MMPR033 SELF-ADMINISTRATION
OF MEDICINES PROTOCOL
Table of Contents
Why we need this Protocol ................................................................................................... 4
What the Protocol is trying to do .......................................................................................... 4
Which stakeholders have been involved in the creation of this Protocol............................. 4
Any required definitions/explanations.................................................................................. 4
Key duties .............................................................................................................................. 5
Medicines Management Committee................................................................................. 5
Ward/Unit Manager .......................................................................................................... 5
Nursing Staff ...................................................................................................................... 5
Multidisciplinary Team ...................................................................................................... 5
Prescriber........................................................................................................................... 5
NHFT Pharmacy Team ....................................................................................................... 6
Self-administration programme ............................................................................................ 6
Objectives of the Programme............................................................................................ 6
Inclusion Criteria ................................................................................................................ 6
Exclusion Criteria ............................................................................................................... 6
Protocol for Self-Administration of Medication Programme ............................................ 7
Programme Stages............................................................................................................. 8
Progression through the Programme ................................................................................ 9
Removal/suspension from the Programme ...................................................................... 9
Patients Going on Leave .................................................................................................... 9
Patients being discharged ................................................................................................. 9
Solutions to support patients to self-administer their medicines..................................... 9
Use of Re-usable Multi-compartment Compliance Aids (RMCA) .................................... 10
Use of an Extended Programme...................................................................................... 10
Controlled Drugs (CDs) .................................................................................................... 10
Self- Administration of Insulin on Inpatient Units ........................................................... 11
Storage and Security of Medication for the Programme ................................................ 11
Discharge Planning .......................................................................................................... 11
Training requirements associated with this Protocol ......................................................... 12
Mandatory Training ......................................................................................................... 12
Specific Training not covered by Mandatory Training .................................................... 12
How this Protocol will be monitored for compliance and effectiveness ............................ 12
Equality considerations ....................................................................................................... 12
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Document control details .................................................................................................... 14
Appendix 1 - Entry of patient into the self-administration programme ............................. 15
Appendix 2 - Information for patients about the self-administration programme ............ 17
Appendix 3 - Stage 3 Medication record sheet for random checks .................................... 18
Appendix 4 – Patient Medication Reminder Chart. ............................................................ 19
Appendix 5 - Compliance aid assessment protocol............................................................. 20
Page 3 of 24
Why we need this Protocol
The traditional method of giving medicines to patients in hospital involves nurses preparing
patients’ medicines from stocks on the ward and distributing them. It has been estimated
that up to 40% of nurses time in hospitals is taken up with the administration of medicines1.
The principles underlying self- administration are that patients should be as independent as
possible, should participate in their own care thereby increasing patient responsibility and
autonomy during the course of their admission, make decisions about their treatment in
partnership with nursing and medical staff, and therefore be able to make informed choices.
Patient involvement in self administration of medication assists their individual recovery and
rehabilitation process and co-production of care and patient satisfaction.
Self- administration of medication has also been shown to increase knowledge and
understanding of treatment and to improve patient concordance with medication. Patients
should be encouraged to self-administer medication whenever it is practical and safe to do
so taking into account the individuals needs and risks.1,2,3
What the Protocol is trying to do
The aim of the protocol is to describe the principles behind self -administration, describe the
self -administration programme and the protocol to be followed when patients self administer.
This protocol can be used in all adult inpatient areas. The aim being to enable all patients
discharged from hospital to manage their own medication safely and accurately in 'normal
life situations' by using a structured supportive protocol to inspire the patient’s recovery by
promoting Hope of recovery and the Opportunity to take Control of their care. Due to
factors relating to the ward environment some wards may not be able to facilitate all stages
of the self- administration programme.
Which stakeholders have been involved in the creation of this
Protocol
Medicines Management Committee
Any required definitions/explanations
NHFT
- Northamptonshire Healthcare NHS Foundation Trust
“Self-administration occurs when a patient takes responsibility for taking / using a
medication as prescribed by a doctor and dispensed by a pharmacist for the patient”
MCA- medicines compliance aid. This could be, for example, a chart, large print labels,
medication reminder alarm
SMCA – sealed multi-compartment compliance aid containing tablets or capsules (filled by
pharmacy)
RMCA – reusable multi-compartment compliance aid that can be re-filled by the patient or
their relative
Page 4 of 24
Key duties
Medicines Management Committee
Will approve the protocol and is responsible for the implementation and dissemination of
this protocol.
