Knowledge and Understanding

K1: The current legislation, guidelines, policies and protocols which affect my work practice in relation to the administration of medication, are:-

Torbay care trusts community skills and competence framework- A framework outlining the parameters for delegation of health and social care tasks by registered professionals to skilled not registered staff (SNR) working in torbay care trust (see log- 24).

Medicines policy for skilled not registered staff (SNR)- This policy provides a clear framework to support the safe use of medicines by skilled not registered staff, and to enable them to administer medication safely and to define the accountability (see log- 25)

The Human Rights Acts- For example everyone has the right to a fair and equal service under law (see log- 1).

The Disability Discrimination Act- To treat everyone equally, regardless of any disability (see log- 5).

The Data Protection Act- For example personal data processed for any purpose shall not be kept for longer than is necessary (see log- 14).

Health Emergencies- What to do if a patient I am treating has an adverse reaction, for example anaphylaxis (see logs- 15, 26).

Infection Control- This includes RIDDOR, COSHH, the disposal of sharps and personal protective equipment (PPE) etc (see logs- 16, 17, 23).

Moving and Handling- The correct way of moving someone safely into the desired place or position (see log- 18E).

The Caldecott Report- For example don’t use patient identifiable information unless it is absolutely necessary (see log- 19).

Hand Decontamination- Patients are put at risk of developing infection when a healthcare practitioner caring for them has contaminated hands (see log20).

Consent for Examination and Treatment- Before I examine, treat or care for competent adult patients I must obtain their consent (see log- 20).

Aseptic Technique- Is the method used to prevent contamination of wounds and other susceptible sites by potentially pathogenic organisms (see log- 21).

a, Drug storage- Medicines must be stored safely and be accessible to the service user, or if not appropriate for the service user to have access, where it is only accessible to relatives and carers, health professionals and domiciliary care staff. This should be recorded and agreed on the care plan. If the care is not in the service users home, medicines should be stored in locked cupboards. Some drugs have special storage needs, such as insulin, liquid antibiotics and eye drops need to be refrigerated.

b, Drug handling, preparation and administration- Whenever handling medication I should have washed my hands or if not possible to have used alcohol gel. When applying medicine to the skin, protective gloves should be worn. Before administering medication I should gain the service users consent. Medication must be administered in accordance with the prescriber's instructions, as printed on the pharmacy label and medication administration record (MAR). I must also check that the medication is within its expiry date.

c, Health and safety when dealing with drugs- Whenever I am handling drugs I must observe all rules and procedures relating to the use of hazardous substances (see log- 27). I must wear any personal protective equipment (PPE) necessary, for example wearing gloves while applying a steroid cream. Also I must make sure drugs are stored safely, for example in a household with young children drugs must be stored out of reach and in a safe place. When dealing with sharps I must follow Torbay care trusts policies and

procedure on there disposal (see log- 23), and also what to do in the event of a needlestick injury or other accident (see log- 28).

K2: My responsibilities and accountability in relation to the current legislation, policies and protocols are:-

Torbay care trusts community skills and competence framework- A framework outlining the parameters for delegation of health and social care tasks by registered professionals to skilled not registered staff (SNR) working in torbay care trust (see log- 24).

The Human Rights Act- If a patient because of their religion for example refuses a treatment or examination; I must respect that (see log-1).

Medicines policy for skilled not registered staff (SNR)- This policy provides a clear framework to support the safe use of medicines by skilled not registered staff, and to enable them to administer medication safely and to define the accountability (see log- 25)

The Disability Discrimination Act- To treat everyone equally, regardless of any disability and not to presume they are any less able to understand or give consent for their treatment (see log- 5).

The Data Protection Act- I should only share necessary information about a patient with other relevant people and with the patients consent (see log- 14).

Health Emergencies- I should only act within my sphere of competence and seek appropriate help when necessary (see log- 15).

Infection Control- This includes reporting diseases or infections (RIDDOR) and wearing the appropriate personal protective equipment (PPE), and making sure I do not infect patients (see log- 16).

Moving and Handling- I should only move a patient with their consent and in a safe way, using any equipment provided, only if I am trained and competent to use it (see log- 18E).

The Caldecott Report- When sharing patient information with another relevant person, I should use the minimum amount of patient identifiable information necessary (see log- 19).

