GUIDANCE ON THE HANDLING OF MEDICATION OF RESIDENTS OF APPROVED PREMISES

PURPOSE
The purpose of this circular is to set out updated guidance on the handling of medication belonging to residents of approved premises.

Probation Circular
REFERENCE NO: 33/2004 ISSUE DATE: 8 June 2004 IMPLEMENTATION DATE: Immediate EXPIRY DATE: June 2009 TO: Chairs of Probation Boards Chief Officers of Probation Secretaries of Probation Boards Chairs of Voluntary Management Committees Approved Premises Managers CC: Board Treasurers Regional Managers AUTHORISED BY: Liz Hill, Head of Public Protection and Courts Unit ATTACHED: N/A

ACTION
Please could all staff note the contents of this circular and take action as appropriate.

SUMMARY
Residents of approved premises are not permitted to keep their own prescribed medication in their rooms or on their person. Instead this must be kept in a secure cabinet at the approved premises and issued by staff. This circular sets out guidance on storing and issuing residents' medication.

RELEVANT PREVIOUS PROBATION CIRCULARS
N/A

CONTACT FOR ENQUIRIES
John Russell Tel: 020 7217 0772 Fax: 020 7217 0756 E-mail: JohnFyfe.Russell@homeoffice.gsi.gov.uk Colin Pinfold Tel: 020 7217 8226 Fax: 020 7217 0756 E-mail: Colin.Pinfold2@homeoffice.gsi.gov.uk

National Probation Directorate
Horseferry House, Dean Ryle Street, London, SW1P 2AW General Enquiries: 020 7217 0659 Fax: 020 7217 0660

Enforcement, rehabilitation and public protection

BACKGROUND
1. As a general rule, residents of approved premises are not permitted to keep their own prescribed medication in their rooms or on their persons. Clearly, there will be some exceptions to this. For example, items such as ointments for skin complaints and inhalers for asthma will need to be kept by the resident personally. However, as a general principle, whenever a person becomes a resident of approved premises, they must agree to hand over their medication to a supervisory member of staff for safe-keeping.

PROCEDURES
2. All approved premises must have a system in place for the delivery or collection, safe-keeping and issuing of prescribed medication, or controlled drugs which may be prescribed to any resident. The following guidance must be complied with; a) Residents using prescribed medication must not be permitted to collect it from a pharmacy. All approved premises must use pharmacy collection services where these are available. If, for any reason, such a service is not available locally, then staff must make arrangements themselves to collect prescribed medication on behalf of the resident. b) The receipt of medication must be recorded in an individual medicine record for each resident. Both the type and quantity must be noted. c) Where a resident is keeping and using their own medication, this must be recorded in the resident's case notes and staff should check that the resident can keep and use this medication in a safe manner. d) Please note that prescribed medication remains the property of the resident. It is therefore important that as part of the induction process, the resident confirms that they understand that the medication is theirs and, in particular, that they clearly understand that it remains their own responsibility to request their medication at the right times and in the correct dosages. It is also their responsibility to ensure that it is used correctly and before the expiry date and that any unclaimed medicines at the point of departure will be returned to the pharmacy for destruction. They should also be asked to confirm that they understand that staff have a duty of care, and if staff believe that the resident is under the influence of alcohol or drugs and that the additional prescribed medication is not known or may be harmful, the medication may be held back whilst further advice is sought from the duty manager, pharmacist or medical services. In any event, staff will need to consider immediately what measures need to be taken to ensure the welfare of the resident. e) In general, only prescribed medication should be retained and issued to residents. However, requests by residents for staff to additionally store non-prescribed medication (for example, Paracetamol) should be agreed to, where staff assess that the medicines are legitimate. Such ‘over the counter’ medication should be stored, secured and issued in accordance with the requirements for prescribed medicines. f) Prescribed medication must be kept in a secure cabinet for that purpose and the cabinet must be subdivided so as to clearly separate each resident's medication. This should ideally be a metal cabinet, especially when dealing with controlled drugs. Each resident's medication must be clearly labelled as belonging to that resident. g) Nominated members of staff, who are familiar with the arrangements and required procedures, should be responsible for issuing all prescribed medication, which must be signed for by both the resident and the nominated member of staff in the medication record. The record must always include a note of the time, date and the amount of medication issued. The amount requested should be checked with the prescription. h) Only one resident should be present in the room at the time that the medication is issued, and staff should try and ensure that the resident consumes the medication at that time. However, supervised arrangements for intravenous injection of medication are not normally practical in the approved premises setting and should therefore not normally be provided, unless there are appropriate provisions.

