition above in mind, which of the words below do you think describe the qualities
of a person who is a good coach? Tick the ones that apply and cross the ones that do not
apply.
awareness problem
supportive
raiser solver
good
attentive patient
listener
gives clear
interested
instructions

62
9 supportive 9 awareness
raiser
 problem
solver
9 attentive 9 patient 9 good

listener
 gives clear
instructions
9 interested

Notes:
Notes:
1 A coach is not the same as a teacher. A coach brings knowledge out of you that is
already there. A teacher provides you with new knowledge and skills.
A coach is not the same as a teacher. A coach brings knowledge out of you that is
1
already
A coachthere.
does A teacher
not provides
try to solve youryou with new
problems, knowledge
but helps you and skills.
learn to solve them
2
yourself.
A coach does not try to solve your problems, but helps you learn to solve them
2
yourself.
It is useful to use coaching principles when you are assessing competency or dealing
3
with a medicines incident with a staff member.
It is useful to use coaching principles when you are assessing competency or dealing
3
with a medicines incident with a staff member.
Your Notes...
Your Notes...
63 www.opuspharmserve.com info@opuspharmserve.com 65
©
©Copyright
Copyright2023
2021OPUS
Opus Pharmacy Services Ltd. All rights reserved.
Questioning Techniques
When you coach, you need to ask open questions, which encourage staff to provide you with a
full answer, rather than a simple “yes” or “no”. This means using words like ‘how’, ‘what’, ‘who’
rather than ‘did’, ‘do’, ‘can’.
Which of these questions are good coaching questions:
Question
? Do you think you did that correctly? Good Bad
? What do you think went well? Good Bad
? What would you do differently next time? Good Bad
Question
? Do you think you did that correctly? Good Bad
? What do you think went well? Good Bad
? How could you do better next time? Good Bad
Notes:
The first question is closed, the person can simply answer yes or no. The next two are open
and require the person to think more carefully and give a full answer.
Your Notes...
Feedback Model of Coaching
After competency assessing a staff member, you will need to give them feedback. Structuring
your feedback using the following six steps (incorporating the principles of coaching) can give
you a better understanding of the staff member's knowledge and awareness.
Possible questions you could ask your care workers about their thoughts on
their performance
1 What do you think went well?
2 What do you feel was tricky?
3 What would you do differently next time?
A question to ask care workers to see if they would like to hear your thoughts
about their performance
4 Would you like feedback from me?
Your thoughts on their performance
5 Here’s what I thought went well...
6 Here’s what I think you might do differently next time...
There is an example of how you can use this technique on the following page.
Example
Consider this scenario. The manager is observing the care worker administer eye drops to a
person.
Read the interview and think about what feedback the manager could give the care worker
about how to do things better next time. Write your ideas in the space provided.
Manager Care Worker

I washed my hands before opening the new
bottle of eye drops. I read the label carefully
What went well?
and I recorded on the MAR when I had
administered the drops.
I had to instil 2 drops and a lot of liquid

And what was tricky?
seemed to run down the person's cheek.
I would take my time, not rush and be a bit

What would you do differently next time?
more careful.
Would you like some feedback from me? Yes, that would be helpful.
You did some things really well. You checked

the label very carefully and I could see that
Here's what I thought went well you had checked the 6 rights. You made the
record after you had administered the drops,
which was good.
This is what I think you might do differently next time...
Answer to activity on page 69
This is what I think you might do differently next time...
As it is a new bottle and these eye drops only have a life of 28 days, you should mark the date
of opening on the container to ensure the eye drops are only used when they are in date.
As the dose is 2 drops, you should administer one drop then leave a few minutes for the eye
to clear before administering the second drop.
If you administer 2 drops at the same time, one drop will just wash the other drop out and it
will run down the person’s cheek.
If administered correctly, the person will then receive the correct dose and the best outcome
will have been achieved.
Action
Practise this coaching technique when you are discussing medicines issues with your
staff.
Your Notes...
Assessing Competence
It is an important part of the job of managers and senior staff to support care workers, to help
them develop their knowledge and skills and to assess their competence in a variety of tasks
including medicines handling.
It is only necessary to assess a person’s competence on the tasks they are actually
undertaking.
This section is about how to assess the competence of your staff in administering medicines
and other medicines-related tasks.
Competency assessment tools are a useful way of ensuring that all aspects of medicines
handling are assessed and provide evidence of a care worker’s competence.
Download the OPUS Competency Assessment Tool for Medicines Handling