Ward/Unit Manager
Will be responsible for
•
•
•
ensuring that the protocol is followed within their unit
ensuring the patient’s ability to continue with self-administration is reviewed if errors in
dosing are found
ensure all paperwork is completed and up to date
Nursing Staff
Are responsible for
•
The initial and continued assessment of patients who are self-administering and have
continuing responsibility for recognising and acting upon changes in a patient’s condition
with regards to safety of the patient and others. (NMC Standards for Medicines
Management)
•
Identifying potential problems for an individual patient in following the programme,
discussing the programme with them and counselling them about their medication.
Obtaining informed consent from the patients in their care before embarking on the
scheme
Assessing the patient for suitability for self-administration (see Appendix 1)
Informing pharmacy of the proposed initiation of self -administration for an individual
patient.
Ordering self- administration supplies from pharmacy
Bring to the attention of the Multidisciplinary Team (MDT) or appropriate clinical forum
any problems or risks encountered with the patients in their care with respect to
medication.
Informing pharmacy of changes in medication as soon as possible.
Undertaking random checks on patient held medications (stage 3) and report any errors
in dosing to the ward/unit manager
Liaise with community pharmacies regarding individual patients special requirements
prior to discharge
•
•
•
•
•
•
•
•
Multidisciplinary Team
Any member of the multidisciplinary team can raise concern about the suitability or
otherwise for a patient to self-administer medicines. Explicit written consent from the
consultant is not required for each patient, but agreement of the multidisciplinary team for
self-administration should be documented in the clinical notes8.
Prescriber
Is responsible for ensuring:
Page 5 of 24
•
•
The medication regime is reviewed and simplified prior to the patient starting the
scheme if appropriate
Any subsequent changes in medication are notified to the nursing staff as soon as
possible so that pharmacy may be informed.
NHFT Pharmacy Team
Is responsible for
•
•
•
•
•
•
Review of medication with medical and nursing team
Arrange for the dispensing of regular supplies of medication, labelled with directions, for
each patient when informed that they are to enter the programme.
Assessing patients for solutions to help self-administration where appropriate and
organising supply where necessary
Communicating changes to medicines administration with other members of the MDT
Support the MDT with liaising with community pharmacies regarding individual patients’
special requirements prior to discharge
Providing training to ward teams
Self-administration programme
Objectives of the Programme
• To give the patient control of his / her own life in the area of medication by providing
the opportunity to practice and improve relevant existing skills or the acquiring of
necessary skills to manage their own medicines to promote their recovery.
• To provide information to patients e.g. what, why and how their medication is to be
taken
• To reduce re-admission due to treatment failure caused by non-concordance
• To highlight medication related problems prior to discharge e.g. suitability of containers,
understanding of labelling
• To promote simplified medication regimes
Inclusion Criteria
• Any individual patient that would benefit from the self-administration programme to
promote their recovery will be identified by any member/s of the multidisciplinary team.
• Patients who will have the opportunity to take control of managing their medication at
home as part of their ongoing recovery
• Patients who are expected to remain on the ward / unit for at least 7 days
• Wards / units with suitable facilities for the storage and security of medication
Exclusion Criteria
Patients who are confused or are in an unstable physical and/or mental state
The following medicines should not be self-administered :
•
•
•
once only (STAT) medication
injections except those that will be self-administered following discharge e.g. insulin
medications being titrated, depending on individual patient’s capability.
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•
If any member of the MDT has concerns about the safety of a patient self-administering,
this should be discussed with the team.
If any of the above apply, then self-administration must not be used.
NB If a patient’s level of understanding is insufficient due to language differences or learning
disabilities/difficulties, or if they have a physical condition which would cause problems, this
should not be regarded as an exclusion if these difficulties can be overcome by, for example,
providing an available translation of the patient information leaflets, a large print chart or
alternative packaging of their medicines.
