Standards for self-administration of medication on inpatient wards

1 Introduction

This standard recognises that inpatients require opportunities to acquire greater levels of autonomy and independence within which the self-administration of prescribed medicine is an important aspect of the care process.

The preferred method of medication administration should reflect the ultimate medication system when they are discharged, if this is a monitored dosage system (MDS) filled by a pharmacist, and if possible, this system of medication administration should be introduced to the service user at the earliest opportunity.

It is essential that wherever the patient is encouraged to self-administer medicines the management of such approach will be in keeping with the following principles:

the environment is to have secure individualised storage facilities in place for each patient
an emphasis on support, facilitation and concordance should be the primary feature of self-medication approaches. Whilst the patient may accept a personal challenge for growth and skills development these can neither be expected nor demanded
independence requires education; the pathway to self-administration requires knowledge and understanding of mental illness and the medicines used in treatment. In order to acquire a safe and competent attitude towards medicines the patient will have to understand and value their use from a personal perspective
competence in self-administration will be measurable by the patient’s capacity to demonstrate knowledge and understanding of, and commitment to, the need to safely manage medicines whilst also carrying out the requirements of the prescription
individualised care must be recognised for all patients. Not all patients will be successful in self-medicating and this fact may well determine the level of support that continues to be necessary following discharge from the service
this support, which may become necessary, can be ‘bought in’ as part of their package of care at the point of discharge for the patient if necessary

2 Link to overarching policy

This document links to the overarching safe and secure handling of medicines manual.

3 Aim

This standard is intended to set the standards for patients who self-administer medication on inpatient units.

4 Responsibilities, accountabilities and duties

In line the responsibilities laid out in the overarching safe and secure handling of medicines manual.

Additionally clinical staff working on the ward:

ensure that there is a continuous supply of the patient’s medication (including any PRN (pro re nata or when required) medication)
report any non-compliance with the contents of this standard

5 Procedure and implementation

5.1. The environment

Safe and secure individualised storage facilities for medication are made available for those patients who are deemed to be capable of self-medicating. There are individual medication cabinets located in the treatment room for staff to utilise when patients commence self-medication.

5.2. Supplying and storage of the medication

Medication should be supplied in an appropriate format consistent with the patient’s ability to self-administer medication for example, in original boxes and bottles or a MDS Clozapine prescription are also made up by the pharmacy supplier and not included in the MDS. If the clozapine is to be transferred in to a Dosette type container, this should be done by the patient under the supervision of staff, and documented. MDS systems cannot be opened or amended to do this, prior to actual administration. (Staff should refer to the clozapine clinic standard operating procedures (SOPs) within the clozapine protocols for further guidance)

The pharmacy supplier requires at least 24 hours’ notice to make additions or changes to the MDS.

The only time that medication may not be supplied in MDS format by the pharmacy supplier is when a medicine is known to react with other medications if not kept separate in its foil wrapper.

For those patients who are working towards self-medication their medication is to be kept in the treatment room. Staff will then support, supervise and educate the individual patient to administer their own medication.

The storage and administration arrangements for the following items of prescription medications will be decided on an individual basis following consultation with the service user and documented in the individual care plan.

Topical preparations.
Eye, nose and ear preparations.
Suppositories.
Inhalers.
Other preparations that aren’t given orally.

All medication will be held in the treatment room until it is required for use. It is the responsibility of clinical staff to ensure that there is a continuous supply of the patient’s medication (including any PRN medication).

5.3. Assessing patient ability to self-medicate safely

For any patient to self-medicate safely it is important that staff undertake the following:

when it is felt that a patient is eligible or safe to self-administer medication it is to be discussed in the patient’s multidisciplinary team (MDT) meeting at the first opportunity
an assessment of the patient’s capacity to self-medicate safely (this is to be recorded on an MCA1 form). It is important that they understand the treatment, likely effects, benefits, and side effects. Staff are to refer to the trust’s Mental Capacity Act policy
where there are concerns about a person`s ability to make decisions about self-medication an assessment of their capacity should be undertaken this should be recorded on the patients record on the MCA1 questionnaire. It is important that they understand the purpose and nature of the treatment, likely effects, benefits, and side effects. Staff are to refer to the trust’s Mental Capacity Act policy
if the person lacks capacity to make these decisions, then medication should be administered by staff

5.4. Supporting patients to self-administer medication

For safety reasons all patients who are to self-administer their medication will be observed and supported by a member of the nursing team for at least the first week.

