Care Home Staff

A range of medicines need to be refrigerated, these include insulins, antibiotic liquids, injections, eye drops and some creams. These medicines must be stored between 2ºC and 8ºC.

Medicine's fridges

Dedicated medicines fridges should be of a suitable standard to keep medicines at the correct temperature.

1. To avoid accidentally interrupting the electricity supply, use a switchless socket. Or, clearly label the plug with a cautionary notice, for example: "Do not unplug/switch off"

2. Regularly check the dates of the contents of your fridge. Rotate stock according to your setting's policy

3. Regularly clean and defrost the fridge and keep dated records of this.

• Record the temperature of the fridge daily, you should record minimum, maximum and current temperatures, using a minimum/maximum thermometer. The thermometer should be reset after each reading.

• If you are not sure how to read and reset the thermometer refer to the user manual or seek advice from your manager or designated senior.

• Take care that the thermometer probe cable does not interfere with the door seal. This could cause the temperature to fall outside the recommended temperature range Also try to keep the probe in the centre of the fridge if possible.

• If the fridge is outside the recommended temperature range, refer to your company medicines policy/processes. Action needs to be taken this would usually include quarantine the stock (preferably at the correct temperature if possible) and seeking advice on whether the medicines are still safe to use.

• Keep records of any actions taken when the fridge is outside the recommended temperature range.

• Some small care home services do not regularly keep medicines that need refrigeration. In exceptional circumstances, such services could consider using a separate locked container in the food fridge. Only trained and competent staff should have access. Staff should keep records of temperature monitoring (as detailed above). This approach should be fully risk assessed.

When we think about the safe handling of controlled drugs, we focus on the risk of them being misused (diversion and abuse). As part of the Controlled Drugs (Supervision of Management and Use) Regulations 2013, came the appointment of an Accountable Officer with personal responsibility for the safe management and use of CDs within an organisation which covers:

• Orders

• Receipts

• Storage – Misuse of Drugs (Safe Custody) Regulations

• Supply – according to the drug schedules

• Witnesses and second signatures

• Key holders

• Record keeping – the CD register

• Stock checks and missing CDs (reconciliation)

• Returns procedures

• Disposal – including the use of CD denaturing kits

• Transport – security and receipt

• Monitoring and inspection

Check and follow your Policy. Some services may choose to store schedule 4 and 5 CD's in the controlled drugs cupboard and record them in the controlled drugs register. 

Controlled drug registers

You must record any movement of a schedule 2 controlled drug in a controlled drugs register.

The register must:

• be bound (this may be in the form of a separate bound booklet for each preparation)

• have separate sections for each class of controlled drugs - within this each formulation and strength should be recorded on a separate page. CD registers used in care homes vary in style and design. In practical terms, use a separate page for each form, strength of each medication and resident. The name, strength and form of each medication and the name of the resident should be recorded at the top of each page

• have the name, form and strength of the drug specified at the top of each page.

 Managing stocks of controlled drugs

It is recommended that care homes keep a running balance of the stock levels of each controlled drug preparation. This makes it much easier to spot and track discrepancies.

For good practice, two staff members should witness and sign when:

• receiving controlled drugs stock

• checking stock balances

• administering controlled drugs disposing of controlled drugs.

• both staff members involved in the process should be trained and competent to do so.

Follow the manufacturer's advice on how to store oxygen. 

Store oxygen cylinders:

•    securely to prevent the cylinder from falling

•    away from areas that would block escape routes or fire exits

•    in well ventilated areas

•    away from heat and light sources

•    in an area that is not used to store any other flammable materials

•    away from combustible material (such as paper, cardboard, curtains)

•    so that they are not covered by items of clothing.

Store oxygen concentrators upright. Plug them directly into the mains. Do not use an extension lead.

Place statutory hazard notices in areas where you store oxygen. This includes the person's bedroom.

Oxygen cylinders have an expiry date. Check the dates regularly to make sure you don't use out of date cylinders.

For more information please visit CQC website Medicines: information for all adult social care services and view guide 'Managing oxygen in care homes'.

'Self-administration' is when a person can take their own medicines.

It is important for people living in care homes to maintain their independence.

People have the right to choose to manage their own medicines. Care providers should consider a person's choice and whether there is a risk to them or others.

Self-administration can vary from person to person. Care home staff should find out how much support a person needs to take and look after their individual medicines. This should be risk assessed.

Storing medicines

How to store medicines for self administration will be identified in the patient's care plan. For example, you might store the medicines in a lockable cupboard or drawer in their room. The storage place must not be accessible to other people. Patient's should be able to access any medicines when needed. This includes controlled drugs.

Keeping records

You must keep records when:

• you provide support for a patient to take their medicines. This includes reminding a patient to take a medicine

• you supply medicines (including controlled drugs) for self-administration.

Where a patient self-administers a medicine, this should be noted on the MAR. Individual doses taken by the patient do not need to be recorded on the MAR by care staff.

For more information please visit CQC website Medicines: information for all adult social care services and view guide 'Self administered medicines in care homes'