from: opuspharmserve.com/distance-learning-additional-resources/
Action
Have a look at the OPUS Competency Assessment tool. This tool can be adapted to
your organisation's needs.
The competency assessment is divided into three sections:
Section 1 Section 2 Section 3
Section 1 can be used Section 2 can be used Section 3 contains a

for care workers who where care workers knowledge check on
are supporting administer medicines, medicines procedures
people with self- including tablets,
administration capsules, liquids,
creams, eye drops and
inhalers
Assessing Competence
There are some important general issues about competency assessment. Answer the
following questions. It doesn't matter if you don't get it all right, we will discuss competency
assessment in more detail in this section.
Question 1: How should you assess competence?
Observation
Questioning
Either observation, or questioning or both
Question 2: When should you assess competence?
Every year
Not at all
If competence is in doubt
Following training and shadowing
Question 3: Who should be responsible for assessing competence?
The manager
A care worker who has just had medicines training

A senior member of staff or a manager who is up to date with medicines handling
procedures, and holds an in-date Assessors certificate
Question 4: What happens if you assess a care worker as competent and they make a mistake
the next day?
Coach and support the care worker. Establish the reason for the error. Retrain and
reassess
Your organisation will be considered as non-compliant
Take no further action
Question 1: How should you assess competence?
Observation
Questioning
Either observation or questioning or both
Note:
As you can see, there is no set way of assessing competence. You will need to adopt the
approach that is most appropriate and best suited to your situation.
Question 2: When should you assess competence?
Every year
Not at all
If competence is in doubt
Following training and shadowing
Note:
There are no definite timescales for how often you should assess competence.
Competency assessment best practice:

• You need to be able to evidence that a formal process is in place and the best outcomes
are being achieved for people.
• Skills for Care recommends competency assessing at least annually.
• Suggested times may be following training and shadowing and then yearly or if a care
worker’s competence is in doubt.
• The timescale for assessing competence should be stated in your medicines policy.
The manager
A care worker who has just had medicines training

A senior member of staff or a manager who is up to date with medicines handling
procedures, and holds an in-date Assessors certificate
Question 4: What happens if you assess a care worker as competent and they make a mistake
the next day?
Coach and support the care worker. Establish the reason for the error. Retrain and
reassess
Your organisation will be considered as non-compliant
Take no further action
Note:
Having a formal system of training and a regular competency assessment process in place, as
well as actioning errors or incidents are key ways to show evidence of compliance.
Your Notes...
FAQs: Training and Competency Assessment
Here are some frequently asked questions about training and competency assessment:
What is the difference between medicines training, refresher training and

competency assessment?
Accredited medicines training gives the care worker the basic knowledge and
awareness of medication issues. Refresher training is required to ensure care
workers are updated with the latest procedures and guidelines.
Competency assessment is designed to ensure care workers put their

knowledge into practice on a day-to-day basis. The table below shows our
recommendations for training and competency assessment.
Suggestions of when it
Training Who should complete it
should be done
New staff Induction
Identify training needs

Staff who have made a
following the error and retrain
medication error
OPUS foundation medicines immediately
training
Staff who lack knowledge Immediately
Staff who have received other Assess competence and

medicines training identify training needs
Staff who have previously Recommended every 2 years

Refresher training
been trained or according to your policy
After training and shadowing,

then annually, unless
Competency assessment All care staff
competence is in doubt e.g.
following a medication error
Who should be responsible for assessing competence?
It is essential that any person who assesses competence is familiar with

current medicines procedures and guidelines. This may well be the manager
or a senior member of staff, who also holds an in-date Assessors certificate.
How can competence be assessed?
There are generally 4 ways competence can be assessed, often more than
one method is used.
Direct observation by a senior member of staff using a paper-based or

