Standard Operating Procedure for Administration of Medicines within and REACT Domiciliary Care Services
Version: V2
Ratified by: Medicines Governance and Safety Group
Date Ratified: 30/10/2025
Job Title of Author: Assistant Clinical Director Pharmacy and Medicines
Reviewed by Sub Group or Expert Group: Medicines Governance & Safety Group
Related Procedural Documents: MMPOL33 Medicines Reconciliation Policy
MMSOP65 SOP for the Administration of Injectable Medicines by Healthcare Support Workers in the Community
MMSOP64 Safe Prescribing, Transcribing, Preparing and Administering of Injectable Medicines SOP
IPPOL18 Management & Safety of Sharps
IPPOL03 Infection Control Hand Hygiene
IPGUI02 Infection Prevention & Control Community Guidelines
MMPOL36 Managing Medicines in Provide care solution and REACT
MMGUI74 Self-Care Toolkit for Provide Group Care Services
Review Date: 30/10/2028
It is the responsibility of users to ensure that you are using the most up to date document template – ie obtained via the intranet.
In developing/reviewing this procedure Provide Community has had regard to the principles of the NHS Constitution.
Version Control Sheet
Version Date
V1 March2021
V2 July2025
Assistant Clinical Director Pharmacy and Medicines
Community Health Specialist Pharmacist New
Community Health Specialist Pharmacist
Review Ensure alignment with more recent CQCupdateson medicines optimisation, new Safer Care guidance, and digitalMARbest practices.
Separation of care home and domiciliarySOP
1. Introduction
People requiring Domiciliary Care have the same rights and responsibilities in relation to NHS care; this is set out in the NHS Constitution for England. Treatment and care should consider an individual's needs and preferences. Helping service users to help look after and take their medicines themselves is important in enabling service users to retain their independence. An individual risk assessment should be undertaken to determine the level of support a service users’ needs to manage their own medicines.
This Standard Operating Procedure (SOP) provides REACT Domiciliary Care staff with procedures for the safe administration of medicines. The proper management and administering of medications is a key part to good care for service users within REACT Domiciliary Care services.
This SOP must be read in conjunction with MMPOL36 Managing Medicines in Provide care solutions and REACT.
2. Scope
The SOP is for all staff who have a collective responsibility for the safe and effective administration of medicines to service users with REACT domiciliary care services.
3. Aims and Objectives
• To provide clear guidance to REACT staff and managers on good practice for the safe management and administration of medicines to service users in their care
4. Administration of Regular Medicines
Medication must be administered by appropriately trained staff, in a person-centred way and respecting dignity, independence, privacy, cultural and religious beliefs of the service user at all times.
All medication administered must be recorded in the patients Medicines Administration Chart (MAR), this can be a paper MAR or an electronic Medicines Administration Chart (eMAR).
The MAR/eMAR chart is the confidential, formal record of administration of medicines and may be used as evidence in clinical investigations and court cases. It is therefore important that they are clear, accurate and up to date.
React mainly uses an electronic MAR system called ACCESS; however paper MARs are used as contingencies if there is system outage with the electronic system.
