Staff administering medicines

All staff groups administering medicines must undergo training relevant to their role and be subject to robust governance procedures.

Clinical Governance framework

Organisations have a legal duty of care and are responsible for ensuring a Medicines Policy is in place and that the staff they employ are properly trained and competent to undertake only those responsibilities specified in agreed job descriptions.

Legal mechanisms to supply and administer medicines

Legal mechanisms to supply and administer medicines to individuals must be included in the employing organisation’s overall clinical governance framework.

Training

Where the administration of medicines is being undertaken by staff, any suitably trained and competent member of staff in health or social care may administer medicines that an authorised prescriber has prescribed for an individual.

Registered staff

All registered health professionals, including doctors and nurses, have a duty of care and are professionally and legally accountable for the care they provide, including those tasks they delegate to non-registered staff.

Further information on delegation and accountability is available from the Royal College of Nursing.

Non-registered staff

Appropriately trained non-registered staff can legally administer medicines but those delegating the duty must ensure that these staff are competent to do so safely. Non-registered staff are also accountable for their own practice.

Further information is available from the Department of Health on the administration of medicines in care homes.

Method of supply to administer

Named-patient supply

Medicines that have been dispensed or supplied to a named individual can only be administered to that named individual. This principle applies to registered and non-registered staff at all levels.

Stock medicines

Stock medicines can only be administered to an individual under the care of the organisation where an appropriate prescription,  legal authority, or for Pharmacy (P) and General Sales List (GSL) medicines, a locally approved process, to administer the medicine exists.

Administration of prescribed medicines

Prescription

A prescription is an authorisation against which a supply of medication is made (usually by a pharmacist). It can also be used as a direction to administer a medication to an individual.

A prescription must comply with all legal requirements for prescriptions and controlled drugs (where applicable).

Examples of prescriptions include:

• A Patient Specific Direction (PSD)
• An FP10 prescription form

Direction to Administer

In order for a prescription only medicine (POM) to be administered, it must have been prescribed and a legal supply made. A direction to administer is a written instruction from a prescriber that indicates the intent for a medicine that has already been legally supplied, can be administered  to an individual by a suitably trained and competent person.

In a managed care environment, P and GSL medicines are often prescribed in the same way as POM medicines and the guidance given above should be followed. However as the medicines do not need to be prescribed there may be a local policy on the administation of P or GSL medicines (e.g. Homely Remedies or Over The Counter (OTC) medicines policy.)

In a home environment P and GSL medicines in an individual’s possession may be administered without any additional direction to administer.

Requirements

A direction to administer should  include:

• the individual’s details
• medication details (e.g. name, strength, dose, frequency, duration)

The label of dispensed medicines may be used as a source of medication details.

The person issuing the direction to administer must be a registered prescriber. There is no requirement for the direction to administer to be signed, but it must be authenticated and validated. A signature may be one way of validation, as may be a secure email, an entry into secure clinical notes or another suitable method. This must all be in line with local processes.

Controlled Drugs

Directions to administer for Schedule 2 and 3 Controlled Drugs (CDs) are possible.

Medication Administration Record

A Medication Administration Record (MAR) is a document that records the administration of a medicine. It is predominantly used by social care staff for this purpose.

The MAR forms part of an accurate, complete and contemporaneous record of the administration of medicines.

There is no legal requirement for the MAR to be physically signed or completed by the prescriber. An emailed version e.g. from a community pharmacy, can be printed and accepted for use.

Administration of Medicines under Exemptions

Anyone can administer a medicine listed in Human Medicine Regulations Schedule 19 in an emergency.

It is considered good practice to have a local policy or procedure to support practitioners working under an exemption to the Human Medicines Regulations e.g., local anaphylaxis policy.

Injectable medicines supplied under Human Medicines Regulations Schedule 17 exemptions cannot be delegated to another person to administer.

Administration of medicines supplied under a PGD

Non injectable medicines

If a person has a non-injectable medicine in their possession that has been supplied under a PGD, another person can administer it, if they are appropriately trained/competent.

Injectable medicines

Administration of an injectable medicine must not be delegated under a PGD.

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