Hand Decontamination- I should always decontaminate my hands immediately before each and every episode of direct patient contact/care and after any activity or contact that potentially results in hands becoming contaminated (see log- 20).

Consent for Examination and Treatment- Before I examine, treat or care for competent adult patients I must obtain their consent (see log- 21).

Aseptic Technique- I must always follow the principals of aseptic technique, which are hand hygiene, protective clothing, no-touch technique and sterile inanimate objects (see log-22).

The Safe Disposal of Sharps- After I have used sharps I must dispose of them safely in a sharps bin. When the bin is full it should be sealed and placed in the designated place for collection (see log- 23).

Control of Hazardous Substances- It is my responsibility to observe all rules and procedures relating to the use of hazardous substances. To use personal protective equipment to reduce risk of exposure to hazardous substances (see log- 27).

Sharps and Blood/Body Fluid Contamination Procedures- It is my responsibility to follow Torbay care trusts documented safe working practices, which are aimed at reducing the risk of such incidents occurring in the first place (see log- 28).

K3: I must always work within my own sphere of competence, because to do otherwise could endanger a patient’s health, well-being or possibly even their

life. Also to act outside my sphere of competence could leave myself and the care trust open to litigation or even criminal prosecution. I should only carry out treatments/examinations etc that I have been signed off as and deemed competent to do by an appropriate specialist. I should seek clinical advice when faced with situations outside my sphere of competence, whether that be when I’m asked by a co-worker/patient to do something I’m not competent to do, or when a situation arises while I am treating/examining a patient that is outside my sphere of competence, I should always seek advice and assistance from a suitably qualified person.

K4: In my role I must always apply standard precautions (previously known as universal), because not to do so could endanger a patients health or even life. Standard precautions are a set of principles designed to minimize exposure to and transmission of a wide variety of micro-organisms. Since every patient is a potential infection risk, it is essential that I apply standard precautions to all patients at all times. Also where needles or other sharps are part of the treatment, a sharps bin (which is yellow with a red top) must be used at all times. When this is full it should be taped securely, and have the post code written on the side, and then put in the designated place for collection (see log - 23). Any unwanted, discontinued or expired medication must be returned to the pharmacy as soon as possible. Preferably a family member, friend or representative will undertake the task. I can remove medication from a service users home, but only with the service users permission (or an

authorised representative) and signature on a “permission to remove unwanted medicines” form. Also I must inform my line manager and list the medicines and obtain their permission to do so.

Standard precautions include:Hand hygiene Protective clothing and equipment Isolation nursing The safe disposal of sharps (see log- 23) Laundry management A clean clinical environment Decontamination of equipment Management of exposure to blood and body fluids Education of patients, carers and healthcare workers

K5: Examples of hazards and complications which may arise during the administration of medications are :-

Anaphylaxis- This a severe, sudden and potentially fatal reaction to a substance entering the body, examples of which are flu vaccination, insect stings or bites, foods such as nuts or shellfish and antibiotics. Symptoms of a patient going into anaphylactic shock include breathing difficulties, irregular pulse, swollen tongue and throat, pain, vomiting and diarrhea (see log- 26).

Needlestick Injuries- It is my responsibility to follow Torbay care trusts documented safe working practices, which are aimed at reducing the risk of such incidents occurring in the first place. If an incident does happen I should follow Torbay care trusts procedures, which include immediately rinsing the injury site with cold water, gently encourage bleeding from the site and seeking immediate medical advice and assistance (see log- 28).

Allergies- Many patients will have allergies to medication or food and drink, it is my responsibility to take all reasonable precautions and make all reasonable inquiries as to whether a patient has any known allergies. This can include speaking to the patient and asking them if they have any allergies, and/or speaking to their doctor, nurse or other relevant health professional. Also I should read their care plan and other available documentation to see if there are any known allergies.

K6: Individuals should be supported and told about the medicine or treatment that I am going to administer, because this would allow them to give informed consent, also this would help them to feel included in their treatment and allow them to take “ownership” of it. Patients could be anxious or frightened about the treatment, so I should explain to them what's going to happen and reassure them and tell them what to expect, this could include tactile reassurance such as holding their hand, but only where it is deemed appropriate. Also I should where possible try to get the patient involved in

their own treatment for example where appropriate getting the patient to read medication leaflets, so they know about the medicine and any possible side affects or contra-indications.