The 6 Rights of Administration must be applied at all times:
In order to have ‘capacity’ to manage medication, the service user must be able to:
• understand how to take their medication and understand why the medication has been prescribed
• understand what will happen if they don’t take the medication or not following the GP’s instructions
• retain and use the information
• make choices and be able to tell people about them
Staff need to ask for the service user’s consent each time medication is to be taken:
• Where possible, the service user must provide informed consent. If that is not possible, but there is a possibility that the service user can give consent, then the service user must be supported to make an informed decision
• If consent cannot be obtained or the service user lacks capacity
• Key people acting in the best interests of the service user can make a decision. This must include a full assessment from a healthcare professional. Documentation must be kept of how and why the decision was reached and their competence assessed before this task is undertaken and clearly recorded in the service user’s care plan
• instructions must be sought from the GP. In such cases, the service user’s Care Plan must be referred to
Service users must be given the choice:
• To take or refuse medication. If refused, the circumstances/reason (if provided) must be recorded in the service user’s care plan and current electronic Medicines Administration Record (eMAR) by completing the associated medicines task, unless an agreed plan of action is already in place for when medication is refused, staff should follow information in the patient information leaflet (PIL) for any missed doses unless there are specific instructions from the GP. The GP must be contacted for advice after any three refusals, involving the service user where appropriate
General Principles
• All healthcare professionals and care staff are accountable for their own actions and omissions and must exercise their professional judgment and apply their knowledge and skill when administering medicines, they must also be able to recognise their limit and know when to seek additional advice
• Medicines may only be administered from original containers/packaging or blister packs
People who may administer medicines
• Care staff who have been competently assessed
• Healthcare Support Workers who have been competently assessed
Procedure for Administration of Regular Medicines Preparation
• Gain the service users consent before proceeding (see Refusals)
• Minimise disruptions and distractions
• Adhere to PROVIDE Hand washing guidelines (IPPOL03 Infection Prevention and Control Hand Hygiene Policy)
• Adhere to Provide Personal Protective Equipment (PPE) (IPGUI02 Infection Prevention & Control Community Guidelines
• Refer tothe current medicines tasks in the electronic Medicines Administration Record (eMAR) chart and the service users care plan.
• Check which medicines are due
• Check whether the care plan has specific recommendations regarding medicines administration (e.g. religious or ethnic issues such as acceptance of medicines during Ramadan)
• Retrieve medicines from where they are stored, remembering that they may be in different places (e.g. fridge)
• Check the medicine labels against the medicines task in the eMAR chart
• Administer medicines only from containers that are clearly labelled by the pharmacy
• Ensure you have the correct equipment to administer the medication
Administration
• For warfarin see checklist below
• For medicines other than tablets and capsules, refer to the Checklist for administering medicines in different dosage forms
• Check the expiry date on the container
• Check any special administration instructions on the medicines label including whether it should be taken before or after food or separately from food and drink. (Refer to the Checklist for medicines where timing in relation to food is important)
• Encourage the service user to sit upright to prevent medicines becoming lodged in the oesophagus
• Using a ‘no touch’ technique, push tablets from the original container into a clean and dry container, not into the service users hand
• If the medicine is soluble or dispersible, place it into a small glass of water (as directed) and allow it to dissolve
• Do not crush tablets or empty capsules (this may alter the therapeutic effect) unless a GP/pharmacist has advised that this can be done and it is documented in the service users care plan
• Do not mix medication with thickening agents as this is unlicensed use, unless advised by the service users GP and it is documented in the service users care plan
• If service user has difficulty in swallowing refer to GP or pharmacist for alternative forms available
• If a medicine is dropped on the floor, - this would need to be reported immediately to the manager/office and an incident completed on the app. It will need to be dispose of it according to (MMPOL36 Managing Medicines in Provide care solution and REACT)
• Hand the container to the service user
• Offer the service user water to help with swallowing (no hot drinks – these may scald the service user and can affect stability of medicines; no grapefruit or cranberry juices – these can interact with medicines)
• Stay with the service user until you are sure the medicines have been swallowed
• Return medicine containers to their original storage place.
Dealing with Refusals and Omissions
Service users have the legal right to refuse medicines unless assessed to lack capacity. All refusals must be documented and escalated. Covert administration must only occur under formal best interest decision-making with full MDT and family involvement.
