Medication Support
Scope of this chapter
Many of the people we support need to take medication. This includes both prescribed and unprescribed medication.
It is paramount that all medication activities are carried out safely, but opportunities to promote independence, choice and control must also be maximised.
This chapter provides guidance about good general practice when supporting people to take their medication.
It also contains links by setting to all current CQC guidance and requirements for specific medicines, conditions or circumstances (sections 10-13). The registered person should use these links to inform service policy and/or procedure regarding ordering, transporting, storage, preparation, administration and disposal of different medicines in the service.
The CQC also has a dedicated email for medication advice and support: medicines.enquiries@cqc.org.uk
Relevant Regulations
Related Chapters and Guidance
- Choice and Control
- Consent
- Information and Guidance for Specific Safeguarding issues
- Mental Capacity
- Promoting Independence and Strengths
- Risk Assessment (person-centred)
- Safe Care and Treatment
- CQC: Medicines information for adult social care services
- CQC: Covert administration of medicines
- CQC: Medicines administration records in adult social care
The following are some of the important principles that apply when providing medication support:
- Medication procedures must always reflect current regulations around ordering, transporting, storing, administering and disposing of medicines;
- Nobody must carry out medication tasks until they are fully competent, skilled and knowledgeable to do so;
- Prescription medicines must always be given in line with the instructions of the prescriber;
- Full and proper records of medicine administration must always be kept;
- Consent must always be sought before administering medication;
- Medication must be administered in ways that uphold dignity;
- Opportunities to promote independence, choice and control should always be maximised;
- Covert administration of medication can only be used if authorised by a medical professional under the Mental Capacity Act 2005;
- Medication must never be used as a form of restraint or punishment.
Supporting someone with medication is an opportunity to promote independence, choice and control. The importance of these principles and values are explained in separate chapters of this Handbook, which you should refer to as required:
Self-medication happens when a person can manage their medication with minimal hands-on support. This includes visiting the GP, collecting or ordering prescriptions, storing medication and taking it as instructed.
Minimal hands-on support includes things like:
- Occasional reminders or prompts (verbal or through technology);
- Opening bottles or popping out pills if the person has reduced dexterity;
- Support to read or understand the patient information leaflet;
- Support to understand whether over the counter medication is compatible with prescribed medication.
If we recognise someone may be able to self-medicate, we should take steps to support them to do so. This could involve adding goals to an individual care or support plan or supporting them to access technology.
Consent must always be sought before administering medication. A person has the right to refuse to take their medication at any time.
Where possible, consent should be sought prior to preparing medication. This helps prevent unnecessary waste of medication should the person subsequently decide not to take it.
For guidance on consent see: Consent
If a person refuses to take their medication, you should explain the potential negative consequences and establish whether they understand them. If they do understand they have capacity and deciding not to take the medication is their choice, even if the decision appears to be unwise.
Regardless of the person’s capacity, medical advice should be sought to ensure their safety is not compromised by the decision they have made. Depending on the likelihood and severity of potential consequences, this could be telephoning the GP or Pharmacist, or it could be calling 101 or 999 for more urgent medical advice. We have a duty of care, so this advice can be sought without the person’s consent.
In all cases you should also try to find out why someone does not want to take their medication. There could be many reasons for this, some of which can be easily rectified.
For example:
- It may taste horrible;
- It may be difficult to swallow;
- It may have negative side effects they want to avoid;
- They may not believe the medication is helping them;
- They may not want you to give it to them;
- They are tired and don’t feel like taking it at that time.
Potential solutions to rectify the above could be:
- Providing a flavoured drink with the tablet;
- Speaking to the GP about more palatable options;
- Looking at the patient information leaflet to explain what the medication does;
- Asking a medical professional to explain what the medication does;
- Asking a colleague to administer the medication;
- If the medication is not time specific, trying to administer it later.
Note: Under no circumstances must anyone administer medication covertly, unless the person lacks capacity to refuse consent and crushing, hiding or disguising their medication has already been agreed by a medical professional to be in their best interests. Guidance about covert medication is provided in section 7. below.
