Medications are substances that are given in order to prevent, diagnose, cure, control or alleviate disease, or improve a person’s physical or mental wellbeing. Medications can be prescription and non-prescription and include complementary healthcare products (APAC 2006).

Medications are crucial in maintaining health, preventing illness and treating health conditions - but when used inappropriately or incorrectly, they pose a serious risk of harm (TAS DoHHS 2016).

For this reason, workers employed by National Disability Insurance Scheme (NDIS) providers must be able to competently manage medications for participants who require them.

What is Medication Management?

Medication management takes place at both an individual level and a system level. It may include:

• Selecting, ordering and supplying medications
• Recording and reviewing medications
• Storing and disposing of medications
• The way in which people take medications or are assisted to take them
• Supporting, monitoring and evaluating the use of medications.

(TAS DoHHS 2016)

Types of Medications

Medications come in a variety of forms. Workers may need to administer:

• Tablets
• Capsules
• Wafers or melts
• Pastilles or lozenges
• Oral liquids
• Topical skin preparations
• Eye and ear drops
• Nasal drops or sprays
• Inhalants
• Transdermal patches.

(NDS 2016)

Management of Medication in the NDIS Practice Standards

Management of medication is a requirement of the NDIS Practice Standards, under Core Module 4: Provision of Supports Environment.

This Practice Standard aims to ensure that NDIS participants feel confident that their provider administers, stores and monitors the effects of the medications being administered, and that providers work to prevent errors and incidents (NDIS 2020).

Management of Medication Quality Indicators

NDIS providers must meet the following quality indicators:

• The provider’s records clearly state the medications and dosages required by each participant, including all information required to correctly identify the participant and safely administer the medication
• Workers who are responsible for administering medications understand the potential effects and side effects of medications and know what steps to take if an incident involving a medication occurs
• Medications are safely and securely stored, can be easily identified and differentiated, and can only be accessed by appropriately trained workers.

(NDIS 2020)

Medication Administration Records (MAR)

Medication Administration Records (MAR) are used to monitor, review and reconcile a person’s medication information and administration (TAS DoHHS 2016).

MARs are essential in reducing medication errors and incidents. They also:

• Support safe prescribing and administration
• Improve communication
• Ensure continuity in treatment between differing support settings.

(TAS DoHHS 2016)

A participant’s MAR should be a current, accurate and reliable record of all their medications. This should include all prescription, non-prescription, complementary and alternative medications being used by the participant (TAS DoHHS 2016).

NDIS Providers must ensure that MARs clearly state each participant’s required medicines and dosages. Information that is required to correctly identify participants and safely administer medicines must also be included (NDIS 2020).

Safe Medication Administration

In order to safely administer medicines, all workers must adhere to the following checking process known as the 13 Rights of Medication Administration:

1. Right Person
2. Right Medication
3. Right Dose
4. Right Route
5. Right Time
6. Right Effect
7. Right Documentation
8. Right Reason
9. Right Expiration Date
10. Right of the Person to Refuse
11. Right Education
12. Right Assessment
13. Right Evaluation

(Ausmed 2019)

All medication administration should be documented (TAS DoHHS 2016).

Medication Effects and Side-Effects

Before administering medication, a worker should, as far as possible, understand:

• The reason why the individual is taking each medication
• How the medication should be administered
• Potential side effects and interactions with other medications.

(TAS DoHHS 2016)

This information can be provided by the participant’s pharmacist directly or via written information, for example, a consumer medicine information (CMI) leaflet.

CMI leaflets contain information on the safe and effective use of prescription and pharmacist-only medications. They provide information aimed at bringing about better health outcomes.

For more information on medications, search the NPS MedicineWise website.

Medication Incidents

A medication incident is ‘any event where the expected course of events in the administration of medications is not followed’ (TAS DoHHS 2016).

Medication incidents include:

• Giving medication to the wrong person
• Giving the wrong medication
• Giving the wrong dose
• Giving medication at the wrong time
• Giving medication via the wrong route
• Missing a dose or giving an incomplete dose
• Spilling or dropping medication
• Losing a medication
• Medication being out-of-date
• The participant refusing medication or requesting not to be given medication
• A near miss.