Protocol for Self-Administration of Medication Programme
Pharmacist and Doctor to review therapy, rationalise medication and simplify regime
With patient’s consent and engagement, nursing staff to complete patient assessment
checklist - Appendix 1. This should be scanned into the SystmOne record.
If after completing the Appendix 1 – (entry of patient into the self-administration
programme assessment) the answers to questions 6 and/or 7 are NO, ward pharmacist or
technician should complete Appendix 5 - Compliance Aid Assessment Protocol to find
possible solutions to help the patient self-administer their medicines.
Following assessment of the individual patient’s abilities, level of understanding and
opportunity to administer their own medicines at home, patients who would benefit from
the self-administration programme will be introduced to it. Nurse to inform patient about
the programme using information sheet and obtain their consent to take part – Appendix 2.
This should be scanned into the SystmOne record. Where appropriate contact and liaise
with patient's carers (with patient's consent).
Inform NHFT pharmacist or technician of intention for patient to self-administer and obtain
supply. The supply of Controlled Drugs must fulfil the legal prescription requirements by
using the hospital Controlled Drugs prescription form.
Pharmacy will dispense regular supplies, labelled with directions, for each patient when
informed that they are to enter the programme. The amount supplied will depend on the
location of the patient.
Nursing and pharmacy staff may use their discretion based on individual risk assessment to
request smaller quantities than would be routinely supplied if necessary.
Nursing or pharmacy staff to counsel patient about medication i.e. therapeutic effects,
adverse reactions, side effects, interactions, non-prescription medicines and make
medication information leaflets available. Record this in the patient’s SystmOne record.
Endorse Inpatient Prescription and Administration Record in “other useful information”
section with “SELF-ADMINISTERING”.
Patient to begin programme
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Review progress regularly
Programme Stages
The stage of the programme must be recorded in the “other useful information” section on
the Prescription and Administration record.
Stage 1 : Patient called to take medication
The patient's medicines are stored in a named container in a locked cupboard or drug trolley
and are the responsibility of the nursing staff. Patients are called at designated times i.e.
drug rounds.
A qualified nurse must supervise the selection and taking of medication by the patient. Best
practice is that this should be undertaken in a quiet area bearing mind patient confidentiality
After the medication has been taken correctly, the nurse signs the prescription and
administration record in the usual way and medication is returned to the locked cupboard or
drug trolley.
Stage 2 : Patient to request medication
The patient will approach nursing staff requesting the medication at the designated times. If
the patient forgets and the drug round has ended, nursing staff will prompt the patient. A
note of this must be made in the patient’s SystmOne record. The prescription and
administration record will be signed as per Stage 1.
Stage 3 : Patient to keep own medication
The patient will keep their medicines in a locked drawer or cabinet in their room and be
responsible for their own key / key code. Nursing staff will check medication on arrival from
Pharmacy and record the quantity supplied on the Stage 3 Medication Record Sheet before
issuing the medication to the patient (Appendix 3).
Patients will be responsible for taking their medication and no record will be made of
individual doses by nursing staff. Patients can be given a Patient Medication Reminder Chart
(Appendix 4) by the NHFT pharmacy team to prompt them with taking of medication. This
should be completed in plain English e.g. water tablet not diuretic, depending on discussion
with individual patient. The card must be updated when any prescription changes are made.
Record on Prescription and Administration record “Patient Medication Reminder Chart
produced…..date” Regular random checks must be made by nursing staff on the quantity of
medication remaining and recorded on the Stage 3 Medication Record Sheet (Appendix 3).
The frequency of the checks is at the discretion of nursing staff.
Where patients are self-administering “as required” ( prn) medications nursing staff must
have regular conversations with the patient about what as required medications have been
taken i.e. which medicines they are needing to take and how often. This information should
be recorded in the patient’s SystmOne record to allow review of as required medications in
ward rounds.
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Patients must inform nursing staff if they drop tablets or spill any liquid medications.