A record must be made of the refused medication, why it was refused, any views on the person’s capacity to make this decision and what action was taken to ensure safety was not compromised. Any advice given by a medical professional should be clearly recorded. Full guidance on recording can be found below: Recording administration of medication.
The person’s individual care or support plan and/or medication risk assessment must be updated where necessary. Any changes must be communicated to anyone that administers medication.
Needs, preferences, and risks must be established before the service begins.
A formal review of needs, preferences and risks should take place annually, and whenever there are signs that needs, preferences or risks have changed. For example, a medication is stopped, started or dosage is changed.
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Personal details |
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Health professionals |
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Known allergies |
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Prescribed medications (regular) |
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Prescribed medication (PRN) |
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Over the counter medication |
Services should only support with the administration of unprescribed medicines when a GP has given approval to this. |
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Known issues with medicines |
For example:
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What can the person do independently and what do they need support with? |
People often need support with only one or two elements of a task. Break the task down and maximise opportunities for independence. |
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Preferences |
For example:
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All needs and preferences must be recorded in the individual care or support plan and communicated to staff.
Before preparing medication, anyone that will be involved in handling medicines must wash their hands and put on any PPE that has been deemed necessary for the task.
To wash hands effectively, see below.
Source: Food Standards Agency
If you think another member of staff has not washed their hands, emphasise how important it is to wash their hands when working with medication. If they do not wash them straight away tell a manager or the registered person.
Disposable gloves
If the service uses disposable gloves for medication, this is not an alternative to effective handwashing. Hands should be washed before using gloves and afterwards. Gloves should be disposed of after use and if damaged.
Unless the person can remove their own medication from the packaging, it should be dispensed into a suitable container. For example, a medication pot.
This should be done without physically handling the medication wherever possible.
Check to make sure that the correct dose has been dispensed and prepared in line with the prescribers' instructions.
If the medicine is one that cannot come into contact with other medications the person is taking at that time, a second container will be needed.
Give the person their medication in line with the instructions in their individual care or support plan. This should include giving them their preferred drink etc.
Stay with the person whilst they take their medication.
Do not rush - allow the person time to take their medication at their own pace.
If the person is struggling to take oral medication in the form that it is currently in, seek consent to speak to their GP. Most solid medicines can be provided in liquid form.
Give medication to one person at a time - this avoids the risk of error.
All medicines administration records should:
- Be legible;
- Be signed by staff;
- Be clear and accurate;
- Have the correct date and time (either the exact time or the time of day the medicine was taken);
- Be completed as soon as possible after the person has taken the medicine;
- Avoid jargon and abbreviations.
A record must be made of all medication administered by, or in the service.
This includes:
- Medication taken by the person without support (self-medication);
- Medication administered by staff;
- Medication administered by visitors, including family members and health professionals.
The record must be made on a MAR sheet.
The record must be checked and signed by 2 staff members.
If the person receives any kind of medication administration support, a record must be made each time that support is provided.
Sometimes, medication support will be shared between staff and an informal carer. If an informal carer has administered medication, this should also be recorded. The record can be made by the informal carer (if they have access to the record) or the staff member, whichever is agreed between the two.
The recording template should contain the following information and instructions for staff, in line with NICE recommendations:
- The name of the person and their date of birth;
- The name, formulation and strength of the medicine(s);
- How often or the time the medicine should be taken;
- How the medicine is taken or used (route of administration);
- The name of the person’s GP practice;
- Any stop or review date;
- Any additional information, such as specific instructions for giving medicine. For example, medicines to be taken with food (such as ibuprofen) or without food (such as some antibiotics).
The record made on the template should include:
- The name of the staff member/informal carer administering the medication;
- The name of the medication and dosage;
- The date and time administered;
- What support has been provided e.g., prompts, support to open a blister pack;
- Whether the medication was taken or refused.
The staff member/informal carer completing the record should sign it.
Note: If a person manages their medication with no support whatsoever, a record does not need to be made.
All medication records must be kept for 8 years after the person’s service has ended.
This includes records of:
- Ordering and supply;
- Administration;
- Medication errors, incidents or near misses;
- Disposal.
After 8 years, records should be reviewed and, if no longer needed, destroyed securely.
