Giving medicines

Make sure you are legally allowed to give the medicine

Remember: Right patient, Right medicine, Right dose, Right route, Right time, Right documentation, Right to refuse

What you do — follow the RIGHTS for giving medicines

RIGHT patient

Make sure you have right patient and right set of records

Ask patient’s name, date of birth, bush name, next of kin
Check patient’s name and date on prescription

RIGHT medicine

Check name and spelling of medicine against prescription
Check use-by/expiry date on package
Is it safe for this person — always ask about allergies, pregnancy, breastfeeding, other medicines, medical problems (eg kidney problems)

Could it interact with other medicines the person is taking

Is it in your protocol manual (eg STM, WBM)
Look up in reference manual (eg AMH, Medicines Book). What is it, how does it work, what is it used for
Are you allowed to give the medicine or do you need to contact doctor or pharmacist

RIGHT dose

Check dose on prescription and in reference manual (eg AMH, STM, WBM)
Check strength — medicine can be packaged in a range of different strengths and forms
Measure dose carefully using proper equipment
If dose is by weight — check person's weight. Always weigh children
Watch and help parent/carer give first dose to children

RIGHT route

Check how to administer (give) medicine

Oral — tablets, syrups, sublingual, buccal
Injection — IM, IV, subcut
On the skin — transdermal, topical

RIGHT time

Check how and when medicine should be taken — night, morning, with food, on empty stomach
Use times that are meaningful to the person

RIGHT documentation

Record medicine administered/supplied in file notes. Include active ingredient, dose, frequency, quantity supplied — (eg dicloxacillin 500mg 4 times a day (qid), 24 caps)

RIGHT to refuse

Person may not want to take medicine you give them
Make sure person knows reason for the medicine so they can make an informed decision
If person doesn't want to take medicine — try to find out why, a different medicine may be appropriate
If person still doesn't want to take medicine — always document this

Label medicine

See example of completed medicine label — Figure 6.1

Figure 6.1

Written in red on white background — KEEP OUT OF REACH OF CHILDREN
Name (active ingredient) of medicine, strength (eg microgram, mg, g) and form (eg liquid, tablet, capsule)
Total number of tablets or amount of liquid in package
How to take, dose and number of times a day — 'Take 2 tablets 3 times a day'
Name of patient
Name, address, phone number of clinic
Your name or initials, date you gave out medicine, medicine use-by/expiry date (take from original packet), prescription reference number (if your clinic uses these)
Special directions — 'Take with food', 'Keep in fridge'

Use warning stickers if your dispensary has them
Use medicine time stickers for people with poor english or eyesight
Morning/evening — Figure 6.2
Middle of the day — Figure 6.3
Night time, before bed — Figure 6.4

Figure 6.2

Figure 6.3

Figure 6.4

Check what you have done and document

Record in file notes, hand-held record for travellers, in register (eg Schedule 8), if needed
Make sure file notes include

Name of medicine, date and time of supply
Reasons for giving
Name of person ordering medicine, or protocol used
Strength and amount (quantity) given (eg 2mg in 4mL, 20 x 500mg tabs)
Way it is given (route) — (eg by mouth/oral or by injection into muscle/IM)
Dosing instructions — (eg 'Take 1 tablet 3 times a day')
Counselling given, including any possible side effects
Name and designation of person supplying medicine

Before giving medicine make sure person knows

Why they are taking the medicine
Possible side effects and what to do about them
When and how to take it
How to store it (eg in fridge, away from children)
What will happen if they don’t take it
What other things to do to manage condition (eg exercise)
Ask them to repeat what you told them to make sure they understand

Check

Are tests needed (eg blood tests)
Does person need to come back to clinic and when

Dose administration aids

Includes dosette boxes, blister packs, sachets

Filling dose administration aids (dose aids, DAA)

Do not

Do not get distracted when filling dose aid. Focus on the job
Do not use dose aid label to refill aid — it may have an old prescription
Do not put packets back onto shelves or throw away empty containers until dose aid has been checked

Attention

For medicine safety — best to have dose aids filled by pharmacy if possible (eg sachets, blister packs)
Dose aid must be labelled "KEEP OUT OF REACH OF CHILDREN"
If person visiting from another community — ask if they have a copy of their prescription/s. If not check electronic health record or ask their clinic to send current copy

What you need

Up-to-date prescription or file notes
Dose aid
Pen
Medicine/s — take extra care to find the right medicine

What you do

Check right person and right prescription or file notes
Clean reusable dose aid. Most slide out at side for easier cleaning and refilling
Clean and tidy preparation area, ensure hands clean

Dose aid label

You must check every time dose aid is filled

Full name of person
Name and strength of medicine
Amount to give, how to give, how often
Name of clinic where usually filled
Label and any changes to medicines are clear. If not — use new label

Filling dose aid

Put in medicines one at a time. Follow current prescription in same order
Put medicine packet back into basket or move to one side

Do not put packets back onto shelves or throw away empty containers until dose aid has been checked

Record in file notes — date, your name and designation, name of person checking, whether dose aid was given to person or stored for later collection
Check again you have right person, they understand how to use dose aid
Before sealing check filled dose aid by asking another staff member to check medicine/s in dose aid using the process described below. If not possible — do a second check yourself
Write on sticker across end of dose aid — date, your name, clinic name

Checking filled dose aid

What you do

Check

Medicine used has not expired
Both original medicine packet and label on dose aid match prescription
One full day’s medicine by emptying out cell/s and refilling from prescription, checking colours from original packets if needed
Each of the other cells for same number and colour (eg 2 small white + 2 large white + 1 yellow + 1 blue/white capsule = 6)

Sign and date record of dose aid check in file notes or on prescription. Make sure person filling dose aid has also signed file notes or prescription

Document number of doses given and expected completion date (when refill needed)

Close dose aid and seal if possible. Some reusable dose aids can be sealed by putting a sticker across opening end. Initial and date sticker

Medicine by delivery type

Attention

If medicine has bitter taste — have person suck on an ice cube before taking
Give children sultanas, fruit, orange juice to help cover unpleasant taste
For specific routes of administration — see Medicines, Eyes, Ears

Giving tablets

Attention

Do not crush enteric-coated tablets or slow-release tablets. If not sure — check prescription or refer to a reference manual

What you do

To halve tablets

Only halve tablets that have a line — Figure 6.5
Use a tablet cutter or sharp knife on clean piece of paper towel

Figure 6.5

To crush tablets

Check manufacturer’s instructions or Don’t rush to crush resource to see if this is OK
Crush between 2 spoons or use mortar and pestle. Mix with honey and/or give with a drink of water

Giving syrups

What you do

If syrup not premixed — add exact amount of sterile water prescribed on bottle. If sterile water not available — use clean tap water

Use graduated measure or syringe for exact measurements

Shake syrup bottle to mix well. Watch for powdery lumps
Put medicine cup on bench and bend down so cup at eye level to check you are pouring out exact amount. If amount small — use syringe