• Check that service user consent to assistance with medicines administration has been documented in the care plan
• Service users have the right to accept or refuse a medicine on each occasion it is offered
• If medicines are refused, wait for a short time and offer them again
• If the service user refuses a second time, do not force him or her to take them. Medicines must not be disguised in food or drink (covert administration), see MMPOL36 for difference between overt and covert administration)
• If the service user is competent, confirm the reason for refusal
• Record the reason for refusal or omission by completing the medicines task in the eMAR chart and in the service user held record and electronic record
• If medicines were spat out or taken from the original containers and then refused, dispose of them promptly according to (MMPOL36 Managing Medicines in Provide care solution and REACT)
• Persistent refusal to take a medication should be reported to a senior member of staff and investigated. The service users GP will need to be contacted within working hours or NHS 111 for ‘out of hours’ If there are any difficulties administrating the prescribed medicine e.g. service user has swallowing problems, advise the prescriber so that an alternative preparation can be sort
• Care staff must not take the decision to stop offering medication by themselves
Records
• After each medicine is administered or taken, log this by completing the medicines task in eMAR chart
• The task should only be completed when the care staff has witnessed the service user taking the medication
• If doses are omitted or refused (e.g. service user cannot swallow or is vomiting), record the omission on the medicines task in eMAR chart using the appropriate code and the reason for omission or refusal
Reporting suspected Adverse Events
• If you suspect that a service user has experienced a possible adverse reaction to a medicine or an allergy, take immediate action to alleviate any suffering or distress
• Inform manager and service users GP or NHS 111 if out-of-hours
• If the service users condition deteriorates, e.g. develops breathing difficulties, call 999 for an ambulance
• Record this in the service user held records and electronic record and care plan
• Complete an incident form on access
• Contact the office and inform the manager who will determine if a Yellow Card reporting is required, this can be done electronically https://yellowcard.mhra.gov.uk/or using the yellow card App or form located at the back of the BNF
Registered managers should decide when appropriate for families to be informed in line with CQC Regulation and local guidance (see QSPOL03 Being Open and Duty of Candour Policy).
Care staff administering medicines should consider the following in a medicines administration process:
SAFETY CHECKS
RIGHT SERVICE USER
✓ Check that you have the right service user and open the right record of the medicine administration task in the eMAR chart
✓ Check the name on the eMAR chart against the medicine containers
RIGHT MEDICINE
Remember the names and packaging of many medicines can be similar.
✓ Read the name of the medicine on the label and double check against the medicines task in the eMAR chart
✓ Check the patients record/eMAR chart and care plan for any known medicine allergies/sensitivities
✓ When removing blister strips of medicines from the original container, check that the medicine name on the back of the blister strip is the same as that on the container and label
✓ Return the blister strip to the same container after removing the prescribed dose, checking the labels as you go
RIGHT TIME
Remember mornings and evenings are the most common times for taking medicines.
✓ Check when medicines were last administered
✓ Check that the medicines you intend to administer are due at this particular time of day
✓ Check service user has not already taken or been given their medicines
✓ For medicines taken weekly (e.g. methotrexate, alendronate), double check the medicines task in eMAR chart to verify the correct day of the week for administration
✓ Check the label for information on whether the medicines should be taken before or after food. (Refer to Checklist for medicines where timing in relation to food is important)
✓ Double check dose intervals for medicines that are not given every day, and to verify dose intervals for modified release medicines, against the medicine label
RIGHT DOSE
✓ Check the number of tablets/capsules (or the number of mls of liquid) needed to give the correct dosage
✓ Check this matches the instructions on the medicine container (e.g. take two tablets, or take one 5ml spoonful)
RIGHT TO REFUSE