Progression through the Programme
The progress of the patient should be assessed by their nursing staff and the findings
presented to the multidisciplinary team. Any problems encountered should be highlighted
and recorded in the patient’s notes on SystmOne
If a patient fails to select / administer their medication correctly at any time, the reasons
should be ascertained, support offered as necessary and the need for compliance reinforced.
When the patient is consistently selecting and taking their medication correctly, in stages 1
and 2, without intervention, they should be considered for progression to the next stage.
No stage may continue longer than a month without review.
The patient’s understanding and knowledge of their medication should be regularly
ascertained throughout the programme
Removal/suspension from the Programme
Nursing staff have the authority to abandon/suspend the programme if the patient suffers a
relapse in their mental or physical state which impairs their ability to self-administer or to
change the patient to a lower stage if appropriate. The suspension of the programme may
only need to be temporary and when the patient’s condition improves the programme may
be re-instated
Removal from the programme will occur where patients are consistently unable to selfadminister despite multiple attempts and counselling, education and support. This can occur
at any stage in the programme and the reasons for doing so to be documented in the
patients' notes. Post discharge arrangements for medication need to be considered and
clearly documented.
Patients Going on Leave
Medication supplied for self-administration may be used if a patient is going on leave with
instructions for the patient to bring back all unused medication to be further used on the
ward / unit. However, smaller amounts can be requested if it is felt that the quantity of
available medication is excessive / inappropriate.
Patients being discharged
Medication supplied for self-administration (in whichever format the patient has been using)
should be used for the patient on discharge in line with Trust and county-wide policies (at
least 14 days supply)
Solutions to support patients to self-administer their medicines
On assessment for self-administration (Appendix 1), it might become clear that a patient has
difficulty taking their medicines correctly from conventional containers.
There may be difficulty, for example, reading standard print on labels, removing tablets from
manufacturers blister strips, remembering when to take medication, administering eye
drops, etc.
Page 9 of 24
Solutions available to help patients with self-administration can include:
•
Large print labels
•
Device for removing tablets/capsules from blister strips (e.g. Medi-popper®, Pill
Popper®)
•
Patient medication reminder charts listing medicines, indications, when to take and
what dose
•
Tick charts to record when dose taken
•
Talking labels that can be recorded with patient name, medicine and directions
•
Medication reminder alarms (available as a stand-alone device, incorporating a multicompartment aid, or as a smartphone app)
•
Devices to help administer eye drops (e.g Opticare®, Autodrop®, Autosqueeze®) or to
actuate inhalers (e.g. Haleraid®)
•
Multi-compartment compliance aids which can be re-useable (usually re-filled by the
patient or their relative) or sealed (filled by the pharmacy)
It is important that any adaptations made are communicated at discharge to the patient’s
GP, and community pharmacy (with patient consent)
Use of Re-usable Multi-compartment Compliance Aids (RMCA)
An RMCA container may be requested from pharmacy if it is felt that it would encourage
patient concordance or simplify a complicated medication regime. Filling of an RMCA
container must be carried out by the patient as this is an essential part of the patient's
learning process. Advice and assistance may be offered by nursing staff but the responsibility
for medication transfer must remain the patient's responsibility at all times.
Use of an Extended Programme
Some patients may be assessed as unsuitable for being responsible for the quantity of
medication routinely supplied to a given unit in Stage 3. In this situation, Stage 3 may
commence with a smaller quantity e.g. one day supply of medication. This can be increased
in stages, one day at a time, until the patient is deemed to be able to cope with the full
quantity of medication.
Controlled Drugs (CDs)
Patients self-administering at Stage 3 and who are on a stable dose of an oral CD may have
custody of and self-administer these on the ward / unit. In addition to being written on the
Prescription and Administration Record, the CD must be ordered on the Prescription for
Controlled Drug Form in order to comply with all legal requirements e.g. total quantity in
both words and figures. The CD must be stored in the patient’s individual locked drawer or
cabinet. On arrival on the ward the supply must be recorded in the Controlled Drugs Register
as a patient’s own supply and be immediately booked out of the register indicating it has
been given to the patient as part of the self-administration programme. No further records
Page 10 of 24
need to be kept in the CD register for patients self-administering at Stage 3; instead regular
counts of the quantity remaining should be made and recorded at the discretion of the
nursing staff as per all other medication at Stage 3.