(TAS DoHHS 2016)

How to Respond to a Medication Incident

Note: The following is intended as a guide only. Always refer first to your organisation’s policies and procedures for the most appropriate course of action.

1. Stay calm.
2. Acknowledge that an error has been made. Try to identify the nature of the error and the cause of the error.
3. Call an ambulance if the situation is an emergency.
4. If appropriate, perform first aid as per DRSABCD.
5. Call a colleague and/or your supervisor for advice and assistance.
6. If the situation is not an emergency, continue to monitor the participant for changes in behaviour or wellbeing.
7. If the participant is refusing to take medication, discuss this with them to find out why they are refusing. Explain why the medication is needed, wait for up to 30 minutes and then try offering the medication again.
8. Call the participant’s prescribing healthcare professional, pharmacist or the Poisons Information Line on 13 11 26 and follow their instructions.
9. Keep monitoring the participant for adverse reactions, or changes in behaviour or wellbeing.
10. Record the error in the participant’s MAR and complete an incident report as per your organisation’s policies and procedures.
11. Inform relevant staff about the error and provide information about the error during handover to other workers.
12. Notify the participant’s family or substitute decision-maker, if appropriate.
13. Clarify instructions for future medication administration and ensure future supply. For example, if the incident was related to a secure dosage administration aid (SDAA), have the aid repacked if too much medication or the wrong medication was administered from it.

(TAS DoHHS 2016)

Storage of Medications

All medications must be safely and securely stored in a way that maintains the quality of the medication and protects those who live in, work in or visit the service environment (TAS DoHHS 2016).

Wherever possible, dispensed medications should be kept in their original packaging (TAS DoHHS 2016).

In some cases, a secure dosage administration aid (SDAA) might be deemed more appropriate for safely storing a medication (TAS DoHHS 2016).

An SDAA is a pharmacy-prepared aid that divides solid oral medications into sealed individual doses. The medications are arranged according to the dose schedule throughout the day (TAS DoHHS 2016).

Medications, including those in an SDAA, should be stored:

• In accordance with legislative requirements
• In their original packaging or a pharmacy-issued SDAA, and
• In a locked cupboard or room.

(TAS DoHHS 2016)

Keys to medication cabinets should be clearly labelled and kept by the personnel in charge of the premises (TAS DoHHS 2016).

In most cases, medications should be stored in a cool, dark, dry and secure place. However, certain medications may require special conditions, for example, refrigeration (TAS DoHHS 2016).

Medications should always be under the control of a specified worker. At the end of each shift, this worker should be responsible for checking the participant’s MAR to ensure that no medication administrations have been missed and that an accurate record has been kept (TAS DoHHS 2016).

Identification and Differentiation of Medications

Workers must always check the medication name on the packaging before beginning to prepare the medication for administration. The medication name on the packaging must be exactly the same as the medication name on the participant’s MAR and should be easily identified and differentiated by the active ingredient and medication strength.

Note that medications can have up to three different names:

1. The chemical name, which is a precise description in chemical terms as to what the medication is
2. The generic name, which is the name of the medication given to it by the pharmaceutical company that manufactures the medication
3. The trade name or brand name, which is the name given to the medication by the company selling it. It is this name that is copyrighted.

For this reason, it is advised to use generic names rather than brand names.

Medications might come in a box, bottle or another kind of packaging. They could also be packed in a pharmacy-issued SDAA, i.e. a blister pack or sachet. Medications that are not in either their original packaging, suitable packaging as supplied by a pharmacist or in a pharmacy-prepared SDAA should not be administered as they cannot be easily identified or differentiated. This means the potential for error is high and it is not possible to comply with the 13 rights of medication administration.

Appropriate Training of Workers

Disability service providers should ensure the workers they employ have a level of competency to provide appropriate and safe medication management support to people living with disabilities. Workers should not administer medications until training has been completed and they are deemed to be competent by an appropriate training organisation (TAS DoHHS 2016).

References