✓ Service users have the right to refuse their medicines if they have the capacity to do so
✓ If a refusal occurs, do not force or persuade record the refusal by completing the medicines task in the eMAR and inform the appropriate person in line with the care plan
✓ Medicines should not be left out to be taken later, if refusal occurs, the medicine should be disposed of and recorded accordingly. Where appropriate it can be handed over to next care staff if they should offer it or not, ring the office /manager for advice
Checklist for Medicines Where Timing in Relation to Food Is Important
This is not an exhaustive list (Refer to the online BNF, office copy for further information or patient information leaflet (PIL))
Commonly used medicines that should be taken with or after food
Allopurinol
Aspirin (including low dose 75mg)
Azathioprine
Betahistine
Bezafibrate
Cefuroxime
Clarithromycin
Co-Dydramol
Diclofenac
Dihydrocodeine
Dipyridamole modified-release
Galantamine
Ibuprofen
Labetalol
Mesalazine
Metformin
Metformin with pioglitazone (Competact)
Metformin with rosiglitazone (Avandamet)
Metronidazole
Naproxen
Nifedipine modified-release (some brands)
Olsalazine
Omacor
Paroxetine
Potassium effervescent (Sando-K)
Rivaroxaban
Ropinirole
Spironolactone
Theophylline
Commonly used medicines that should be taken half to one hour before food
Alendronic acid
Dipyridamole (not m/r)
Fybogel Mebeverine
Gemfibrozil
Omeprazole
Lansoprazole
Lercandipine
Levothyroxine
Risedronate sodium
Commonly used medicines that should be taken an hour before food or on an empty stomach
Ibandronic acid
Flucloxacilin
Montelukast
Tacrolimus
Quetiapine
Zafirlukast
5. Good Practice Guidance: Administration of Warfarin
Warfarin is an anticoagulant drug used in the treatment and prevention of stroke and thromboembolism (blood clot). Anticoagulants are one of the medicines most frequently identified as causing preventable harm and admission to hospital. Nationally it is recognised that procedures promoting safe administration and monitoring of warfarin can reduce the risk of harm and improve care.
Warfarin is available in four different strengths of tablets which are colour coded, 500micrograms (white), 1mg (brown), 3mg (blue) and 5mg (pink)
Responsibilities of Care Staff
All communication regarding INR results should be kept with the service users Yellow Book or equivalent anticoagulant clinic record log
• The yellow book or other INR record sheets (if not kept by the service user themselves) and any confirmation emails must be stored/checked with the service users’ medicines task in the eMAR chart for cross-referencing
• If a service user is transferred to another care setting - the yellow book (or equivalent anticoagulant clinic record log), INR result sheets, a copy of the eMAR sheet and any other information received must be sent with the service user
• If the service user is temporarily transferred (e.g. admitted to hospital) then copies of the above information must be sent with the service user
• Any missed doses within the last two weeks will affect the INR result. The anticoagulant service MUST be informed of any missed warfarin doses. It must also be informed if a service user is refusing or unable to take warfarin
• Inform Anticoagulant clinic of changes in medication, diet, hydration that could affect the warfarin
Recording of Information - Recommendations
• The dose of warfarin intended for the service user must be clearly stated in the medicines task in the eMAR chart - it is good practice to have the medicines task in eMAR chart checked and signed by a second member of staff for accuracy after this information has been added
• Ensure the number of milligrams (mg) of warfarin required is stated in the medicines task in the eMAR charts, not the number of tablets
• Warfarin should never be administered without adequate and regular monitoring of the INR
• It is essential that there is a safe system to ensure that information on INR results and dose to be taken via email, yellow book, INR result sheets and medicines task in eMAR chart are cross-referenced for correlation that the correct dose is being taken
SERVICE USER SAFETY CHECKS PRIOR TO ADMINISTRATION
Step 1 – Confirm that the service user is not experiencing any obvious side effects from warfarin and that there is no significant change in circumstances that might cause side effects in future
• Is there any evidence that the service user is currently experiencing bleeding or bruising?
• Has there been a sudden change in diet (e.g. green vegetables) in the lastweek that may affect service users INR?
• Has there been a sudden change in alcohol intake in the last week that may affect service users INR?