Covert administration is when medicines are given to someone without their knowledge or consent. This usually happens by crumbling the medicine into or hiding it within food.
If a person has the mental capacity to make decisions about medication, it is unlawful to give them medicines covertly. They have the right to refuse to take their medication, even if this is detrimental to their health and wellbeing.
However, the reason that they are refusing should be understood as it could be something easily rectified. For example, they may find a tablet difficult to swallow or not realise the benefit of taking it.
If a person lacks the capacity to make decisions about taking medication, giving it covertly does become an option to be explored. However, it should never be the first option.
It is only necessary and appropriate to give medication covertly when:
- The person actively and routinely refuses their medication; and
- They lack the capacity to make medication decisions; and
- A health professional has deemed the medication essential; and
- A health professional has applied the Mental Capacity Act 2005 and decided that giving covert medication is the least restrictive way of administering the medication.
For further guidance see: Mental Capacity
The National Patient Safety Agency defines a medication error as
“A patient safety incident involving medicines in which there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring, or providing medicine advice, regardless of whether any harm occurred”
Information about medication errors, including what to do if there is a medication error can be found in a separate chapter of this Handbook.
See: Information and Guidance for Specific Safeguarding Issues
All staff administering medication must have undertaken appropriate medication safety training. This should be refreshed regularly.
Some medication can only be provided by staff that have received specialist training and been deemed competent by a relevant health professional. This included epilepsy medication and non-oral routes of medication.
The registered manager should carry out quality assurance checks to make sure that medication is being administered safely, and that processes for ordering, transporting, storing, and disposing of medicines are also robust and being followed.
This process should involve checking MAR sheets, medicine stock levels, expiry of medication etc.
The following is a full alphabetical, unaltered list of CQC guidance and requirements for care homes:
Source: Medicines information for adult social care services
Administering medicines when a person is away from their usual care setting
There will be times when people spend time away from their residential care setting. When this happens, it is vital to consider the safe continuity of medicines supply.
Appropriate use of psychotropic medicines in adult social care
Psychotropic medicines work in the brain. They affect behaviour, mood, consciousness, thoughts or perception. They are used to treat mental illness. Sometimes they are given to people to restrain or to control behaviour seen as challenging by others.
Controlled drugs in care homes
You must have a policy or standard operating procedure which details how you manage controlled drugs within your service. This should cover the ordering, storing, administering, recording and disposal of controlled drugs.
Controlled drugs: pregabalin and gabapentin
Gabapentin and pregabalin are now Schedule 3 controlled drugs under the Misuse of Drugs Regulations 2001, and Class C of the Misuse of Drugs Act 1971.
Covert administration of medicines
Covert administration is when medicines are administered in a disguised format.
Delegating medicines administration
A care worker supporting people with their medicines must be appropriately trained and competent to carry out this task.
Insulin is a hormone which helps to regulate metabolism and lowers blood glucose levels.
All care settings should have a written policy for the safe disposal of surplus, unwanted or expired medicines.
This information reflects new International Dysphagia Diet Standardisation Initiative guidelines adopted from 1 April 2018.
End of life care planning and medicines optimisation
During end of life care, one clinician should be responsible for a person’s medicines. This will depend on where the person lives but would usually be their GP. In some cases, hospice teams may give support.
Enteral feeding and medicines administration
Enteral feeding tubes provide access to the stomach or jejunum (small intestine). They are used in cases where there is an obstruction or difficulty in swallowing.
External medicines such as creams and patches
External medicines can include creams, ointments, lotions and patches.
Handling sharps in adult social care
Sharps injuries are a well-known risk in the health and social care sector. Sharps contaminated with an infected patient's blood can transmit more than 20 diseases, including hepatitis B, C and human immunodeficiency virus (HIV).
High risk medicines: anticoagulants
Anticoagulants are used to prevent the blood from clotting as normal and are therefore used to treat and prevent blood clots.
High risk medicines: clozapine
Clozapine is an antipsychotic medicine used to treat schizophrenia. But it can cause serious side effects.
Lithium is used as a mood stabiliser. Lithium is sometimes prescribed in the management and treatment of mania, hypomania, recurrent depression, and bipolar disorder.
