Policy and guidelines for medication management in Oranga Tamariki residences (2012)

This document provides guidelines/policy statements for the establishment of medication management procedures within each Oranga Tamariki residence.

These guidelines/policy statements provides clear, simple information that can be used to inform and guide:

• the development of medication management procedures for residences that will meet legal and regulatory obligations for the administration of medication that meet the needs of the young people, health providers, residence staff and respective environments
• the minimisation of risks associated with medication administration
• awareness of legal and regulatory responsibilities of registered health professionals and unregistered caregivers.

"A comprehensive medications management system is required in residential facilities to manage the safe and appropriate dispensing, supply, administration, review, storage, disposal and reconciliation of medicines. This system should be clearly documented and available to all staff at all times. Staff involved in medicines management are required to work within their scope of practiceand demonstrate their competence to provide this service. Access to specialist medicines, education and advice for residents and staff must be made available. The clinical file should include documentation that records all relevant details to support safe medicines management and should comply with legislation, regulations, standards and guidelines. The safety of residents, visitors, staff and contractors must be maintained through appropriate storage and access to medicines" (Ministry of Health , 2011).

3.1 Every child or young person in a residence is entitled to prompt, adequate, and appropriate health services and health care. (The Children, Young Persons and their Families (Residential Care) Regulations 1996. Regulation 14 Right to medical examinations and treatment)

3.2 Children and young persons have access to a full range of health care and health promotion services and programmes that maintain or improve their health and well being, including the opportunity for a medical examination within one week of admission. (Oranga Tamariki National Code of Practice: Residential Care Services)

3.3 Every young person will receive medication and health treatment in accordance with the Code of Health and Disability Services Consumer Rights. (Health and Disability Commission (2009)

3.4 All Oranga Tamariki staff who administer medication do so under the direction and delegation of a health practitioner. (NZNO Guidelines for the Administration of Medicines, (2007) section 10.5)

3.5 No residential Oranga Tamariki staff will give any medication except what has been prescribed, including over the counter medication.

3.6 All Oranga Tamariki staff that are administering medication have completed a Medication Administration Training course and have been assessed as competent to do so.

3.7 Every young person in residence who is prescribed medication will receive the right medication:

• in the right dose
• at the right times
• via the right route
• and for the right period of time.

3.8 Medication will be dispensed and recorded in compliance with legal requirements. (Medicines Act 1981, p.3., The Misuse of Drugs Act 1975 and 1977, as cited in NZNO (2007), p.7.)

3.9 In the event of a medication error it will be reported to the health practitioner and the young person will receive appropriate follow up. (Medication Procedures for CYFS Residences, (2012), p6.)

3.10 All medications will be stored in a locked room, dedicated medicines refrigerator or medicines cupboard free from heat, moisture and light. (Ministry of Health, (2011) Medicines Care Guides for Residential Aged Care.)

This document applies to all Oranga Tamariki staff and health practitioners that are involved in or associated with the administration of medication to any child or young person in an Oranga Tamariki residence.

For the purpose of this document and procedures the following definitions will apply:

Young Person: Person residing in the care of Oranga Tamariki within a care and protection or youth justice residence. Their rights in regards to healthcare are protected under the Code of Health and Disability Services Consumer Rights.

Oranga Tamariki Staff: Any non health professional employed by Oranga Tamariki to care for residents (any care staff, team leader, case leader or their managers who are not regulated by Nursing Council or Medical Council). Oranga Tamariki staff must abide by the Children, Young Persons, and their Families (Residential Care) Regulations 1996; Regulation 14, part 5 and 6 in regards to medication administration within a residence.

Residence Manager: The residence manager will support staff engagement in medication training, the performance of medication duties and the follow up of errors and incidents.

"Every Manager of a residential care facility must take all reasonable steps to ensure that at all times, the storage, administration and disposal of medicines are strictly controlled, and that safety, efficacy and accuracy are maintained with respect to "the right dose being administered in the right form to the right person at the right time" as prescribed by a medical practitioner." (Ministry of Health, 1997)

Health Practitioner: Registered Nurse, Nurse Practitioner or Registered Medical Practitioner.

Pharmacist: Dispenses and labels medicines according to prescriptions, legislation, regulations and guidelines. (Medicines Care Guides for Residential Aged Care, 2011)

Medication (medicine): A substance or preparation used in preventing or treating disease. (Medline Plus, 2012) Note: Can be a prescribed or over the counter preparation.