Step 2 – Check if the service user has a yellow Oral Anticoagulant Therapy Record Book
Step 3 - Review yellow record book / prescription chart / care plan (To establish if warfarin monitoring (INR) is required and it is safe for you to administer)
• Make sure that the last documented INR result is available
• Make sure that the last date recorded for the service user to attend for INR monitoring is not overdue
• Look in yellow book / or care plan for the service users target INR
• Compare the service users latest INR result and if not available refer to the prescribing clinician or GP
• Check when the next INR is due
• Check the current daily dosage of warfarin that is recommended
PRESCRIPTION SAFETY CHECKS PRIOR TO ADMINISTRATION
Step 4 – Check the medicines task due in eMAR chart
• Confirm that the daily dosage of warfarin in the medicines task from eMAR chart matches the dose details on the last entry in the yellow record book / pink sheet
• Ensure that the dose of warfarin has not already been administered earlier in the day
• Ensure that there is approx. 24 hours between doses – i.e. check time of previous administration on eMAR chart
MEDICINE SAFETY CHECKS PRIOR TO ADMINISTRATION
Step 5 - Check warfarin tablets
• Check expiry date on packets of warfarin tablets
• DO NOT SPLIT TABLETS
• Make sure that there is adequate stock of warfarin tablets for the next day, if there is not, follow usual procedures for ordering a repeat supply for service user
ADMINISTRATION PROCES
Step 6 – Administer warfarin tablets
• Wash and dry hands
• Remove the minimum number of tablets to make up the correct daily dosage of warfarin
BEFORE ADMINISTRATION: Double check that the tablets used add up to correct daily dose
• Once you have finished make sure that the right strength of warfarin is returned to the correct package
DOCUMENTATION PROCESS FOLLOWING MEDICINES ADMINISTRATION
Step 7 – Document details of warfarin administration
• Document administration of warfarin on service users eMAR chart by completing the relevant medicines task
• If for any reason the dose of warfarin is not administered contact
• the prescribing clinician or GP
6. Best Practice Guidance for Inhalers
Good Practice Points
• Every service user should have an individualised care plan which includes overall aims and a monitoring plan and when to contact their GP
• When asking about asthma symptoms, use specific questions, such as the Royal College of Physicians ‘3 Questions’
1. Have you had difficulty sleeping because of your asthma symptoms, including cough)?
2. Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness, or breathlessness)?
3. Has your asthma interfered with your usual activities (e.g. housework, work/school, etc.)?
• Good inhaler spacer device care and regular monitoring of the inhaler technique are essential to ensure effective treatment and management of asthma or COPD is achieved
• Some of the inhaler medicine may hit the back of the throat which can sometimes cause problems such as thrush in the mouth. This tends to be more of a problem with higher doses of steroid inhalers
• Less medicine hits the throat when using a spacer device. Therefore, a spacer device should be advised if inhalers cause throat problems, especially when a high dose of inhaled steroid is prescribed
• Service users should be advised to rinse their mouth and have a drink of water after using the steroid inhaler
Metered dose inhalers (regular doses)
If service users are not capable of administering their own metered dose inhalers because of inability to co-ordinate breathing with actuation, a spacer device should be used.
1. Remove the cap
2. Check the label for any special administration instructions and read the service user information leaflet
3. Shake the inhaler well
4. Hand the inhaler to the service user to administer
5. Check service user’s inhaler technique – breathing out before actuation, holding the breath afterwards
6. Give the service user a glass of water to rinse the mouth after using steroid (brown) inhalers
7. Replace cap
8. Remove mouthpiece from spacer (if used) and Replace cap
9. Wash spacer device (if used) monthly with detergent, and allow to drip dry
10. If the service user cannot actuate the device, a “haleraid” from the pharmacy may help service users with manual dexterity problems including arthritis
Handy Hints for Using a Spacer
• Care staff should be appropriately trained on how to use an inhaler and spacer properly
• Ensure that the spacer prescribed fits the inhaler
• Advise service user to put one puff of the inhaler into the spacer
• If the service user finds it difficult to take deep breaths, breathing in and out of the mouthpiece several times for at least 10 seconds is just as good
• Repeat the step above for each dose/puff needed and allow 30 seconds between each puff
• Wash the spacer once a month - leave it to drip-dry as this helps to prevent the medicines sticking to the sides. Do not put through a dishwasher
• Spacers should be replaced at least once each year, especially if it is used daily
7. Administering Liquid Formulations
Liquids
1. For liquid medicines, shake the bottle well and remove the cap
2. Measure out the correct amount using a 5ml medicine spoon (not a teaspoon), an oral syringe or measuring pot
3. If using an oral syringe, use the correct size syringe to ensure accurate dosing. (NEVER use an injection syringe)
4. Wipe the top of the bottle to prevent sticking and replace the cap
5. Bring the spoon or measure to the service users mouth for swallowing and watch for signs of gagging or drooling
6. Ensure liquids have date opened dates recorded on the bottle Some pharmacy suppliers may be able to supply date open stickers, check with pharmacy provider
8. Application of Patches
Definition:
A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream.