High risk medicines: valproate
Sodium valproate and valproic acid are known collectively as valproate. Brands include Epilim, Depakote, Convulex, Episenta, Epival, Kentlim, Orlept, Syonell and Valpaland. There are other generic brands.
Oxygen has been widely used medically for many years. It is a gas and you should treat it as a medicine.
Managing seasonal influenza (flu) vaccines in care homes
Care providers must ensure that they manage influenza (flu) vaccines safely and effectively.
Medicine support care plans - making adjustments during the coronavirus (COVID-19) pandemic
The guidance on this page applies during the coronavirus (COVID-19) outbreak. Care staff should involve people in decisions about their treatment and care. People should get the support they need to help them to take a full part in making decisions.
Medicines administration records in adult social care
Good record keeping protects people receiving medicines support and their care workers.
Anti-epileptic drugs (AEDs) are used to prevent seizures. This can include seizures caused by epilepsy as well as non-epilepsy seizures.
Medicines reconciliation (how to check you have the right medicines)
Medicines reconciliation is the process of accurately listing a person’s medicines. This could be when they're admitted into a service or when their treatment changes.
Multi-compartment compliance aids (MCAs) in adult social care
You might use a range of different MCAs in adult social care settings. They should not be the first choice intervention to help people manage their medicines.
Over the counter medicines and homely remedies
Information about a range of frequently used non-prescription medicines which people can buy over the counter to treat minor illnesses.
Primary care medicines support for people living in care homes
Healthcare professionals in primary care support the health needs of people living in care homes. NHS England and NHS Improvement have developed a framework for more structured support. It aims to improve the safety and outcomes for people taking medicines in a care home.
Re-using named patient drugs as medicines supply
The guidance on this page applies during the coronavirus (COVID-19) outbreak. Medicines re-use should only be considered where there is an immediate need for the medicine, and either no other stocks are available or no suitable alternatives exist for an individual.
Reporting medicine related incidents
NICE guidance on managing medicines in care homes (SC1) states that care home providers should ensure that a robust process is in place for identifying, reporting, reviewing and learning from medicines errors involving residents.
Self administered medicines in care homes
People have the right to choose to manage their own medicines. Staff should consider a person's choice and whether there is a risk to them or others.
Storing medicines in care homes
Medicines should be stored in a way that means they are safe and will be effective when administered.
Storing medicines in fridges in care homes
This guidance describes how you must manage medicines which need to be in the 'cold chain'.
Some medicines need to be given at a certain time to make sure they are safe or work effectively.
Training and competence for medicines optimisation in adult social care
Appropriate training, support and competency makes care safe, high quality and consistent.
Vitamin D supplements - supporting people who receive adult social care
Meeting nutritional and hydration needs is governed by regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain in adults.
When required medicines in adult social care
PRN medicines are prescribed to treat various conditions and should be taken when required by the patient.
Working with external health care professionals
NICE launched a campaign to encourage health commissioners and local authorities to have written agreements. These agreements should set out clear responsibilities for home-based medicines support. The guiding principles are also useful for staff working in care homes.
The following is a full alphabetical, unaltered list of CQC guidance and requirements for home care services:
Source: Medicines information for adult social care services
Appropriate use of psychotropic medicines in adult social care
Psychotropic medicines work in the brain. They affect behaviour, mood, consciousness, thoughts or perception. They are used to treat mental illness. Sometimes they are given to people to restrain or to control behaviour seen as challenging by others.
Your policy or standard operating procedure on managing medicines must include controlled drugs. When you assess what medicines support a person needs, you must include support with controlled drugs.
Controlled drugs: pregabalin and gabapentin
Gabapentin and pregabalin are now Schedule 3 controlled drugs under the Misuse of Drugs Regulations 2001, and Class C of the Misuse of Drugs Act 1971.
Covert administration of medicines
Covert administration is when medicines are administered in a disguised format.
Delegating medicines administration
A care worker supporting people with their medicines must be appropriately trained and competent to carry out this task.
Insulin is a hormone which helps to regulate metabolism and lowers blood glucose levels.
