Tailored Care Services Ltd Page: 1 of 2

Office S11, Flexspace, Monckton Road , Wakefield, West Yorkshire, WF2 7AS Last Reviewed: 16/11/2019
Phone: 07534450280 Last Amended: 16/11/2019

CS528 - Medication Care Plan - Example

Mrs Jane Smith CN101212
Service User Name Service User Number

Abilities, preferences, wishes:

Š Is Mrs Smith able to self-administer some or all medication or does she wish for staff to support,
remind or practically assist?
Š Is she able to order and collect medication or would she like staff to do this for her?
Š Does Mrs Smith like medication to be given via a spoon or in liquid form?
Š Are there any allergies or medication contraindications?

What does a good day look like? What does a not so good day look like?

Mrs Smith has a good understanding of when Mrs Smith may not ask for PRN medication and
medication is due and what it is for. staff will need to offer this and establish need.

She relies on staff to provide medication at the right

times and explain what the medication is for.

Support needed from staff:

Š All medication will be recorded on the Medication Administration Record (detail any other
documents in use such as Topical Medication Record)
Š Mrs Smith’s ability to self-medicate and cross reference to the risk assessment or state what staff
need to do to support
Š Storage and role of staff regarding audit and reordering
Š Additional requirements of staff for high risk medication, e.g. CD’s, Warfarin - frequency of blood
tests, etc.
Š If Mrs Smith has PRN medication - cross reference to the PRN protocol
Š Covert medication - state when and which medication and cross reference to GP authorisation,
pharmacy authorisation, MCA and BI decision
Š Over the counter medication, if applicable
Š Action to take if Mrs Smith declines medication
Š When to refer Mrs Smith to the GP or other prescriber
Š Specific needs to help take medication, e.g. she likes them on a spoon, liquids, etc.
Š Swallowing difficulties
Š Specific times of meds to be given
Š If Mrs Smith has medication via different routes, PEG or similar - risk assess where medications
need to be crushed. PR - consent for administration
Š Information is available to educate Mrs Smith on her medication and how frequently medications will
be reviewed
Š Where a specific goal has been set, such as to stop taking sleeping tablets, how can staff support this
(cross reference to Sleeping Care Plan)

This policy is Copyright © Quality Compliance Systems Ltd. 2019 (Last updated 2019) and is only licensed for use with a current Licence Certificate.
If you have a current Licence Certificate, it can be accessed in your online account. Use without a current Licence Certificate is strictly prohibited.
Tailored Care Services Ltd Page: 2 of 2
Office S11, Flexspace, Monckton Road , Wakefield, West Yorkshire, WF2 7AS Last Reviewed: 16/11/2019
Phone: 07534450280 Last Amended: 16/11/2019

CS528 - Medication Care Plan - Example

Associated documents in place:

Š Self-Administration, Covert MCA/BI GP and Pharmacy Authorisation

Š Topical Administration Record
Š Patch Application Form
Š Sleeping Care Plan

Who was involved in producing my Care Plan

Name: Role: Signature: Date:

Mrs Jane Smith Service User x 05/07/2019

Mr John Smith Service User's Son x 05/07/2019

Mrs Key Worker Key Worker x 05/07/2019

Care Plan review: (Full details of the review and who was present should be recorded within
the daily record. Use this section as a quick glance tool only)

Date: Date: Date:

Change: Change: Change:
Yes No Yes No Yes No
Initial: Initial: Initial:
Date: Date: Date:
Change: Change: Change:
Yes No Yes No Yes No
Initial: Initial: Initial:
Date: Date: Date:
Change: Change: Change:
Yes No Yes No Yes No
Initial: Initial: Initial:

Note: All QCS Policies are reviewed annually, more frequently, or as necessary.

This policy is Copyright © Quality Compliance Systems Ltd. 2019 (Last updated 2019) and is only licensed for use with a current Licence Certificate.
If you have a current Licence Certificate, it can be accessed in your online account. Use without a current Licence Certificate is strictly prohibited.