PC33/2004 - Guidance on the handling of medication of residents of approved premises

2

i) In circumstances where a resident demands that all of their medication be returned to them, staff must use their discretion and judgement to defuse such a situation in the best way possible. Residents will have already agreed at induction; • To hand in their medication • That it remains their responsibility to ask for it at the correct times and in the prescribed dosages and to use the medication correctly and before the expiry date • That in exceptional circumstances, medication may be held back whilst further advice is sought where it appears to the staff that it may be harmful for the resident to administer the prescription • That they understand that if they need more prescribed medication in the future, it will be collected for them and placed in the secure cabinet • If their stay at the premises ends, for whatever reason, and the medicines are not claimed, they will be returned to the pharmacy for destruction. j) When a resident concludes their stay at approved premises, their un-issued medication must normally be returned to them at the point of departure (but not in advance of them leaving) and signed for in the normal way, but the medication record must be retained. k) In rare circumstances, if, at the point of departure, staff consider that with regard to quantity, street value, the risk of potential self harm or if there is a high risk of misuse, staff should consider withholding some of the medication, after consultation with the resident's GP. Staff should attempt to agree arrangements with the resident which give regard to the duty of care on the Service and welfare of the resident. Advice should be sought from the duty manager if the situation cannot be resolved. Depending of the outcome, duty staff should additionally assess whether there needs to be any follow up action. l) Unwanted or unclaimed medicines should be returned to the pharmacy for disposal by staff with a corresponding entry on the resident’s personal medical record. m) If a resident dies, medicines should be retained for a period of seven days in case access is needed by the police or a pathologist, or longer if requested by any other authority, and the medication record retained with the case file until the normal file destruction date. n) If a resident is using medication which needs to be administered by injection (depot) such as insulin for the control of diabetes, appropriate arrangements must be in place for the safe disposal of needles. o) ‘Sharps’ boxes should be secure and sited unobtrusively but careful consideration must be given to their location within the approved premises so as to avoid them being broken into. It is recommended that local advice is sought on provision of such boxes including the type and siting of the boxes and the arrangements for collection and disposal. p) There should be daily recorded audit checks of the medicines stored to ensure that out of date or uncollected medicines are returned to the pharmacy but, in particular, that residents are requesting the medication that they have been prescribed. This may have greater importance for some residents than others, depending upon the illness and the treatment potential of the medication. In some cases, daily checks for ensuring medication has been requested and issued, will be an element of the plan to manage the risk the resident presents to themselves or to others.

HANDLING CONTROLLED DRUGS
3. Please note that under the Misuse of Drugs Regulations 2001, approved premises staff are acting in a legal manner if they are in possession of controlled drugs on behalf of a resident, in the manner set out above, so long as those drugs have been prescribed by any person entitled to do so under the Regulations. Under Regulation 6(7)(f) of The Misuse of Drugs Regulations 2001, approved premises staff are classed as "a person engaged in conveying the drug to a person who may lawfully have that drug in their possession", and so accordingly Regulations 6(5) and 6(6) apply. Regulation 6(5) states;

PC33/2004 - Guidance on the handling of medication of residents of approved premises

3

"Notwithstanding the provisions of section 4(1)(b) of the Act, any of the persons specified in paragraph (7) may supply any controlled drug to any person who may lawfully have that drug in his possession". Regulation 6(6) states: "Notwithstanding the provisions of section 5(1) of the Act, any of the persons so specified may have any controlled drug in his possession" We hope that this clarifies this issue.

CONCLUSION
4. It is important that these arrangements on medication are put in place urgently, if they are not already in place. Any enquiries about this Circular should be referred to the contact point above.

PC33/2004 - Guidance on the handling of medication of residents of approved premises

4