K7: It is vital that when communicating with a patient that I am understood, if I am not this could lead to misunderstandings that could lead to distress and anxiety for the patient, them not having given their consent or even loss of life or limb. I should always communicate with a patient in a language that they understand, this may involve getting a family member or close friend or an interpreter to help with communication. Also a patient may have hearing problems which may mean I have to speaker louder and slower so I can be understood. Another patient may have learning disabilities, so I might have to explain what is happening in a more simplified way or use visual aides such as pictures. Above all when communicating with patients I should be patient and treat them with respect and as individuals.

K8: Factors which may compromise the comfort and dignity of individuals during drug administration are a lack of privacy. This may mean transferring the patient with their consent to another room where it is more private or politely asking people who are not involved in the treatment to leave the room. Also ensuring the patient is calm and relaxed and also making sure they are comfortable and warm. If clothing has to be removed for treatment I should do my utmost to protect their modesty and dignity.

K9: Common types of medication and rules for their storage include :-

Paracetamol- Is used to ease mild to moderate pain. For example, to ease headaches, sprains, toothache or the symptoms of a cold. Also it can be used to help control a fever (pyrexia). For example, when you have the flu (influenza). Paracetamol should be kept in its original packaging or in a blister pack and in a cool dry place, out of sight and reach of children and vulnerable adults.

Antibiotics- Are medicines that kill the bacteria that cause infection. They can be used to treat a wide variety of infections caused by bacteria. These include ear, nose and throat infections, chest infections, skin infections, mouth and dental infections and sexually transmitted infections. Antibiotics should be kept in their original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults. Liquid antibiotics should be kept refrigerated.

Microlax- Is an enema used for the relief of constipation. Microlax should be kept out of the reach of children. It should not be removed from the carton until just before use.

Pessary- A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapse. There are a variety of

pessaries available, made of rubber, plastic, or silicone-based materials.

Nystatin- Is an anti-fungal medication. It is available as an cream, tablet or oral liquid and is used to treat among other things thrush.

Fentanyl- Is used to relieve severe pain. It comes in either a patch which is placed directly on the skin, usually the upper arm or torso, or a lozenge which should not be swallowed or chewed but placed against the tongue or inside of the cheek where it will dissolve. Fentanyl is a controlled drug. Fentanyl should be kept in its original packaging and in a cool dry place out of sight and reach of children and vulnerable adults.

Glycerine Suppositories- Belongs to a group of medicines called stimulant laxatives. Glycerine suppositories should be kept in its original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults.

Furosemide- Is one of a group of medicines known as diuretics, they should be kept in their original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults. They work on your kidneys to get rid of excess water from the body. In my role I regularly come across patients taking diuretics who have swollen limbs usually ankles and lower legs and hands and forearms (Oedema). Furosemide should be kept in

its original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults.

Warfarin- Is an anticoagulant. This means that it stops the blood from clotting. It is used to treat and prevent certain health conditions. These include deep vein thrombosis, pulmonary embolism and transient ischaemic attack (TIA). Warfarin should be kept in its original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults.

Bisacodyl- This belongs to a group of medicines known as stimulant laxatives. Stimulant laxatives are used to treat constipation. Constipation can be caused by poor diet, not drinking enough water and not going to the toilet as soon as you feel you need to. It can also be caused by medications and conditions such as Parkinson's and Multiple Sclerosis. Bisacodyl should be kept in its original packaging and in a cool dry place out of sight and reach of children and vulnerable adults.

Anti-hypertensives- These medicines are used to control high blood pressure (hypertension). Drug therapies include ACE inhibitors (eg ramipril), alpha blockers (eg doxazosin), diuretics (eg bendroflumethiazide) and beta blockers (eg atenolol). These medicines should be kept in their original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable

adults.

Non-steroidal anti-inflammatories (NSAIDs)- Are medicines used to ease pain and swelling in various parts of the body. For example, they are used to relieve painful swelling and inflammation in the joints caused by rheumatoid arthritis or osteoarthritis and overuse or impact injuries such as sprains and strains. NSAIDs are also used to relieve headaches, migraines, period pain, toothache and back pain. NSAIDs are usually given in tablet form, but are also available as liquids, creams, sprays and suppositories. NSAIDs should be kept in their original packaging or in a blister pack and in a cool dry place out of sight and reach of children and vulnerable adults.

