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MEDICINES CHECKLIST AUDIT

AIMS

1. To identify the current status of policies in the care home


2. To determine how far those policies are adhered to

Method

The visit should be planned and agreed with the manager of the home it is not intended to be a surprise visit

Work through the checklist with a member of staff responsible for handling medication.

Identify any areas where changes or improvements could be made

Discuss these changes with the home manager or a designated member of staff

Results
Give one copy to the home and one copy to; Debbie Clark, Primary Care Projects Officer, NHS Walsall, Jubilee House.

Completed checklists should be returned by 10th July 2009

Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf May 2008. ver 3 1


Records/Labelling audit

Care Home Audit-complete yes/no for each chart and question and work out % of Yes answers
Care Homes records audit-MAR Chart no 1 2 3 4 5 6 7 8 9 10 %

Are MARs Charts completed in ink?

Are MARs Charts current (in date)?

Are MARs Charts legible?

Are MARs Charts signed?

Are all medicines detailed on the MARs Chart, including prn?

Are the MARs charts initialled every time medicines are administered?

Are the MARs charts initialled every time a patient refuses medication?

Are the MARs charts initialled every time the patient does not receive the drug because it is not available?

Does the Mars Chart contain special instructions for specific drugs where appropriate?

Care Homes labelling audit-MARs Chart No 1 2 3 4 5 6 7 8 9 10 %

Are all MDS boxes clearly labelled?

Are all tablet bottles and blister packs clearly labelled?

Do medicines containers and MDS show special instructions for specific drugs where appropriate?

Are all eye drops labelled clearly on both the bottles and boxes?

Are all creams and ointments labelled clearly on both the tubes/jars and boxes?

Are all other topical preparations clearly labelled?

Is the home provided with a Patient Information Leaflet for each medicine?

Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf May 2008. ver 3 2


Policies YES NO If drug trolleys are used are they well constructed and
A Is there an Obtaining Medicines Policy? large enough to store individual patients medicines
Are stocks of medicines/appliances checked before separately?
ordering prescriptions? Can the drug trolley be either locked to wall or locked in
Prescriptions are checked against order by care home a cupboard when not in use?
before sending for dispensing? Is there a refrigerator for storing medicines?
Dispensed medicines/appliances are checked against Is there a record of the fridge being cleaned and
those requested and those currently prescribed? defrosted regularly?
Is stock rotated and expiry dates checked? Check the fridge temperature log-is it complete and are
Are new stocks of medicines/appliances received all temperatures within the 2-80 range?
recorded? Does the policy indicate the action to be taken if the
Are remaining stocks of current medication carried fridge temperature is outside the range 2-80?
forward onto new MARs chart? Is the fridge used to store non-medicines?
Is there a clear process for what to do if medicines are D Is there a policy for Medicines Administration?
missing or cannot be found? Are medicines only administered from containers labelled
Is there a process for obtaining acute medications and and supplied from the pharmacy/dispensing doctor?
supplies out of hours? Is there a robust system for identifying patients?
B Is there a policy for Record Keeping? Does each member of staff administering medicines
Have you completed the attached Records/Labelling know what each medicine is for?
Audit? Are all staff administering medication aware of any
Is there a system for when medication changes occur special precautions e.g. for bisphosphonates?
part way through the life of a MARs chart? Is there a process for reporting ADRs?
Is there a process for medicines reconciliation for Is there a process for managing product recalls?
patients being transferred into or from the care home? Are staff administering medicines continually assessed?
C Is there a policy for Storage of Medicines?
Is there a policy for crushing tablets for patients with
Are medicines stored in individual patients locked swallowing difficulties?
draw/cupboard? Is there a policy for drug administration via a naso-
Are medicines stored centrally? gastric tube?
If stored centrally are the cupboards big enough, with a Is there a policy for drug administration via a PEG?
secure lock? Is consent obtained from residents for staff to administer
Is access to the locked drug cupboards limited to named medicines?
staff members? Are cultural and moral beliefs of patients considered
Are topical medicines, dressings appliances and MDS when administering medicines?
stored separately in suitably sized cupboards? E Is there a policy for Self-administration of
Are storage cupboards/trolleys situated in dry areas that Medicines?
are neither too hot, cold or damp and do not have large Are patients continually assessed as to their ability to
temperature variations? continue to self-medicate?
If patients need support to self-administer, is the level of
support required documented in the patient’s care plan?

Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf May 2008. ver 3 3


Policies YES NO Does training cover supply, storage, and disposal of
F Is there a Controlled Drugs Policy? medicines, safe administration, quality assurance, record
Are CDs stored in individual patients locked keeping, accountability, responsibility and confidentiality?
draw/cupboard? Does policy allow for assessment of training needs for
Are CDs stored centrally? If stored centrally, is there an new staff at induction?
approved secure CD cupboard or cabinet used for CDs Are care workers with no previous experience allowed to
only? administer medicines?
Is the register kept correctly-running balances that are Do staff have a practical assessment after their training is
reconciled regularly? complete?
Are keys held by designated persons only? Does training cover all aspects of Medicines
Administration Policy?
Is the CD register bound with numbered pages?
J Is there a policy for Criminal Activity within the home?
Are records of receipt, administration and disposal of CDs
Is there a procedure for dealing with patients who bring
completed?
illicit drugs into the care home?
Is a second signature required on MARs chart when CD
Is there a procedure for dealing with theft within the care
are administered?
home?
Are CDs disposed of correctly?
G Is there a policy for Disposal of Medicines?
K Do patients receive a regular medication review by
Does the home keep a record of Disposed Medicines their GP?
which can be easily accessed e.g. a” Waste Book” Do patients have regular MURs conducted by the
Do records show the date of disposal, name and strength pharmacist?
of medicine, quantity removed and who the medicine was L Is there a policy for Reporting Errors and near misses?
for?
Do the records show the name of the member of staff
who arranged the disposal? M Storage of Gases and Hazardous substances
If a non-nursing, home are unwanted medicines returned Are these stored safely?
to a pharmacy? Are appropriate notices displayed?
If a nursing home, are unwanted medicines disposed of
via a licensed waste management company? O Nutritional Status
Are unwanted medicines disposed of promptly?
Does the home order nutritional supplements for patients
Are medicines kept for 7 days in the event of a patient’s without referring to a Dietician of the patient’s GP
death? If” yes” is an assessment tool used.
H Is there a policy for Minor Ailments? Name of tool:
Does the home allow treatment with “Homely Medicines”? P NPSA/MHRA Alerts
Does the care home get advice on homely remedies from Are these received regularly and is the appropriate action
a doctor, nurse or pharmacist? taken?
Does the home have a detailed protocol for minor Is the information contained in them shared with all staff?
ailments available to staff, patients and relatives?
Does the home record purchase, administration and
disposal of homely remedies
I Does the home have a Staff Training Policy?
Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf May 2008. ver 3 4
Pharmacists recommendations continued:
Criteria:
All the main policy documents A to L should be in place.
Indicate the number of ticks in the grey boxes below:

The above checklist was completed on………………………………….

Name of home………………………………………………………...……….

Address………………………………………………………………………….

…………………………………………………………………………………….

Signed………………………………….................Care Home Manager

Signature of pharmacist……………………………………………………..

Address of pharmacy if applicable………………………………………..

Pharmacy telephone number………………………………………………

Time taken for visit………………………………….hours


Give one copy to Care Home and send one to Debbie Clark,
Pharmacists recommendations: Primary Care Projects Officer, NHS Walsall, Jubilee House,
Bloxwich Lane, Walsall, West Midlands. WS2 7JL

Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf May 2008. ver 3 5