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

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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
A Is there an Obtaining Medicines Policy?
Are stocks of medicines/appliances checked before
ordering prescriptions?
Prescriptions are checked against order by care home
before sending for dispensing?
Dispensed medicines/appliances are checked against
those requested and those currently prescribed?
Is stock rotated and expiry dates checked?
Are new stocks of medicines/appliances received
recorded?
Are remaining stocks of current medication carried
forward onto new MARs chart?
Is there a clear process for what to do if medicines are
missing or cannot be found?
Is there a process for obtaining acute medications and
supplies out of hours?
B Is there a policy for Record Keeping?
Have you completed the attached Records/Labelling
Audit?
Is there a system for when medication changes occur
part way through the life of a MARs chart?
Is there a process for medicines reconciliation for
patients being transferred into or from the care home?
C Is there a policy for Storage of Medicines?
Are medicines stored in individual patients locked
draw/cupboard?
Are medicines stored centrally?
If stored centrally are the cupboards big enough, with a
secure lock?
Is access to the locked drug cupboards limited to named
staff members?
Are topical medicines, dressings appliances and MDS
stored separately in suitably sized cupboards?
Are storage cupboards/trolleys situated in dry areas that
are neither too hot, cold or damp and do not have large
temperature variations?
Prepared from http://www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf
YES NO If drug trolleys are used are they well constructed and
large enough to store individual patients medicines
separately?
Can the drug trolley be either locked to wall or locked in
a cupboard when not in use?
Is there a refrigerator for storing medicines?
Is there a record of the fridge being cleaned and
defrosted regularly?
Check the fridge temperature log-is it complete and are
all temperatures within the 2-80 range?
Does the policy indicate the action to be taken if the
fridge temperature is outside the range 2-80?
Is the fridge used to store non-medicines?
D Is there a policy for Medicines Administration?
Are medicines only administered from containers labelled
and supplied from the pharmacy/dispensing doctor?
Is there a robust system for identifying patients?
Does each member of staff administering medicines
know what each medicine is for?
Are all staff administering medication aware of any
special precautions e.g. for bisphosphonates?
Is there a process for reporting ADRs?
Is there a process for managing product recalls?
Are staff administering medicines continually assessed?
Is there a policy for crushing tablets for patients with
swallowing difficulties?
Is there a policy for drug administration via a naso-
gastric tube?
Is there a policy for drug administration via a PEG?
Is consent obtained from residents for staff to administer
medicines?
Are cultural and moral beliefs of patients considered
when administering medicines?
E Is there a policy for Self-administration of
Medicines?
Are patients continually assessed as to their ability to
continue to self-medicate?
If patients need support to self-administer, is the level of
support required documented in the patient’s care plan?
May 2008. ver 3 3
 Policies
F Is there a Controlled Drugs Policy?
Are CDs stored in individual patients locked
draw/cupboard?
Are CDs stored centrally? If stored centrally, is there an
approved secure CD cupboard or cabinet used for CDs
only?
Is the register kept correctly-running balances that are
reconciled regularly?
Are keys held by designated persons only?
Is the CD register bound with numbered pages?
Are records of receipt, administration and disposal of CDs
completed?
Is a second signature required on MARs chart when CD
are administered?
Are CDs disposed of correctly?
G Is there a policy for Disposal of Medicines?
Does the home keep a record of Disposed Medicines
which can be easily accessed e.g. a” Waste Book”
Do records show the date of disposal, name and strength
of medicine, quantity removed and who the medicine was
for?
Do the records show the name of the member of staff
who arranged the disposal?
If a non-nursing, home are unwanted medicines returned
to a pharmacy?
If a nursing home, are unwanted medicines disposed of
via a licensed waste management company?
Are unwanted medicines disposed of promptly?
Are medicines kept for 7 days in the event of a patient’s
death?
H Is there a policy for Minor Ailments?
Does the home allow treatment with “Homely Medicines”?
Does the care home get advice on homely remedies from
a doctor, nurse or pharmacist?
Does the home have a detailed protocol for minor
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
YES NO Does training cover supply, storage, and disposal of
medicines, safe administration, quality assurance, record
keeping, accountability, responsibility and confidentiality?
Does policy allow for assessment of training needs for
new staff at induction?
Are care workers with no previous experience allowed to
administer medicines?
Do staff have a practical assessment after their training is
complete?
Does training cover all aspects of Medicines
Administration Policy?
J Is there a policy for Criminal Activity within the home?
Is there a procedure for dealing with patients who bring
illicit drugs into the care home?
Is there a procedure for dealing with theft within the care
home?
K Do patients receive a regular medication review by
their GP?
Do patients have regular MURs conducted by the
pharmacist?
L Is there a policy for Reporting Errors and near misses?
M Storage of Gases and Hazardous substances
Are these stored safely?
Are appropriate notices displayed?
O Nutritional Status
Does the home order nutritional supplements for patients
without referring to a Dietician of the patient’s GP
If” yes” is an assessment tool used.
Name of tool:
P NPSA/MHRA Alerts
Are these received regularly and is the appropriate action
taken?
Is the information contained in them shared with all staff?
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