Insulin- Is mainly given to type 1 diabetics, although it can be given in combination with medication in tablet form (such as Metformin or Sulphonylureas) to type 2 diabetics. Type 1 diabetics will need to have regular insulin injections (usually 2-4) everyday for the rest of their lives to keep their glucose levels normal. Insulin can be administered using a syringe or an insulin pen (auto-injector). There are different types of insulin preparations such as slow release, fast release and a mixture of the two. Examples of these are Humalog, Insulatard, Mixtard and Novarapid. Insulin should be kept in its original packaging and in a cool dry place out of sight and reach of children and vulnerable adults. Many types of insulin need to be kept refrigerated when not being used.

Topical Steroids- Are commonly used to treat the symptoms of eczema, a skin condition characterised by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They work by reducing inflammation of the skin so easing the symptoms. There are four types of topical steroids, mild such as hydrocortisone, moderate such as Eumovate, potent such as Betnovate and very potent such as Dermovate. Topical steroids should be kept in their original packaging and in a cool dry place out of sight and reach of children and vulnerable adults. Some types of topical steroids need to be kept refrigerated when not being used.

Digoxin- Is a medicine that belongs to a group known as cardiac glycosides. Digoxin is used to treat arrhythmias and heart failure. Digoxin works by correcting irregular heartbeats to a normal rhythm and by slowing an overactive heart, especially after a heart attack. Digoxin also strengthens the force of the heartbeat, which is why it is useful in heart failure. Digoxin is available in tablet, oral liquid and injection form. Digoxin should be kept in its original packaging and in a cool dry place out of sight and reach of children and vulnerable adults.

Hydroxocobalamin- Is an injectable form of vitamin B12. The most common cause of vitamin B12 deficiency is pernicious anaemia where the absorption of the vitamin is impaired due to the absence of an “intrinsic factor”. Supplements are also needed in certain bowel disorders such as coeliac

disease. Hydroxocobalamin should be kept in its original packaging and in a cool dry place out of sight and reach of children and vulnerable adults.

Eye Drops- They're are different types of eye drops. Antibiotics such as Chloramphenicol, Gentamicin and Fucidic acid are used to treat infections. Antiviral agents such as Zovirax are used to treat the herpes simplex virus. Glaucoma drugs such as Timoptil, Betagan and Xalatan are used to treat glaucoma. Steroids such as Prednisolone, Hydrocortisone and Betnesol are used to treat allergic and inflammatory conditions. Eye drops should be kept in their original packaging and in a cool dry place out of sight and reach of children and vulnerable adults. Many types of eye drops need to be kept refrigerated when not being used.

Ear Drops- They're are also different types of ear drops. Antibiotics such as Betnesol, Predsol and Gentisone work by killing the bacteria that are causing the infection. Steroids such as Betamethasone and Prednisolone act to calm down the swelling and stop the pain. Ear drops should be kept in their original packaging and in a cool dry place out of sight and reach of children and vulnerable adults. Many types of ear drops need to be kept refrigerated when not being used.

K10: The effects of common medication relevant to the individuals condition are :-

Paracetamol- Is used to ease mild to moderate pain. Paracetamol is thought to work by blocking the production of chemicals, known as prostaglandins, which are involved in pain transmission. But unlike NSAIDs, it blocks them in the brain not at the source of the pain. Examples of what paracetamol is used for include headache, muscle and joint pain, backache and period pain.

Fentanyl- Is used to relieve severe pain. It works on the nerves and brain to reduce the pain you feel. Fentanyl is a much moor potent pain reliever than morphine.

Microlax- Is a fast acting enema which works to soften bowel motions and gently assist bowel emptying without irritating the lining of the bowel.

Antibiotics- Are medicines that kill the bacteria that cause infection. They can be used to treat a wide variety of infections caused by bacteria. These include ear, nose and throat infections, chest infections, skin infections, mouth and dental infections and sexually transmitted infections.

Glycerine Suppositories- Belongs to a group of medicines called stimulant laxatives. Glycerin acts as a lubricant and a mild irritant and stimulates the

muscle of the intestine, causing it to contract. The contractions help to move the stool along and makes passing them out of the body much easier.