CDs for all other patients at all other stages must be ordered, stored and recorded in
accordance with the Control of Medicines Policy and the Controlled Drug Protocol for
Inpatient Wards.
Self- Administration of Insulin on Inpatient Units
Empowering patients to self -administer their insulin as an in-patient is seen as a way of
ensuring the correct insulin and the correct dose is delivered at the correct times.
(MMG001- Guidance for the use of Insulin passports)
When a patient is admitted on insulin the following should occur:
On admission or as soon as possible after admission diabetics using insulin must be assessed
as willing and able to take responsibility for their insulin administration while in hospital and
that it is safe and appropriate for them to do so
When patients are self- administering:
•
•
•
•
•
Administered doses should be recorded on the Prescription and Administration Record,
clearly marked as self- administering.
They should have access to quality controlled blood glucose monitoring equipment and
opportunities to record their blood glucose results.
They should be given clear guidance as to when and how to seek additional support or
advice
They should have secure access to their insulin e.g. lockable bedside cupboard or the
insulin stored on the drug trolley and given to the patient to self -administer. This should
be risk assessed on an individual patient and environment basis
They should have access to a sharps bin.
For patients that are nil by mouth, sedated or in other ways incapacitated additional safety
protocols should be considered and where necessary administration of insulin temporarily
performed by nursing staff.
Storage and Security of Medication for the Programme
All medication must be stored in an individual locked drawer or cabinet in a manner that
complies with Trust Policy. Patients must be reminded of the need to keep medication
locked away at all times when not in use, for ensuring the key is kept safely and out of reach
of other patients, and key codes are kept confidential.
Discharge Planning
Patients must be informed of the need to contact their GP for continuing supplies of
medication after discharge from hospital. The use of a regular pharmacy should be
encouraged to enable familiarity with a patient's medication and to reduce the risk of any
drug interactions should OTC / non-prescription medication be purchased. Where patients
Page 11 of 24
have special requirements e.g. large print labels the ward team / NHFT pharmacy team
should contact the patient’s chosen community pharmacy to arrange ongoing supplies.
Training requirements associated with this Protocol
Mandatory Training
There is no mandatory training associated with this protocol
Specific Training not covered by Mandatory Training
Ad hoc training sessions based on the need of individual ward teams will be provided by the
NHFT pharmacy team, particularly where wards are undertaking self -administration under
this protocol for the first time.
How this Protocol will be monitored for compliance and effectiveness
The table below outlines the Trusts’ monitoring arrangements for this document. The Trust
reserves the right to commission additional work or change the monitoring arrangements to
meet organisational needs.
Aspect of
compliance or
effectiveness being
monitored
Process for Patient
Self administration
Method of
monitoring
Spot checks on
wards which
undertake selfadministration
of the
documentation
and supplies.
Individual
responsible
for the
monitoring
Chief
pharmacist
Monitoring
frequency
Quarterly.
Group or
committee
who receive
the findings
or report
Group or
committee or
individual
responsible for
completing any
actions
Medicines
Management
Committee
Medicines
Management
Committee
Equality considerations
Refer to MMP001 Control of Medicines Policy
Reference Guide
1 Audit Commission. A spoonful of sugar – medicines management in NHS Hospitals London:
Audit Commission 2001
2 Lowe CJ, Raynor DK, Courtney EA, et al. Effects of a self-medication programme on
knowledge of drugs and compliance with treatment in elderly patients. BMJ 1995; 310:
1229-31.
3 National Prescribing Centre. Service Improvement Guide: Self administration of medicines
in Mental Health Trusts. April 2008.
Page 12 of 24
4. Guidance on the Use of Monitored Dosage Systems (November 2013). Nene and Corby
Clinical Commissioning Groups. Pathfinder website.