1
electronic competency assessment tool
2 Questioning by a senior member of staff (in conjunction with observation)
3 Setting up a scenario and testing understanding of procedures
4 Online competency assessment
What is the online competency assessment process?
1. Watch Videos 2. Identify Errors 3. Answer Questions 4. Competency

Assessed
Watch a series of Note errors in Respond to a series of Receive a Learning

medication scenario the medication scenario-based Needs Report and proof
videos administration process questions of competence
What are the advantages of online competency assessment?
The advantages are:
Time saving – it takes approximately 30 minutes to complete so care staff only need
1
to be released for a short period of time
2 Consistency – it ensures all care workers are assessed in the same way
No senior staff time is required during the process. A Learning Needs Report identifies
3 where a care worker is competent and identifies any outstanding training needs they
may have. After the assessment is complete, a discussion takes place between the
line manager and the care worker.
Suggested Activity:
If you would like to assure yourself that you are competent and up to date, before you assess
the competence of your staff, an Advanced Online Competency Assessment is available to
purchase through the OPUS website: opuspharmserve.com/opus-competency-assessment-
overview/
Following the competency assessment, you will receive a learning needs report which identifies
where you are competent and any areas that require further training.
Is the online competency assessment recognised by CQC?
Yes. CQC requires you to demonstrate and evidence that outcomes are being
met for people with regard to their medicines. A Learning Needs Report
is produced as evidence of who is competent in each area of medicines
handling to enable these outcomes to be met. This can be used to evidence
the competence of your staff.
Who assesses the assessor?
Assessors can also complete the advanced online competency assessment

as part of their training pathway. Attending an Assessors Workshop and
completing a peer to peer check after one year will support the assessor in
their role.
Completion of the OPUS Safe Handling of Medicines Foundation e-learning

will ensure assessors are up to date with current procedures and guidelines.
To view a demo of the e-learning, email info@opuspharmserve.com
Your Notes...
What is the procedure in practice for competency assessment?
Take the following steps:
Before you assess anyone, make sure you are familiar with all current medicines
1
procedures and guidelines.
2 Reassure the care worker and tell them that they are being assessed.
3 Decide how you are going to assess (e.g. observation, questioning, scenarios, online)
If you are assessing by observation then witness the care worker administering
4 medicines to a person as follows:
i) Ask them to complete the process of medicines administration in the way they
normally would.
ii) Observe using a competency assessment tool as your reference. Mark off what
you saw during observation; you may also decide to ask open questions to clarify
or add to your observations.
iii) Give feedback.
iv) Set a time for reassessment.
Consider the case studies on the following page.
Competence Case Studies
You are assessing a care worker, Salma Begum, on a variety of tasks. Read the scenarios then
write down what factors you would be looking out for in assessing Salma’s performance.
Scenario 1: Prompting Observations
Salma is supporting a person

with their medicines. She is
required to prompt the person to
take tablets and use an inhaler.
Scenario 2: Administering Observations

Liquids and Creams
Salma is administering a
liquid medicine and a cream
to a person. As well as all the
factors considered in scenario
1 above, what else would you
be looking out for?
Scenario 3: A Year After Observations

Training
Salma has been administering

medicines for some time – she
was trained a year ago. What
issues other than the ones
above would you be looking
for?
Scenario 1: Prompting Observations
Salma is supporting a person ; Has good communication skills and

with their medicines. She is empathy with the person
required to prompt the person
; Reads and understands the care plan and
to take tablets and use an
what her role is
inhaler.
; Has an awareness of medicines even
though she is not administering
; Records any actions she takes (e.g. date

and time of the prompt)
; Knows when to feed back any issues
; Understands person-centred care
; Ensures the person is comfortable
Scenario 2: Administering Observations

Liquids and Creams
; Has good communication skills and
Salma is administering a liquid empathy with the person
medicine and a cream to a
; Reads and understands the care plan and
person. As well as all the factors
what her role is
considered in scenario 1 above,
what else would you be looking ; Reads the label
out for?
; Follows the correct administration
procedure for liquids and creams
; Records administration on the MAR
; Has an awareness of medicines
; Knows when to feed back any issues
; Understands person-centred care
; Ensures the person is comfortable
Scenario 3: A Year After Observations