Nystatin- Belongs to a group of medicines called antifungals. It works by killing the fungus or preventing its growth. It is used to treat fungal infections of the skin, mouth vagina and intestinal tract.

Furosemide- Is one of a group of medicines known as diuretics, they work on your kidneys to get rid of excess water from the body. In my role I regularly come across patients taking diuretics who have swollen limbs usually ankles and lower legs and hands and forearms (Oedema).

Bisacodyl- This belongs to a group of medicines known as stimulant laxatives. Stimulant laxatives are used to treat constipation. Bisacodyl works by encouraging the muscles in the bowel to increase the movement of waste products through the body helping the patient to go to the toilet.

Warfarin- Is an anticoagulant. This means that it stops the blood from clotting. It is used to treat and prevent certain health conditions. These include deep vein thrombosis, pulmonary embolism and transient ischaemic attack (TIA).

Anti-hypertensives- These medicines are used to control high blood pressure (hypertension). Before mentioning drug therapy, raised blood pressure can

sometimes be treated through the patient giving up smoking, eating a low fat, low salt diet, reduced alcohol intake, take regular moderate exercise and lose any excess weight. Drug therapies include ACE inhibitors which make the walls of the blood vessels relax and widen. Alpha blockers (eg doxazosin), these help widen the blood vessels. Diuretics (eg bendroflumethiazide), these increase the amount of water and salt removed from your blood by your kidneys, this triggers hormones which lower blood pressure. Beta blockers (eg atenolol), these drugs reduce the work your heart has to do, by reducing your pulse rate at times when it may beat too forcefully such as during exercise or when you are feeling stressed.

Non-steroidal anti-inflammatories (NSAIDs)- Are medicines used to ease pain and swelling in various parts of the body. When you have a sprain or a strain, or a inflammatory disease such as arthritis, your body releases chemicals called prostaglandins, which travel rapidly to the injured area. Prostaglandins make the tissue around the injury swell up and become inflamed, causing you to feel pain. NSAIDs prevent the production of prostaglandins, stopping further swelling and relieving pain. For example, they are used to relieve painful swelling and inflammation in the joints caused by rheumatoid arthritis or osteoarthritis and overuse or impact injuries such as sprains and strains. NSAIDs are also used to relieve headaches, migraines, period pain, toothache and back pain.

Insulin- Is mainly given to type 1 diabetics, although it can be given in combination with medication in tablet form to type 2 diabetics. Type 1 diabetics will need to have regular insulin injections (usually 2-4) everyday for the rest of their lives to keep their glucose levels normal. This is because their body creates little or no insulin, which is produced by the pancreas (a gland behind the stomach). Insulin moves glucose out of the blood and into cells, where it is broken down to produce energy. Type 2 diabetics bodies do not make enough insulin, or cannot use insulin properly. This is called insulin resistance. This type of diabetes is usually linked with obesity. You can usually control type 2 diabetes by making changes to your diet, losing weight and taking regular exercise, or as mentioned above you may need to take tablets or insulin injections.

Topical Steroids- Are commonly used to treat the symptoms of eczema, a skin condition characterised by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They work by reducing inflammation of the skin so easing the symptoms. There are four types of topical steroids, mild such as hydrocortisone, moderate such as Eumovate, potent such as Betnovate and very potent such as Dermovate.

Digoxin- Is a medicine that belongs to a group known as cardiac glycosides. Digoxin is used to treat arrhythmias and heart failure. Digoxin works by correcting irregular heartbeats to a normal rhythm and by slowing an

overactive heart, especially after a heart attack. Digoxin also strengthens the force of the heartbeat, which is why it is useful in heart failure.

Hydroxocobalamin- Is an injectable form of vitamin B12. The most common cause of vitamin B12 deficiency is pernicious anaemia where the absorption of the vitamin is impaired due to the absence of an “intrinsic factor”. Supplements are also needed in certain bowel disorders such as coeliac disease.

Eye Drops- They're are different types of eye drops. Antibiotics such as Chloramphenicol, Gentamicin and Fucidic acid are used to treat infections. Antiviral agents such as Zovirax are used to treat the herpes simplex virus. Glaucoma drugs such as Timoptil, Betagan and Xalatan are used to treat glaucoma. Steroids such as Prednisolone, Hydrocortisone and Betnesol are used to treat allergic and inflammatory conditions.