5. MCA stability database. Specialist Pharmacy Service.
https://www.sps.nhs.uk/?s=&cat%5B%5D=3253
6. Improving patient outcomes: The better use of multi-compartment compliance aids. Royal
Pharmaceutical Society. July 2013
7. Pharmaceutical Services Negotiating Committee Briefing 01/16: Disability Discrimination
Act 1995; Equality Act 2010; and Multi-compartment compliance aids January 2016
8. Mann, R; Jani, J.R; Lakkappa, B. (2016), Email to Jenny Clarke, Self-Administration Protocol
update , 21 March 2016, 22 March 2016, 15 April 2016.
Page 13 of 24
Document control details
Author:
Approved by and date:
Responsible committee:
Any other linked Policies:
Protocol number:
Version control:
Version
No.
1.
Date
Ratified/
Amended
15.11.16
Chief Pharmacist
15.11.16
Medicines Management Committee
MMP001 - Control of Medicines Policy
MMpr033
1
Date of
Next
Implementation Review
Date
15.11.16
30.11.18
Reason for Change (eg. full rewrite,
amendment to reflect new legislation,
updated flowchart, minor amendments, etc.)
Review
Page 14 of 24
Appendix 1 - Entry of patient into the self-administration programme
ASSESSMENT
This form must be completed by the nurse and retained in the patient's record and
scanned in to SystmOne.
1. Will the patient be self -administering at
YES/NO
home
If NO the patient is not suitable for
self—administration
2. Has the patient been identified by the
multidisciplinary team as a likely candidate for
self –administration?
YES / NO
3. Is the patient confused?
YES / NO
4. Does the patient have a history of alcohol /
drug abuse or overdose, accidental or
intentional?
5. Does the patient have a history of noncompliance to medication leading to relapse
or risk of relapse?
6. Can the patient open child-resistant closures,
foil or blister packaging?
7. Can the patient read the label?
8. Does the patient understand the purpose of
the programme and is motivated to
commence self-administration?
If YES, reconsider suitability for
program or postpone programme till
a later stage
YES / NO
If YES, consider risks & any additional
support that might be required
YES / NO
If YES, consider risks & any additional
support that might be required
YES / NO
If NO, inform pharmacy for
alternative to be supplied
YES / NO
If NO, inform pharmacy for
alternative to be supplied
YES / NO
If NO, reconsider suitability or
postpone programme till a later
stage
Page 15 of 24
9. Has the patient read, understood and signed
the 'Information for Patients about SelfAdministration Programme' sheet?
YES / NO
10. Has the patient been told which medicine to
take, why it is being taken, when to take it
and what to do if a dose is missed?
YES / NO
If NO, provide this information
11. Does the patient understand the purpose of
PRN medication and when and how it should
be used?
YES / NO
12. Has the patient been informed of any side
effects likely to occur and what to do if they
appear?
YES / NO
13. Does the patient require translations of
patient information leaflets?
YES / NO
If YES, contact ward pharmacy team
for assistance
Delete as applicable:
Patient suitable for self-administration of medication
Patient may be suitable for self-administration of medication pending Compliance Aid
assessment
Patient not suitable for self-administration of medication
Patient assessed by :
Name.................................... …………………………..(print name)
Signature..........…................... ……………………………..
Designation ……………………….....................................
Date.............................................
Page 16 of 24
Appendix 2 - Information for patients about the self-administration
programme
A Self-Administration programme is in use on this ward / unit to allow you to be responsible
for taking your own medicines. It is designed to improve your knowledge about your
medicines so that you are better able to cope with them when you go home.
Your nurse will assess you to see if Self-Administration is suitable for you. The programme is
not compulsory and you need not feel that you have to take part in the programme. This will
not affect your care or your treatment, now or in the future. If you choose not to take part,
your medicines will be given to you in the usual way by nursing staff.
If you are entered into the programme and if you agree to join, your nurse will give you as
much information and help as you need.
You will be given a card, that you can keep, to remind you of the medicines, doses and times
that you need to take them. As you become familiar with your medicines, the medicines will
be kept in a locked drawer or cabinet in your room and you will be given the key / key code
so that you may take your medicines without help.
It is important that you keep your medicines safely out of sight and locked in your drawer
or cabinet at all times.
Always follow the instructions on the label and never take more than what the label says.