Training
You would need to:
Salma has been administering
; Ensure that she still follows the correct
medicines for some time – she
medicines administration procedure i.e. she
was trained a year ago. What
has not become complacent or developed
issues other than the ones
shortcuts
above would you be looking for?
; Ensure she has an understanding of current
procedures and guidelines
; Identify any training needs
SECTION FOUR
INCIDENT MANAGEMENT
A medication error is a mistake someone makes when administering a medicine e.g. giving
the wrong dose. A medication incident is an event that involves a person's medicines that is
not an error e.g. liquid medicine spilled.
It is essential to have clear procedures and processes in your service for managing medicines
errors and incidents. Staff need to know what to do in the event of a medication error or
incident and how to report it to management.
In England, Regulation 18: Notification of other incidents is about notification of safety

incidents in a care setting and sets out when CQC needs to be informed.
TIP: Make sure you are familiar with when to notify your regulator
CQC must be informed without delay about any events that cause:
y Any injury to a person resulting in:
» an impairment of the sensory, motor or intellectual functions of the person which is

not likely to be temporary
y Changes to the structure of a person’s body
y The person experiencing prolonged pain or prolonged psychological harm
y The shortening of life expectancy of the person
y Any injury to a person requiring treatment to prevent
» death of the person
» an injury if left untreated would lead to one or more of the above
This list is not exhaustive - see Regulation 18: Notification of other incidents
What to do when a medicines incident has occurred
When a medicines error or incident occurs in your organisation it is important that you get to
the root cause of it and do whatever you can to make sure it does not happen again. When a
medicines error or incident occurs you should do the following:
1 Meet with the care worker/team about the incident as soon as possible.
2 Consider all the factors that could have contributed to the error.
3 Prioritise the key factors.
4 For each key theme, decide what actions would reduce the risk of recurrence.
Create an action plan with responsibilities and realistic timescales; put it into
5
place and review.
Case Study - Incident Management
To help you understand these steps, let’s look at an example:
John and Edith Evans share a room.

John lives with diabetes and Edith
lives with dementia. Yesterday John
was given one of Edith’s tablets in
error.
Let's work through the steps....
Meet with the care worker/team about the error as

Step 1 soon as you can.
Soon after an error has occurred, people start to forget the details. The sooner you can
discuss it and make a note of what happened, the more accurate your information will be.
You should not focus on attributing blame to any particular person. To do this would only
encourage staff to cover up their mistakes which would not be in the best interests of the
people you support.
Step 2 Consider all the factors that could have contributed to the error.
Contributory Factors
Contributory Factor
Interruptions from the person
Care worker rushing due to lateness or staff shortage
Similar looking tablets










Contributory Factor
Interruptions from the person
Care worker rushing due to lateness or staff shortage
Similar looking tablets
Untrained staff
Dispensing error from pharmacy
Poor lighting
Care worker not concentrating
Complacency
Care worker forgot their glasses
Distraction due to personal problems
Not following administration procedure
Not checking medication record
Tablets stored together
This list is not exhaustive, you may have thought of other factors that could have contributed
to the error.
Step 3 Prioritise the key factors that are part of the error.
Key factors can be things like:
Î Poorly trained staff
Î Inadequate procedures in place
Î Poor communication within the organisation
Î Complacency of staff
You will need to decide which factors are the most important for each particular error.
Step 4
For each key factor, decide what actions would reduce the risk of
recurrence.
An example is shown below.
Contributory factor Action
Refresher training on medicines procedures and

Poorly trained staff
competency assessment
Note on timescales and responsibilities - you will need to determine:
Î Realistic timescales for each action (e.g. a staff meeting would take place the week of
the error or incident, whereas a review of the procedures may take longer)
Î Who is responsible for taking the action
Î Dates when actions should be completed
Î Review dates
Reflection: Consider appropriate actions for the remaining key factors identified
above. Then look at the following page for a suggested action plan.
Suggested Action Plan
Contributory factor Action