Ear Drops- They're are also different types of ear drops. Antibiotics such as Betnesol, Predsol and Gentisone work by killing the bacteria that are causing the infection. Steroids such as Betamethasone and Prednisolone act to calm down the swelling and stop the pain.

K11: Examples of medications which demand for the measurement of specific physiological measurements and why these are vital to monitor the effects of the medication are :-

Digoxin- Can cause abnormally slow heartbeat (bradycardia), and also an abnormally fast heartbeat (tachycardia).

Antibiotics- Some people are allergic to antibiotics, particularly penicillins, and can develop side effects such as a rash, swelling of the face and tongue, and difficulty breathing when they take them. Sometimes the reaction can be serious or even fatal, this is called an anaphylactic reaction.

Furosemide- A commonly observed side effect of this drug is low blood pressure (hypotension).

Anti-hypertensives- Side effects which are possible when taking these drugs include allergic reaction, low blood pressure, abnormal heart rhythm (Arrhythmia), pounding or galloping heartbeat (palpitations), dizziness and fainting.

Insulin- Hypoglycemia is the most common side effect that may occur during insulin therapy. Symptoms may include nausea, tiredness, perspiration, headache, heart palpitations, cold temperature and loss of consciousness.

Also an allergic reaction can occur, which for example, could be a minor rash or a very severe reaction (anaphylactic shock).

K12: Examples of common adverse reactions to medications, how they can be recognised and the appropriate actions required. Around 15 per cent of patients hospitalised in the UK report adverse reactions to medication, but less than 5 per cent of those reports are true allergic reactions (mostly to antibiotics). Of this 5 per cent, less than 1 per cent are fatal. Allergic reactions vary from slight rashes to severe anaphylactic immune reactions, such as those seen with penicillin. Some medicines can trigger a histamine release in the body, these include aspirin, anti-inflammatories and morphine. Examples of drugs that can cause an allergic reaction are antibiotics, ACE inhibitors, codeine, aspirin, ibuprofen, iodine, vaccines, warfarin and although it is not a drug I will mention latex as this can be used while administering medicines. The most common symptom that occurs from an adverse reaction is skin symptoms. Hives and swelling suggest an allergic cause, while blistering, peeling and sunburn like reactions suggest a non-allergic immunologic cause. If a patient was having a mild adverse reaction to a medication I would inform my line manager and the patients doctor. In the case of a severe reaction I would call the emergency services.

K13: Examples of common side effects of the medication being used are :-

Paracetamol – Side effects are rare when it is taken in its recommended dose. Skin rashes, blood disorders and acute inflammation of the pancreas have occasionally occurred in people taking the drug on a regular basis for a long time. One advantage of paracetamol over aspirin and NSAIDs is that it doesn't irritate the stomach or cause it to bleed.

Antibiotics- The most common side effects are diarrhoea, feeling sick and being sick. Fungal infections of the mouth, digestive tract and vagina can also occur with antibiotics because they destroy the protective “good” bacteria in the body, as well as the “bad” ones, responsible for the infection being treated. Sometimes, particularly in older people, antibiotic treatment can cause a type of colitis (inflamed bowel) leading to severe diarrhoea. Some people are allergic to antibiotics, particularly penicillins, and can develop side effects such as a rash, swelling of the face and tongue, and difficulty breathing when they take them. Sometimes the reaction can be serious or even fatal, this is called an anaphylactic reaction.

Furosemide- One of the most common side effects is potassium deficiency, which can lead to abnormal heart rhythms, weakness and confusion. Also the patient can feel dizzy, especially during the first few days of treatment. Other less common side effects can include feeling sick, digestive problems, gout,

muscle pain and a skin rash.

Fentanyl- Side effects include a rash or itching underneath the patch, feeling or being sick, constipation, drowsiness or dizziness and a dry mouth. It can also cause breathlessness, difficulty urinating, a fast/slow or fluttering heartbeat, seeing or hearing things that arn't real and mood changes.

Bisacodyl- Side effects include tummy cramps or griping (colic) and sometimes the suppository can cause irritation around the bottom.

Warfarin- The most serious side effect is bleeding. This could be passing blood in urine or faeces, severe bruising, prolonged nosebleeds, blood in vomit and unusual headaches. Antihypertensives- Side effects can include slow heart rate (bradycardia), cold fingers and toes, gastrointestinal problems and tiredness.