If another patient or any visitor asks to, or does, take your medication please inform the
nurse-in-charge at once.
If you have any queries about your medicines or about the programme, please talk to your
nurse.
I HAVE READ THIS INFORMATION SHEET AND HAD IT EXPLAINED TO ME. I WOULD LIKE TO
TAKE PART IN THE SELF-ADMINISTRATION PROGRAMME.
Signed........................................................... Date..............................................................
Patient's name..................................................................................................
Ward / Unit........................................................................................................
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PATIENT DETAILS:
Appendix 3 - Stage 3 Medication record sheet for random checks
DRUG
DOSE
QUANTITY
DISPENSED
QUANTITY REMAINING
DATE
EXPECTED
ACTUAL
Name of Person
undertaking random
Check
Signature
ANY AMBIGUITY TO BE RECORDED IN PATIENT’S NOTES
Page 18 of 24
PATIENT DETAILS:
Appendix 4 – Patient Medication Reminder Chart.
NAME & STRENGTH OF
MEDICINE
WHAT IS IT FOR?
WHEN TO TAKE MEDICINE
BREAKFAST
LUNCH
COMMENTS
TEATIME
BEDTIME
If you forget to take a dose, inform nursing staff as soon as you remember. DO NOT DOUBLE THE NEXT DOSE.
Completed by……………………………. Designation…………………………… Date ………………….
Page 19 of 24
Appendix 5 - Compliance aid assessment protocol
Who Can Assess?
Patient should be assessed by the NHFT pharmacist /medicines management technician involved in
the care of the patient.
Prescribing for Compliance Aids
For many compliance aids it is important for the dispensing pharmacist/ to know what time of day
the medicines are to be administered. Medications should be prescribed specifically e.g. 1 tablet in
the morning.
Where patients are required to alter the dosage form for administration e.g. opening capsules,
crushing and dispersing tablets in water it is important that this appears on the dispensing label to
give the patient the authority to do this. Prescriptions therefore need to be descriptive.
Nursing/Residential Homes6,7
. In some situations SMCAs may be used after an individual patient assessment has taken place
which deems it necessary to support independent living.
Social Care6,7
Carers should be sufficiently trained to administer medications dispensed in original containers by a
pharmacist and therefore should not specifically require an SMCA to facilitate the administration of
a patients’ medication as per the Policy and Protocol for Medicines Management in the Domiciliary
Setting (Adults) for Northamptonshire. Their training should allow them to help the patient through
a variety of methods appropriate to their individual needs.
Stability and Licensing Issue 5,6,7
Many manufacturers state that their drug(s) are not licensed for inclusion in a multi-compartment
medication compliance aid based on the absence of any stability studies and that this will affect their
liability. Therefore any medications packed into an SMCA should be considered unlicensed and as
such the prescriber and dispensing pharmacist share legal responsibility for provision. Patients
should be informed of this.
Some medicines CANNOT be packed into an SMCA due to stability problems.
For further information regarding stability please contact Pharmacy. The following link may also be
helpful: https://www.sps.nhs.uk/?s=&cat%5B%5D=3253 (Specialist Pharmacy Service database)
Communication
This protocol is intended to support and promote patient centred care therefore it is essential all
relevant parties are communicated with at all key points during admission including GP, Community
Pharmacist/Dispensing Practice, Patient and anyone else appropriate.
Page 20 of 24
COMPLIANCE AID ASSESSMENT TOOL
Please complete, scan into patient’s SystmOne record, and send a copy to the patients’ GP and
Community Pharmacist as appropriate.
Patient details: (addressograph label if
available)
Name
Address
Hospital number
DOB
NHS Number
Patient consent to share information with
community pharmacy?
Yes/No
GP details:
GP Name:
Name of surgery:
Telephone Number:
Fax number:
Community Pharmacy/Dispensing Practice details:
Name:
Address:
Telephone Number:
Fax Number:
Usual Circumstances:
Will the patient be discharged to a nursing home or other residential care setting where they will NOT be
self-administering their medication?
If ‘YES’, no further assessment required. However, consider whether they self –administer inhalers etc as
they may need review to ensure they can still use them.