Refresher training on medicines procedures and
Poorly trained staff
competency assessment
Inadequate procedures Review all medicines procedures. Ask OPUS for advice
Poor communication within the Regular staff meetings and briefings.

organisation Detailed handovers.
Staff meeting to highlight the importance of medicines

Complacency
issues.
Your Notes...
USEFUL RESOURCES
To help you manage medicines outcomes and evidence compliance, here is a list of useful
resources:
Document Name Description

• NICE: Managing Medicines in Care How to handle medicines in specific settings
Homes (SC1)
nice.org.uk/Guidance/SC1
• NICE: Managing Medicines for
nice.org.uk/guidance/ng67
People Receiving Social Care in the
Community (NG67)
CQC guidance document

Guidance for Providers
cqc.org.uk
Guidance on the management of medicines
Other standards also apply
Regulation 12, Fundamental Standards
cqc.org.uk/guidance-providers/regulations-
enforcement/regulation-12-safe-care-treatment
Guidance on notification of incidents (England)
CQC Registration Regulations

Regulation 18
cqc.org.uk/guidance-providers/regulations-
enforcement/regulation-18-notification-other-
incidents
An electronic or paper-based tool for carrying out

In-house Medicines Audit Tool*
a medicines audit
Competency Assessment for Medicines An electronic or paper-based tool for assessing

Handling* competence
*Available for download on our website: opuspharmserve.com/distance-learning-additional-

resources/
SELF-ASSESSMENT CHECKLIST
When you have completed all the sections in this workbook, you will be able to
complete the following self-assessment checklist:
I have completed the Competency Assessment, Auditing and Managing Medication: An

Advanced Distance Learning Workbook & Resource Pack which had the following learning
outcomes:
Recognising the characteristics of an excellent service
Identifying aspects of poor medicines practice
Describing how to deal with a wide variety of medicines

management and audit issues
Undertaking competency assessment in my care setting
Undertaking the incident management process
Producing an action plan to improve medicines handling in

my service
I have completed the following:
Completed all of the workbook topics
Undertaken all of the activities and checked my answers
Assessment
You should now be ready to take the assessment. You may refer to this
workbook during the assessment.
Before you take the assessment, complete the action plan on page 91, then go to
page 92 to find instructions for taking the assessment.
Good luck!
PUTTING YOUR LEARNING INTO ACTION

Congratulations you have completed the workbook! We hope you enjoyed the Competency
Assessment, Auditing and Managing Medication: An Advanced Distance Learning Workbook
& Resource Pack. Please take a few minutes to consider how you will put your learning into
practice.
When By
Action Actions
by whom
Understanding your
responsibilities
Coaching
Assessing
Competence
Medicines
Management and
Auditing
Incident Management
General
NEXT STEP: ACCESSING YOUR

ASSESSMENT
All assessments are completed online
What do I need to complete my assessment?
9 A computer, tablet or smartphone with a secure internet connection
9 Your login details and login instructions
How do I get my login details?
If your workbook was purchased by your organisation
Î Your organisation will send you your log in details and instructions by email.
If you purchased your workbook as an individual
Î Your login details with instructions of how to login were sent to the email address
you referenced when purchasing.
If you haven’t received them for any reason, firstly please check your spam emails.
If you still can't find your login details or you provided the wrong email address, please contact
us at assessments@opuspharmserve.com and we will resend them to you.
What Happens Next?
Following successful completion of the assessment, you (and your Manager) will be able to:
9 Access your certificate through the portal
9 Download or print a copy of your certificate to keep.
Best of Luck!
SUPPORT FROM OPUS
Other support available from OPUS Pharmacy Services for you

and your care staff include:
E-Learning
Î Safe Handling of Medicines Foundation and Refresher medicines courses for:

• Care homes • Homecare • Extra care • Supported living • Day care • Foster care
Distance Learning Workbooks
Î Safe Handling of Medicines Foundation Workbooks for:

• Care Homes including Learning Disability Services
Î Homecare & Reablement Medicines including
• Extra care • Supported living • Day care
Online competency assessment - Foundation & Advanced
Virtual and Face to Face courses by Pharmacist Trainers