Controlled Medication: Medications that are listed under the Misuse of Drugs Act, and require two people (who have demonstrated medication management competency) to check and sign for when administering. Controlled medications have specific rules for prescribing, registering, storing and disposal.

Prescribing: The process of designating or ordering the use of a remedy (Medline Plus, 2012). In NZ medicines can be prescribed only by a:

• Dentist
• Medical Practitioner
• Designated Nurse Prescribers
• Registered Midwives.

Standing Order: A tool for procuring the administration of treatment or medicines in the absence of a qualified practitioner (NZNO). Can be utilised by registered nurses only.

Verbal Order: A telephone or verbal order to administer medication before a written prescription is made. An authorised prescriber must prescribe and countersign within an agreed timeframe to comply with legislation. (NZNO, 2007).

Administering: The process of giving medication to a person. To give remedially (Medline Plus, 2012). In the Oranga Tamariki residence medications can only be administered:

• in accordance with the directions of the prescriber
• by Oranga Tamariki staff who have been delegated to do so by a health practitioner and Oranga Tamariki, and who are working in accordance with Oranga Tamariki policies and guidelines
• by health practitioners in relation to their scope of practice and in accordance with their legal and regulatory accountabilities.

Dispensing Medication: The process of making a medicine available from a central supply for individual use, a process usually carried out by a pharmacist. (Johnson, 2004, p.262 cited in NZNO 2007)

Medication Training and Assessment: A residence specific course, to be completed by Oranga Tamariki staff who are to administer medications. Includes legal responsibilities, policies and procedures and practical assessment by a pharmaceutical specialist or registered health practitioner.

Health and Disability Commissioner

Medicines and Medical Devices Safety Authority

Refer to your local contracted pharmacy for assistance or the residence health provider for clarity.

Authors of this document (2012): Donna Southorn (Pegasus Health), Robyn Sharp (Te Maioha o Parekarangi), Lyn Tupai (Ivita Health Services), Hannabel Chase (Lower North Island YJ), Di Hare (Bealey Pharamacy), Kerry Oxenham (pharmacist), Gayle Lauder (Pegasus Health) in conjunction with Denise Tapper (Oranga Tamariki Manager Clinical Services).

These guidelines/policy statements have been authorised by General Manager Residential and High Needs Services.

Standing Orders (under development)

Each residence requires individualised medication management procedures. Using this policy and these guidelines, health practitioners and Oranga Tamariki staff will:

1. review their procedures to ensure they meet legal and policy requirements, OR
2. write new procedures that meet policy requirements.

Oranga Tamariki staff will (when trained and assessed as competent to do so and delegated by the registered nurse):

• administer medication when it is prescribed
• receive prescribed medication from the pharmacy and give it to a young person
• sign for controlled medication with another person
• work according to Oranga Tamariki residence policies and procedures.

Oranga Tamariki staff will not:

• give any medication, natural remedy or over the counter substance without a written prescription from a Dr
• give any medication unless they have been educated and deemed competent to do so by the health practitioner
• dispose of medication
• sign for and administer controlled medication alone.

Young people can:

• refuse to take medication (please tell the nurse and sign as refused in the chart)
• expect to be fully informed about their medication and give verbal consent
• consent to immunisation and medical treatment if they are deemed intellectually capable of making that decision.

Young people can not:

• keep possession of their medication while in residence
• change prescribed medication times without the written consent of the prescriber.

Nurses will (within their scope of practice):

• check and administer medication that is prescribed from a prescription or Doctors prescribed medication chart
• administer medication on a standing order or verbal order
• provide education and supervision for non health staff that are delegated to give medication
• be professionally accountable for medication administration and risks within the residences.

Nurses will not:

• repackage medication from a stock supply for an individual
• give medication that does not have a prescription or standing order
• sign for and administer controlled medication alone.

Child Young Person’s and their Families (Residential Care) Regulations 1996. Ministry of Social Development.

Child Youth and Family National Code of Practice: Residential Care Services

Health and Diasability Commissioner Code of Rights. (n.d.). Retrieved February 7th, 2012, from Health and Disability Commissioner website.

Medline Plus. (n.d.). Retrieved February 7, 2012, from Medline Plus Merriam Webster.

Ministry of Health . (2011). Medicines Care Guide for Residential Aged Care. Wellington: Ministry of Health.

New Zealand Nurses Organisation. (2007). Guidelines for Nurses on the Administration of Medicines. Wellington, New Zealand: New Zealand Nurses Organisation.