Are you confident that any person providing assistance e.g. carer, friend or relative, is competent to
order, collect and administer medicines from the original packs? If ‘YES’, no further assessment required.
Does the patient already have a SMCA arrangement with their GP surgery/community pharmacy? If ‘YES’
no further assessment required, however please inform them that the patient is currently in hospital if
not done on admission (see medicines reconciliation Protocol), and inform them of patient’s discharge.
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Assessment of abilities:
Current medication arrangements: e.g. RMCA, SMCA, Original Packs?
What are the patient’s feelings and opinions about self-administration?
YES
Understands each medicine’s dosage instructions?
Mental
Understands time / day of the week
Understanding
Understands the importance of each medicine?
Understands how to take PRN (when required) medication?
Understands how to take variable doses? (e.g. warfarin)
Memory
Remembers to take their medication regularly and at the
appropriate time?
Remember to order their repeat medication?
Swallowing
Swallow all their tablets/capsules?
Open medicine boxes?
Open and pop out medication from blister strips?
Open and close child-resistant lids?
Physical
Open and close winged lids?
Dexterity
Pour/dispense medicines from bottles?
Measure liquid medications?
Halve tablets themselves (if required)?
Instil eye drops or eye ointments?
Use inhaler/s correctly?
Read standard print labels?
Read large print labels (16/18 point Arial?)
Sensory
Read braille labels (if patient is blind)?
Can the patient hear an alarm?
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NO
Action:
Based on the assessment above, in order to self-administer this patient needs:
Large print labels
Provide symbols on each box
Device for removing tablets/capsules from blister strips (e.g. Medi-popper®, Pill Popper®)
Dispense blister packed medications into bottles
Provide halved tablets
Provide screw/winged lids
Provide large bottles/boxes
Relative/carer prompts to take medications
Patient medication reminder charts listing medicines, indications, when to take and what dose
Tick charts to record when dose taken
Talking labels that can be recorded with patient name, medicine and directions
Medication reminder alarms (available as a stand-alone device, incorporating a multi-compartment
aid, or as a smartphone app)
Devices to help administer eye drops (e.g Opticare®, Autodrop®, Autosqueeze®)
Devices to help actuate inhalers (e.g. Haleraid®)
Change inhaler devices to……………………………………………………..
Reusable multi-compartment compliance aids (re-filled by the patient or their relative)
Sealed multi-compartment compliance aids (filled by the pharmacy)
See check-list below
Check list to ensure an SMCA is appropriate:
1.
Could the current medication regime be simplified?
YES
NO
This should have already been completed (see section 5.5 of policy) If ‘YES’ review with prescriber
before completing assessment
2.
Is the current medication regime stable? (No recent or planned future changes in dose or
frequency?)
YES
NO
3.
Are all medicines in a formulation which can be packed into an SMCA? (liquids, fridge items,
cytotoxics and when required medicines are not suitable for SMCA’s) Check SPS database.
YES
NO
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4.
If not all medications are suitable would the patient still benefit from having some of their
medications in a SMCA? (ask the patient)
YES
NO
YES
NO
If answers ‘NO’ to Questions 2, 3 and 4 no further assessment is required.
5.
Does the patient have medication requiring more than 4 doses a day e.g. co-careldopa?
If ‘YES’ then the patient is unsuitable for an SMCA but please see list of suggestions for alternative
solutions (e.g. store-bought compliance aid with extra slot).
6.
Can the patient select medication from the correct compartment? Are they oriented in time
(do they know what day of the week it is?)
7.
Can the patient remove the medication from the SMCA?
8.
Is the patient willing to change current medication system?
Summary:
It is my opinion that this person has/does not have (delete as appropriate) problems with taking their medication
It is my opinion that this person would/would not (delete as appropriate) benefit from adjustment(s) to the presentation of
their medication
The recommended reasonable adjustment(s)
for this person is:
Provide details:
Patient/service user signature (if applicable) :
Assessor signature:
Designation:
Date:
Pharmacy Authorisation Signature:
Designation:
MMT/Pharmacist (delete as appropriate)
Date:
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