This information reflects new International Dysphagia Diet Standardisation Initiative guidelines adopted from 1 April 2018.
Enteral feeding and medicines administration
Enteral feeding tubes provide access to the stomach or jejunum (small intestine). They are used in cases where there is an obstruction or difficulty in swallowing.
External medicines such as creams and patches
External medicines can include creams, ointments, lotions and patches.
Handling sharps in adult social care
Sharps injuries are a well-known risk in the health and social care sector. Sharps contaminated with an infected patient's blood can transmit more than 20 diseases, including hepatitis B, C and human immunodeficiency virus (HIV).
High risk medicines: anticoagulants
Anticoagulants are used to prevent the blood from clotting as normal and are therefore used to treat and prevent blood clots.
High risk medicines: clozapine
Clozapine is an antipsychotic medicine used to treat schizophrenia. But it can cause serious side effects.
Lithium is used as a mood stabiliser. Lithium is sometimes prescribed in the management and treatment of mania, hypomania, recurrent depression, and bipolar disorder.
High risk medicines: valproate
Sodium valproate and valproic acid are known collectively as valproate. Brands include Epilim, Depakote, Convulex, Episenta, Epival, Kentlim, Orlept, Syonell and Valpaland. There are other generic brands.
Managing medicines: home care providers
These are some of the key points from the NICE guidance about administration of medicines for adults in community settings.
Medicine support care plans - making adjustments during the coronavirus (COVID-19) pandemic
The guidance on this page applies during the coronavirus (COVID-19) outbreak. Care staff should involve people in decisions about their treatment and care. People should get the support they need to help them to take a full part in making decisions.
Medicines administration records in adult social care
Good record keeping protects people receiving medicines support and their care workers.
Anti-epileptic drugs (AEDs) are used to prevent seizures. This can include seizures caused by epilepsy as well as non-epilepsy seizures.
Medicines reconciliation (how to check you have the right medicines)
Medicines reconciliation is the process of accurately listing a person’s medicines. This could be when they're admitted into a service or when their treatment changes.
Multi-compartment compliance aids (MCAs) in adult social care
You might use a range of different MCAs in adult social care settings. They should not be the first choice intervention to help people manage their medicines.
Over the counter medicines and homely remedies
Information about a range of frequently used non-prescription medicines which people can buy over the counter to treat minor illnesses.
Reporting medicine related incidents
NICE guidance on managing medicines in care homes (SC1) states that care home providers should ensure that a robust process is in place for identifying, reporting, reviewing and learning from medicines errors involving residents.
Some medicines need to be given at a certain time to make sure they are safe or work effectively.
Training and competence for medicines optimisation in adult social care
Appropriate training, support and competency makes care safe, high quality and consistent.
Vitamin D supplements - supporting people who receive adult social care
Meeting nutritional and hydration needs is governed by regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain in adults.
Working with external health care professionals
NICE launched a campaign to encourage health commissioners and local authorities to have written agreements. These agreements should set out clear responsibilities for home-based medicines support. The guiding principles are also useful for staff working in care homes.
The following is a full alphabetical, unaltered list of CQC guidance and requirements for shared lives schemes:
Appropriate use of psychotropic medicines in adult social care
Psychotropic medicines work in the brain. They affect behaviour, mood, consciousness, thoughts or perception. They are used to treat mental illness. Sometimes they are given to people to restrain or to control behaviour seen as challenging by others.
Shared Lives Schemes - managing medicines
Shared Lives Schemes register with CQC to provide personal care. Medicines administration is an ancillary activity to personal care and regulated by CQC. We regulate at scheme level, through agency locations.
The following is a full alphabetical list of CQC guidance and requirements for supported living:
Appropriate use of psychotropic medicines in adult social care
Psychotropic medicines work in the brain. They affect behaviour, mood, consciousness, thoughts or perception. They are used to treat mental illness. Sometimes they are given to people to restrain or to control behaviour seen as challenging by others.
Supported living schemes - managing medicines
A CQC registered provider may provide personal care to a person in a supported living scheme and also administer their medicines. The medicines administration is considered ‘ancillary to’ the personal care they are receiving.
Last Updated: March 22, 2022
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