Î Safe Handling of Medicines Foundation, Intermediate & Advanced
Î Refresher medicines courses
Î Medicines Management and Audit
Î Assessors Workshop for Medicines Handling
Î Medical Conditions
Î Managing Medicines for People with Dementia
Î Infection Control
Medicines Audit Services
Medicines policy writing and review
FREE pharmacist advice and support – contact info@opuspharmserve.com
To view our full range of courses and services, visit our website:
opuspharmserve.com
Visit the Download section of our website to see the variety of useful forms and documents
that you can download to help you manage medicines in your care service.
If you have enjoyed this workbook and would like to undertake further distance
learning, we have the following distance learning workbooks available in this
series:
Understanding Medicines in Parkinson’s Disease
Understanding Medicines in Schizophrenia
Understanding Medicines in Anxiety & Sleep Disorders
Understanding Medicines in Depression and Bipolar Disorder
Understanding Medicines in Dementia
Administration of Warfarin
Administration of Buccal Midazolam
Understanding Medicines in Diabetes
Anaphylaxis and the Use of Adrenaline Auto-Injectors
Transcribing Course
Supporting People with Swallowing Difficulties (Dysphagia)
For details, visit our website: www.opuspharmserve.com

or e-mail: info@opuspharmserve.com
or call 0333 939 0053
Sign up to our newsletter and receive important updates and also gain access to
FREE downloadable resources.
OPUS Pharmacy Services
@OpusPharm
@Opuspharmserve

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ABBREVIATIONS USED IN THIS WORKBOOK

CI Care Inspectorate (Scotland)

CIW Care Inspectorate Wales

CQC Care Quality Commission (England)

MAR Medication Administration Record

NICE National Institute for Health and Care Excellence

PRN 'pro re nata' - Latin for 'when required'

GP General Practitioner (the person's doctor)

CPN Community Psychiatric Nurse

INTRODUCTION AND LEARNING

On completion of this pack, you will be able to:

; Describe the characteristics of an excellent service

; Discuss aspects of poor medicines practice

; Demonstrate how to complete a competency assessment in your care setting

; Explain the incident management process

; Produce an action plan to improve medicines handling in your service

UNDERSTANDING YOUR RESPONSIBILITIES

In 2015 in England, CQC introduced a set of fundamental standards

Understanding the Regulations

Regulation 12 is about Safe Care and Treatment.

Regulation 12 states that you must make sure:

Care is provided in a safe way

There is proper and safe use of medicines

You consult nationally recognised guidance

Carers are effectively trained and competency checked.

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Will fill in later

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Your organisation should always have "sufficient quantities of medicines

Look at the case study below:

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We will look at incident management in more detail later in the workbook.

"Consulting nationally recognised guidance" means referring to current best

Support people to make informed decisions

Have a clear process for safeguarding

Make sure you are familiar with all of them.

Person-centred care Safeguarding

Meeting nutritional and

Need for consent Good governance

Safe care & treatment Duty of candour

Safeguarding is described as “keeping people safe”.

What do you think may be classed as a safeguarding issue with medicines?

NICE guidance states that safeguarding issues with medicines include:

Deliberate withholding of a medicine without a valid reason

Deliberate attempt to harm through the use of a medicine

Accidental harm caused by incorrect administration or medication error

Local safeguarding arrangements vary; be aware of your local requirements!

It is important to keep up to date as procedures and guidelines change. It is also important

5 describe the agreed ways of working in relation to medication

5 describe the agreed ways of working in relation to healthcare tasks

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Here are some more suggestions:

Î Make sure you have detailed care plans in place

You will find more suggestions in the appropriate NICE guidance.

Return to question on page 6

Î Have a clear medicines policy with procedures

Return to question on page 7

Î Medicines not reordered

Return to question on page 7

Please note that this list is not exhaustive.

OPUS Competency Assessment, Auditing & Managing Medicines Online Interactive Workbook

OPUS Competency Assessment, Auditing & Managing Medicines Online Interactive Workbook