NSAIDs- Side effects include indigestion, heartburn, feeling or being sick and diarrhoea. Ibuprofen is among the NSAIDs least likely to cause problems. Other less common side effects include ankle swelling, headache, dizziness, vertigo, tinnitus and unusual bruising or bleeding. NSAIDs can also cause allergic reactions such as skin rashes and wheezing. NSAID preparations applied to the skin can commonly cause reddening, smarting, itching and skin rashes.

Insulin- Hypoglycemia is the most common side effect that may occur during insulin therapy. Symptoms of hypoglycemia include nausea, hunger, tiredness, perspiration, headache, blurred vision, cold temperature and loss of consciousness.

Topical Steroids- Side effects include skin thinning (atrophy), easy bruising and tearing of the skin and susceptibility to skin infections.

Digoxin- The most common side effects are related to digoxin toxicity and heart rhythm disturbances. Other side effects include abdominal pain, nausea, vomiting, loss of appetite, skin rash and blurred vision. Hydroxocobalamin- Side effects include mild diarrhea, itching, or a feeling of general swelling may occur. An allergic reaction to this drug is unlikely, symptoms of an allergic reaction include rash, severe swelling and dizziness.

K14: Different routes of medicine administration are :-

Subcutaneous Injections- Are administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis. Subcutaneous injections are highly effective in administering vaccines and such medications as insulin and morphine.

Intramuscular Injections- Is the injection of a substance directly into a muscle.

It is used for particular forms of medication that are administered in small amounts. Depending on the chemical properties of the drug, the medication may either be absorbed fairly quickly or more gradually. Examples of medications that are sometimes administered intramuscularly are codeine, hydroxocobalamin and diazepam.

Oral- These are medications taken by mouth. This is the most common form of administering medication.

Topical- These are medications applied to the skin. These include balms, creams, gels, oils, lotions, patches, ointments and sprays. Examples of types of topical medications are analgesics, antibiotics, steroids, anesthetics and antiseptics.

Bladder Washouts- Are considered medications and require a doctors written authorisation. The most common cause for use is a catheter being blocked by encrustation caused by build up of calcium phosphate, this occurs when the urine becomes alkaline due to bacteria.

Suppositories- Are medicines to be inserted into the rectum, vagina or the urethra. A suppository may be used for either local or for systemic effects. Though suppositories are used for a variety of drugs they are mainly used in the treatment of constipation and hemorrhoids. They are useful for older

people who cannot swallow oral medication, bed ridden people, post operative people, people suffering from severe nausea or vomiting and people suffering from an obstruction in the intestine. Suppositories are used in the administration of steroids, local anesthetics, analgesics and NSAIDs.

Eye Drops- They're are different types of eye drops. Antibiotics such as Chloramphenicol, Gentamicin and Fucidic acid are used to treat infections. Antiviral agents such as Zovirax are used to treat the herpes simplex virus. Glaucoma drugs such as Timoptil, Betagan and Xalatan are used to treat glaucoma. Steroids such as Prednisolone, Hydrocortisone and Betnesol are used to treat allergic and inflammatory conditions.

Ear Drops- They're are also different types of ear drops. Antibiotics such as Betnesol, Predsol and Gentisone work by killing the bacteria that are causing the infection. Steroids such as Betamethasone and Prednisolone act to calm down the swelling and stop the pain.

Nasal Sprays- Are used for a variety of medications such as antihistamines, decongestants and corticosteroids.

Inhalers- Are portable handheld devices that deliver medication in a form that the person breathes in directly to the lungs. Types of inhalers include bronchodilators, corticosteroids and nebulisers. Inhalers are used to treat

many conditions including chronic obstructive pulmonary disease (COPD), allergies and asthma.

