As required/variable dosage medications (also known as PRNs)
8.3
‘As required’ medications are prescribed medications intended to be taken when needed rather than at specific times or intervals, for example for pain relief or for indigestion. Some prescribed medications have a variable rather than a fixed dose, for example 1 or 2 tablets.
8.4
Carers will not administer any prescribed ‘as required’ medication which may have a sedative or other effect on behaviour unless:
agreed by GSL, and
the supporting health professional (such as a community nurse) has provided a written protocol specific to the person for whom the medication was prescribed. The protocol must detail the circumstances when the prescribed ‘as required’ medication should be used
8.5
The carer will record the reason for administering an ‘as required’ / variable dose medication, the time and the dose administered on the PRN Medication Administration Record sheet each time the medication is given (PRN MAR).
8.6
GSL carers must follow the GSL PRN guidance as per appendix 4.
8.7
PRN information, PRN protocol and PRN MAR sheets are expected to be available to all carers supporting a person at the required times. This will include a “handover” between carers.
8.8
Carers will contact the person’s GP, the prescribing pharmacy or the NHS 111 helpline for advice if they are unsure about:
when to give an as required / variable dose medication
what the dose should be
the effect of the medication
Over the counter/non prescription medications
8.9
Carers:
may support people with capacity to take ‘over the counter / non prescription medications’ in accordance with the information in the person’s Medication Profile and Risk Assessment
will not administer over the counter / non - prescription medications to people who lack capacity except where:
the person’s GP / other relevant health professional has advised that it is safe for the person to take the medication, and
the carer has documented the conversation with the GP / health professional in the person’s medical record. This could be either on the back of the MAR or/and in the carer logs
it is in the person’s best interest
Requests for support with medications that GSL carers are not usually expected to administer
8.10
Generally, health services are responsible for meeting primary health care needs.
8.11
GSL may consider requests for support with medications which a health professional rather than a GSL carer would usually be expected to administer. Examples include but are not limited to emergency medications, controlled drugs, certain ‘as required/ variable dosage’ medications, medication where dosage is dependent on blood test results, oxygen therapy. GSL will only consider such a request in exceptional circumstances where:
a relevant health professional has:
confirmed in writing to GSL that support is necessary and GSL is satisfied that potential risks can be managed
developed and provided to GSL a written protocol specific to the person’s medication and health needs which includes arrangements for regular review by a relevant health professional
a relevant health professional / accredited training provider has agreed to provide specialist training and to assess initial and ongoing competency
both the person (or their legally appointed representative) and the carer agree to proposed arrangements
or in the best interest of a person who lacks capacity
8.12
Where GSL does not agree to a request for a carer to provide medication support, GSL may not be able to offer a GSL arrangement unless alternative medication support is available.
8.13
Where GSL agrees to provide medication support, GSL will monitor adherence to the written protocol and will alert the relevant health professional to any changes / concerns.
Controlled drugs
8.14
Drugs listed in the Controlled Drugs Act 1985 have special rules about how they are:
stored
disposed of
administered
reported if they are lost or missing
8.15
If a person supported by GSL is prescribed drugs from the controlled drugs list, the GSL carers should seek clarification and instruction from the person who has prescribed them on how to store, dispose of, administer, and report on the medication.
