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There is a carefully planned framework surrounding legislation in the care home setting; this also includes an individual’s home and domiciliary care. The Medicines Act 1968 was the first legislation on medications in the United Kingdom and this provides a legal framework for manufacturing, licensing prescriptions and the supply and administration of medication. It also classifies medication into different categories:

  • Prescription-only medication. These are medications which have to be authorised by a doctor, vet, dentist or a nurse prescriber. The pharmacist is the expert on all aspects of medication, including legislation, and they can be consulted at any time.
  • Pharmacy-only medication. This is medication that can be purchased from a pharmacy and the pharmacist has to be present.
  • General sales medication. This is medication that could be purchased anywhere, without the need for a pharmacist to be present. This would include paracetamol and ibuprofen, along with various cough and cold medicines.
  • Unlicensed medication. These do not have a license for the use in which they are being prescribed for. The doctor or dentist takes liability for any harm that may be caused when this medication is administered. The manufacturer will accept no liability. The doctor or dentist will only prescribe this if they feel that the benefits far outweigh any risks. In addition, when dealing with unlicensed medication, although they may have been prescribed by a doctor, you should ensure that you have sufficient information to administer the medication. If you are unsure at any time always speak with your line manager, and also remember that you can always speak to the pharmacist or check with the GP.

We will now look at is the Misuse of Drugs Act, 1971. This was designed to check and reduce the unlawful use of the kinds of drugs that could cause dependence. It gives the definition of controlled drugs, which would include cocaine, heroin, methadone, amphetamine, opium and morphine. Controlled drugs can only be prescribed by a medical practitioner or registered dentist. Every GP or dentist is required to keep a record of all controlled drugs which are prescribed for use. Regulations that govern the administration of controlled drugs say that the prescription must be in ink and that the prescription must be signed and dated by a prescriber. Prescription must specify the dose to be taken and the form, strength and quantity of units.

When storing controlled drugs, we have a normal, locked cupboard for our everyday medication and inside that cupboard will be a separate locked unit, which is where the controlled drugs are stored. When dispensing controlled drugs, two people have to present, one person administering and a second as a witness. There is also a separate record book, which will be stored within the controlled drugs cupboard and the stock of controlled drugs need to be checked every seven days.

The Human Medicines Regulations 2012 are a major consolidation of medication law. They largely replace the Medicines Act 1968 and some 200 further pieces of secondary legislation, including the Prescription Only Medicines for Human Use Order 1997 that defined and set out the authority of non-medical prescribers.

We then have the Prescription by Nurses Act, 1992. With extra training, nurses can go on and prescribe, although this applies to only a limited number of drugs, and they are all found in a nurse’s formulary.

In the UK since 2006, Nurses, pharmacists, dentists and some other healthcare professionals are now able to train as independent prescribers, meaning they can prescribe any drugs within their competency, including controlled drugs. This has helped to improve access to medication, which frees up a doctor’s time.

We then have the Care Standards Act, 2000. This sets out the minimum standards for all aspects of care. The main standards relating to medication are medication within the home and domiciliary care. To comply with the Care Standards Act 2000, staff administering medications must have received appropriate training that must include basic knowledge of how medicines are used and how to recognise and deal with problems in use, and the principles behind all aspects of the home's policy on medicine handling and recordkeeping.

Administration of medication needs to be carried out by a designated member of staff, who needs to have a basic understanding of the medication they are giving out to the extent that during their training they will have had observations of them administering medication. Usually within the care home setting, a second person is a witness when giving out medication.