Patches
1. Locate and remove old patch first (transparent patches can be difficult to see check medicines task in the eMAR chart/ patch sheet for current location see Appendix 1 for Patch Sheet)
2. If the service user is using more than one type of patch (e.g. nicotine replacement plus analgesic), take care to remove and replace the correct patch. Most patches have the name of the medicine printed on the surface
3. Remember, patches are often changed infrequently, two or three times a week –check the patch is due to be changed at this time
4. Fold the old patch in on itself for disposal
5. Ensure that the application site is rotated to avoid skin irritation
6. Remove the new patch from its protective pouch and check for damage
7. Some patches have the facility to record the date of application on
8. Remove the backing paper without touching the sticky side of the patch
9. Apply the patch to a clean, dry, smooth area of skin. Choose an area that is free from spots, cuts and, if possible, body hair. Do not apply patches to areas where they may chafe or catch on clothing, e.g. inside of the arm or under a waistband. If the service user is likely to remove the patch, choose a difficult to reach area e.g. upper back
10. Smooth the patch down to ensure adherence to the skin and hold in place for 30 seconds
11. In general, never apply more than one patch at a time
12. Never cut a patch to halve the dose
Recommendations
• The service users care plan should contain a clear indication for treatment and intended outcomes
• Use a personalised patch application record sheet for all patches This should be kept with the service users current eMAR chart/electronic records
• Medicine task in eMAR charts need to be clearly annotated to highlight when the next patch change is due. The days when a patch change is not required there should be no related task on the eMAR sheet
• If a service user is transferred to another care setting (e.g. hospital) communicate information of the patch, when it was last changed, the current location and when the next patch change is due
• When applying a patch for a service user, gloves should be worn. If applicable, remove the old patch and dispose of it first before applying a new one
• It is good practice to write the date the new patch has been applied on the patch itself, so that it is visible to all care staff involved
• Apply patch to clean dry, non-inflamed, non- irritated, hairless skin on upper arm or trunks. Body hair may be clipped, but do not shave. If the site needs to be cleaned before application, use only clear water and let the skin dry completely
• In cases where more than one patch is required, these should be placed on the same area of the body however it needs to be ensured that these do not overlap
• Bathing, showering or swimming should not affect the patch, but water should not be too hot. Avoid hot baths
• If a patch falls off, it must be documented and discussed with the manager/office if a new one is to be applied and a medicine task should be created on eMAR chart. If A new patch should be applied and removed at the correct duration. An interim prescription may be needed or a discussion with the GP regarding early ordering of the patch for the next medication cycle
• The patches are waterproof but avoid soaking in a hot bath, saunas or sunbathing. Heat increases the rate of transdermal drug absorption and can cause toxicity – avoid direct contact with heat (e.g. hot water bottle, heat pad)
• If a service user has missed or has been non-compliant to their opioid (e.g. Fentanyl or Buprenorphine) patch then you need to check with the GP before applying the next patch
• If the service user has an elevated temperature, inform the GP as the patch dose may need to be reviewed. Note: Drug concentrations from opioid patches may increase if the skin temperature increases to 40°C such as with Fentanyl patches. Used patches still contain active drug
• After removal fold the patch in half over on itself so that the adhesive side sticks together. Domiciliary care would dispose of used patches in household waste out of the reach of children and pets.
• If the brand of a patch is changed to another by the prescriber, in particular with controlled drugs such as Fentanyl Patches, counselling should be sought from your GP or community pharmacist. Drug concentration may vary between different brands
