The quality illustration in our A quality framework for support services (care at home, including supported living models of support) states, ‘people have as much control as possible over their medication and benefit from a robust medication management system that adheres to good practice guidance’. To support providers in demonstrating this we have developed the following statement to clearly set out the expectations for how people should be supported with their medications. We will be producing a practice note to support providers which will be shared in due course.

When people are receiving a care at home service for medication support an assessment of capabilities with medication must be in place. This may be provided by the local authority commissioning the package of care. The assessment will then be used to inform the basis of the personal plan and risk assessment to safely support the person in line with good practice Prompting, Assisting and Administering Medication. Providers can use this tool Medication Support Assessment Tool and Guidance or one of their own (following the same principles) if they need to re-assess a person’s capabilities with medication. This would then inform further decisions to ensure the right care and support package in place.

The service should have a clear organisational policy and procedure which sets out for staff what it means by:

prompting with medication
assisting with medication
administering medication.

If staff are supporting prompting or assisting, they can record in the daily notes aligned to the personal plan what support is given.

Multi-compartmental Compliance Aids (MCA) can be used to support people to be as independent as possible with their own medication. If staff are supporting people to use these through prompting or assisting, they can record this in the daily notes.

Good practice examples:

“Prompted Mrs Smith with her morning medicines. She had not taken them by time I left".
"Assisted Mr Jones by popping out his medication from his multi compartmental compliance aid at his request”.

When staff are required to support with administering medication then it is necessary to follow the principles of safe and appropriate handling of medicines. This includes having a medication administration record that can be audited. This should clearly detail each individual medicine, the dose given at each time point, and a signature corresponding to the staff administering the medicine. Medications can be dispensed using original packs or by Monitored Dosage Systems/Blister Packs. If these devices continue to be used by staff to administer medicines, then they must be able to identify the medication and record the administration following the same principles mentioned above. This should be set out in the risk assessment and personal plan.

Staff should be trained to administer medicines safely in whatever format they are supplied in. The format should be discussed between the provider and the pharmacist to ensure the principles of safe and appropriate handling of medicines can be followed. This should include involving people and/or their representatives as identified in their personal plan.

Services should evaluate their current practice and procedures to align with best practice. If any aspect of medication management needs improvement this should be set out in the service improvement plan detailing what actions are to be taken, which may include staff training, and involving people in reviews using a collaborative approach. Proportionate and realistic timescales should be considered in managing this change.