Following this the level of support required by individual patients will be routinely reviewed at their MDT review.

The level of support provided will be based on a current risk assessment of the patient. A plan of care will be formulated to ensure the appropriate amount of support is in place.

Each member of the nursing team is to be made aware of the level of support and, or amount of prompting each individual patient requires with regards to the self-administration of medication as recorded in their care plan. Discussions and education around what medication the patient is prescribed. Assess their understanding of medications (MCA1/2). Patients should not be excluded if on Mental Health Act paperwork. Considerations should be taken in regards to changes in capacity and the ability to self-administer safely, as part of this assessment their ability to understand and comply with the regime should be assessed. To be discussed at MDT to decide if patient is appropriate and safe with medication administration. Prescriber to order medication for self-administration either in TTO (to take out) or nomad dependent on patient choice or identified need. Risk assessment completed.

To ensure the safe self-administration of medication as a minimum the following details must be included in the care plan:

5.4.1 Stage 1

Named nurse to complete individualised care plan with patient.
Patient to attend clinic room at prescribed medication time and to self administer medication under direct supervision.
The length of this stage will be dependent on patient understanding and ability to self-medicate.
Discussion with the responsible clinician (RC) and Clinical team and appropriate risk assessed to progress to next stage.
At this stage the use of stock medication should be considered to limit the number of TTO’s being generated.
Doses should be recorded as self-administered on the drug chart as per electronic prescribing medicines administration (EPMA) SOPs.

5.4.2 Stage 2

Named nurse to complete individualised care plan with patient covering the following:

patient attends clinic room each morning to collect a full day’s medication. Staff to ensure drug chart is updated accordingly to reflect a day’s supply of medication has been given
staff to ensure the patient understands the need for safe storage of medications. A risk assessment is to be completed to reflect same
staff to perform random checks on those patients who self-medicate to ensure compliance with taking prescribed medication, and storage. If any concerns are highlighted then please refer back to previous stage or cease the self-administration care plan dependent on highlighted concerns. This is to be reviewed within an MDT at the earliest opportunity
a record should be made of the checks in the patient record
discussion with RC and clinical team and appropriate risk assessed to progress to next stage

5.4.3 Stage 3

Named nurse to complete individualised care plan with patient covering the following:

patient will attend the clinic room in the morning to collect 7 days of medication
staff to ensure drug chart is updated with the documented 7 days self-administration accordingly
staff to ensure patients understand the need for safe storage of medications. Risk assessment to reflect same
staff to perform random checks on patients who self-medicate to ensure compliance with taking prescribed medication and storage as per stage 2
this should be as a minimum weekly, and must be marked on the medication chart accordingly
any concerns highlighted to refer back to previous stage or cease self-administration care plan dependent on highlighted concerns. This to be reviewed within an MDT at the earliest opportunity

5.5 Information to patients

Prior to any patient being prescribed medication whether they are self-medicating or not, it is important that both they, and if appropriate their carers, have a full discussion with the prescribing clinician about the risks, purpose and nature, and benefits of the proposed treatment. This discussion should also include:

expected benefits of the treatment
common side effects
available alternative treatments
risks and consequences of not having the treatment

Patients will also be given the above information in writing.

For patients whose first language is not English arrangements will be made for the presence of an interpreter. Staff should refer to the trust’s interpreters policy (provision, access and use of, for patients, service users and carers).

A medication guide can be given to the patient outlining what they are on, and when it should be taken. Pharmacy services can be contacted to generate one of these

6 Appendices

Document control

Version: 1
Unique reference number: 547
Date ratified: 6 April 2021
Ratified by: Clinical policy review and approval group
Name of originator: Medicines management committee
Name of responsible individual: Executive medical director
Date issued: 21 May 2021
Review date: April 2024
Target audience: Trust wide inpatient areas

Page last reviewed: April 24, 2024
Next review due: April 24, 2025

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