K15: Information which needs to be on the label of medication, both prescribed and non-prescribed and the significance of the information. All over the counter (OTC) drugs are required to have a drug label which provides ingredients, instructions for use and any important cautions and interactions. A drug may not give the intended effect if labels are not followed and the drug can, in fact, damage your health from poor drug label compliance. The directions are extremely important to follow because taking too little of a drug may not provide the desired effect and taking too much could cause an overdose. The instructions will include the dosage amount (eg 2 capsules) and the frequency (eg 3 times per day). It is imperative that the patient follows the frequency exactly as directed. Some labels will also provide a maximum to be consumed within a day. Another type of direction may be the delivery of the drug. Some drugs are simply taken with a glass of water while others may be delivered through the skin in an ointment or cream etc. The label will include warnings or cautions about possible interactions with foods, beverages, other drugs or alternately, other medical conditions. Also included may be warnings against sun exposure, which can occur due to increased skin sensitivity from certain drugs. If the drug has a sedating or drowsy effect, cautions may be given against driving, operating any machinery or partaking in any activity that requires focus and could cause

harm if focusing is impaired. Cautions will often remind you to keep the drug out of a child's reach. It's also important that the patient doesn't use the medication if the seal has been broken. Also drug labels will include things like storage recommendations and the expiry date.

K16: Examples of various aids to help individuals take their medication are :-

Spacers- People who use inhalers sometimes have difficulty using them. A spacer is a large plastic or metal container, with a mouthpiece at one end and a hole for the aerosol inhaler at the other. Benefits of spacers are they make aerosol inhalers easier to use and more effective and you get more medicine into the lungs than when just using the inhaler on its own.

Haleraid- Is a device that is designed to assist people who have difficulty pressing down their puffer. The haleraid provides extra leverage to the user of the inhaler to provide a squeezing action.

Innolet- Is a doser specifically developed for people with diabetes who face difficulties in insulin injection due to poor eyesight or reduced manual dexterity due to disability or joint related conditions.

Blister Packs- Are prefilled by the patients pharmacist with a weeks supply of medication. These are particularly useful for patients with memory problems,

dementia, visually impaired and a lack of the manual dexterity needed to open conventional medicine containers.

Eye Dropper- Are useful for patients using eye drops that do not have the very good manual dexterity.

Pill Box With Alarm- Are useful for patients with memory difficulties, dementia and other conditions.

K17: Different types of materials and equipment needed for the administration of medication are syringes used for the administration of subcutaneous and intramuscular injections. Spacers which are used for people who have difficulty using their inhaler. Eye droppers are useful for administering eye medication for patients who have reduced manual dexterity.

K18: Example of factors which affect the choice of materials and equipment for the administration of medication to individuals are using non-latex gloves where a patient is known to have a latex allergy. Also using a blister pack for a patients medication where due to visual impairment or cognitive ability they are unable to manage their own.

K19: Please see attached sheets 1 and 2 to see how to read prescriptions and medication administration records (MARS) charts.

K20: My understanding of how to prepare medication for administration using a non-touch technique includes washing my hands with warm soapy water and wearing single use gloves, also when administering tablets I could pop the medication out of its blister pack into a clean container and then pass it to the patient.

K21: I would check that the individual has taken their medication by asking them and also checking blister packs to see if the appropriate dose has been taken and also by looking at the medication administration records (MARS) and also looking at the care plan. If the patient was taking the medication while I was present, I would ask them to open their mouth so I could see if the medication had been swallowed. If I was still unsure I would seek assistance from an appropriate person ie nurse, line manager etc.

K22: The disposal of medication should be carried out by the patients relatives or representatives. They should make arrangements for the return of all unused medication to the pharmacist for safe disposal. Where there is noone able to do this, consent should be obtained directly from the patient or care manager. Medication should be returned as soon as possible to the pharmacy. A form should be completed for any medication that requires disposal. Sharps will not be accepted for disposal by the pharmacy and team leaders should make arrangements with the council for their safe disposal.

Following the death of a patient, the medication becomes part of the estate and becomes the property of the person inheriting the estate. Please see log25 for full details of disposal policy.

K23: I should always correctly record my activities following Torbay care trusts policies and procedures, so that it is documented exactly what, when and why I have done something, because if it's not recorded it officially didn't happen.

K24: It is important that I keep accurate and up-to-date records. I should always make my notes factual and accurate and not speculate on what I have seen or heard. Also, whichever care-giver visits the patient after me needs to be able to read my notes and know what has been done and how the treatment is progressing.

K25: It is important I immediately report any issues which are outside my own sphere of competence without delay to the relevant member of staff, because not to do so could affect the patient's standard of care, or even endanger their health. For example if there was a change in the patients condition and I did not understand why, I should speak to a district nurse or other relevant person and seek their help and advice.