Administration of Medicine in a Care Home: Who is Responsible?

Medication plays an important role in care home life, which is why the administration of medicine in a care home must always be done carefully while adhering to the proper guidelines.

So, who can administer medicine in a care home and what are the guidelines that need to be followed? We’re here to provide all the answers.

Members of Staff that can Administer Medication

In the average care home, every day or non-complex medications can usually be administered by care home staff and carers. 

It's vital that care staff should only be permitted to administer medication that they are trained and competent to give. This might include:

• Assisting residents to take tablets, capsules or other oral medication
• Applying creams or ointments
• Administering eye drops, ear drops or nasal sprays
• Administering inhaled medicines such as asthma pumps 
  
  

Registered nurses

In a care home or nursing home, medication and controlled drugs will typically be administered by the medical practitioner or a Registered Nurse, or RN. 

Registered Nurses also handle more invasive or specialist medical techniques that require more advanced training, such as:

• Suppositories
• Injectable drugs, e.g. insulin
• Gastronomy procedures
• Oxygen

Registered nurses can delegate medicine administration tasks to more junior members of staff, but it is the responsibility of a registered nurse to make sure that the junior member of staff is capable of administering the medication properly and safely.

Ultimately, despite who is actually giving the resident their medication, accountability is the RN’s.

Health care assistants

Care assistants, also known as Health Care Assistants or HCAs, may also be able to administer medication in a care home if they have had proper training. 

The Department of Health’s Administration of Medicines in Care Homes (with Nursing) for Older People by Care Assistants, published in 2016, states that care assistants can legally administer medication to care home residents, providing they have had suitable training and their practices are regularly reviewed by the care home manager. 

Guidance from the DOH states that care assistants must take responsibility for ensuring that any medication administered is carried out carefully, safely and correctly. This includes checking the exact dosage, a critical component of medicine administration. 

Staff should also receive training on the correct protocol in the event that a care home resident refuses to take medication – this is also usually discussed in the home’s policies and procedures. 

Care home residents technically have a right to refuse medication, unless they are deemed as not having the capacity to make their own decisions; for example, under the Mental Capacity Act of 2005.

Assistant practitioners

Similarly to HCAs, Assistant practitioners may sometimes step in to administer medication if they have received the proper training. 

Assistant practitioners, also known as Care Home Assistant Practitioners, or CHAPS, are healthcare professionals who are trained to carry out similar tasks to registered nurses. 

Staff Training Requirements

Care home staff must receive the appropriate training on the administration of medication which focuses on a few key components, such as:

• Storing and disposing of medication safely
• How to administer medication safely
• Keeping a record of medication administered
• Quality assurance of any medication being administered
• Responsibilities and confidentiality
• How to report errors or incidents
• Selecting the correct dosage
• Good practice measures

Training programmes in a care home can be internal or external, but the end goal is the same: to teach staff how to properly manage and administer medicine and to eliminate medication administration errors.

There may also be specialist training required for administering medicines via invasive or specialised techniques. Training should be conducted by an accredited learning provider and the course needs to meet the requirements of the regulators, care home residents and the training needs of the care home staff.

Depending on the type of home; residential, nursing etc, staff may need to undergo different types of training. Training should be annually reviewed by the care home manager to ensure any gaps in knowledge or changes in techniques are up-to-date.

Common Errors

Care staff should be trained to be aware that there are errors that can arise as a result of administering prescribed medicines. Some of these include:

• The types of medicines that lead to more mistakes being made. For example, medication like asthma inhalers and liquid medicines tend to cause more problems than pills or tablets
• Administering the wrong dose of drug, or the wrong type of drug
• Administering a drug or medication at the wrong time
• Missing antibiotic doses over the course of treatment
• Allergies and drug sensitivities and how to safely check for these before giving medicine
• Administration errors – these are more common at certain times of day and particularly in the morning
• Interruptions when preparing or administering medicines can cause errors

Any errors administering medicines should be reported immediately, as the consequences can be dangerous, for example, administering an incorrect dose.

Self-Administration of Medicine

If you are looking at going into a care home, or have a family member who is, you may be thinking that you’re perfectly capable of taking your own medication – and if this is the case, don’t worry. 

New Department of Health guidance includes some key info on the rights of care home residents to manage their own medication. 

For example, there may be cases where a resident is able to manage their medication – and in such cases, residents should be offered the choice, with staff on-hand to support if requested. 

Dosette boxes make the self-administration of medicine easier.

A risk assessment should be carried out to determine if a resident is capable of managing their medication themselves.

Care home staff will take into account:

• If a resident self-administers medicine, will it pose a risk to the resident or fellow residents?
• Can the resident be trusted to take the correct dose of their medication, at the right time, and in the right way?

As we touched upon before, if a resident is decided to be incapable of making their own decisions, then a best interests decision will be made on their behalf.

Care home staff are obliged to regularly assess residents’ capacity to make decisions about their care or medical treatment, including managing their own medication.

Medication Records

Keeping track of the medical records of care home residents is vital to ensure that each individual is being given the correct medication at the right times of the day. 

There is a statutory requirement that records are kept for all medicines in care homes. The exact details for each care home can be found in the home’s rules and regulations, as well as the Independent Healthcare Regulations or the Regulation of Care (Scotland) Act 2001.

Medicine Administration (MAR) Charts

Medicine Administration Record, or MAR, charts are working documents that care home or healthcare staff sign for record keeping of when medication was administered and which type. 

MAR charts are usually used for prescription medication, but can also be used for occasions when non-prescription medicines are given. When staff record any administration of medication, no matter how small, they must sign and date it – this helps staff swapping shifts to keep track of which resident has been given what. 

All care homes must keep a list of the staff members authorised to administer medicines and their approved initials to check against MAR charts.

Residents’ Rights

When it comes to managing medicines, essentially care home residents have the right to choose how their medication is managed; whether that’s being administered by themselves or care home staff, and also the right to refuse medication. Care home staff should not administer medicines to a resident without their knowledge if the resident has the capacity to make decisions about their medication.

However, as before, different rules apply to residents who have been declared unable to make their decisions, or those who have been detained under the Mental Health act, for whom making their own decisions about managing medicines would not be safe for them or others.

Care Home’s Written Policy

All care homes are required to have a written policy for the safe administration of medicine, including procedures in place for correctly reporting any incidents. 

The policy will keep records of medication, who is qualified to administer it, provide guidance on what to do in the event of a mistake, information on reviewing and listing a resident’s medicines and information on ordering, receiving, storing and safely disposing of medicines. 

Care home policies should be regularly reviewed and updated.

Further Reading

Read this document which covers:

• The legal framework for the administration of prescribed medicines by care assistants
• Safety and quality assurance requirements

We hope this guide has given you all the information you need on how medicines are administered in a care home, and by who. If you’re starting your care home search; for yourself or for a loved one; checking that any medicines you take will be taken care of by staff is vital. For more information on elderly care homes near you, why not get in touch, or take a look at our FAQs.