Clients have the right to safe medication delivery and the right to decide how they receive medication management and assistance from Homewise Health.

Purpose #

To guide the safe and effective administration of medications to clients who have provided informed consent for Homewise Health (HWH) to manage their medications as part of the service delivery process.

Scope #

To all team members involved in managing or administering medication for clients who have consented to receive medication management services from HWH.

Process#

Responsibilities

Clinical/Client Care Manager 

1. Verify that the client’s signed consent form is uploaded to Basecamp.
   • If the client lacks capacity, obtain consent from their responsible person
2. Confirm the medication chart (Client Health Care Summary) is ≤ 6 months old; request an updated list from the GP as needed.
   • The client/decision-maker or the CCM can request this if consent is on file.
   • Place a recurring reminder in the clients' to-dos
3. The RN remains accountable for medication management but may delegate administration to a competent support worker.
   • Ensure every support worker who administers medication holds a valid competency (Competency valid for 2 years).
4. Flag clients who cannot safely self-administer and arrange appropriate support (involving family when capacity is limited).
5. Inform families promptly of any medication incidents.

Support worker 

1. Read the client care plan, confirming that consent has been provided.
2. Hand washing before administration.
3. Follow the 5 rights for medication management (refer to training module).
4. If the client has had changes from their baseline post-administration of medication, notify CCM or, if after hours, 1800 717 590- possible side effects of the medication
   • Notify CCM when medication incidents occur or call 1800 717 590 after hours.
5. For unpacked medications, ensure all medications are within expiry dates before administration.

Client 

1. The client or responsible person manages repeat-script requests and collects the packed meds with the signing sheet.
   1. They also arrange pharmacy deliveries; CCM steps in only if asked.
   2. Regular medications must be in pharmacy-packed DAAs; or if unable to be packed, i.e., liquids, keep contents in original packaging
2. Over-the-counter pain relief (Panadol, Ibuprofen can be kept in the original packaging unless taken regularly, then include them in the DAA.

Inform the CCM of any medication changes by a health professional and provide an updated GP letter or chart.
Governing Body

1. All employees involved in medication management have received appropriate training, including knowledge assessment via the HWH training platform, and a practical competency has been completed.
2. Review of medication policy and practice when legislative changes occur.

Self-Administration of Medications#

Documenting the administration of medications is not required for clients who self-administer their medications. 

• When clients self-administer medication, they retain responsibility for taking it as prescribed.
• If cognitive concerns arise, the CCM conducts a risk assessment, explains the risks, and has the client or responsible person sign a dignity of risk form, should they wish to continue self-administering 
• Where a decline in the client's condition is observed, the CCM works with the client to determine if temporary medication supervision is needed. 
  • In this case, a consent form will be requested, and staff will follow the HWH process for medication administration.

Supported Administration of Medications #

1. Give oral meds only when the client is alert and seated upright.
2. Record all deviations from prescribed medication procedures in the incident-management system.
3. Notify the CCM and log in shift notes if a client refuses medication (not a clinical incident).
   • For clients with cognitive impairment/dementia, offer meds three separate times before recording “Refused Medication.”
4. Call the CCM before administering if the client seems under the influence of alcohol or drugs.
   • CCM consults the decision-maker and GP; if the issue persists, obtain written GP instructions on giving meds alongside substance use.
5. Keep regular meds packed in a DAA, labelled with client name, allergies, pharmacy directions, prescriber, and expiry.
6. Store non-DAA items (creams, drops, etc.) in original, clearly labelled packaging with full instructions and expiry.
7. Ensure the client takes the complete DAA or original packaging whenever they go out.

PRN schedule 8 medications#

Where Schedule 8 medications are not packed in a regular blister pack, the Support Worker must call the client’s Registered Nurse (RN) or the on-call RN (out of hours) prior to administration.

• The palliative care nurse will draw up medication into syringes each day. These will usually be kept in the fridge

1. The Support Worker is to telephone the RN and describe the client’s pain and its location.
2. The RN is to switch the call to a video call (FaceTime on iPhones; WhatsApp video on Android devices).
3. The RN is to cross-reference the medication against the medication chart held in the client’s Basecamp file.
4. The Support Worker is to collect the Schedule 8 medication and show the packaging to the RN on the video call so that the RN can verify that the medication is correct.
5. The Support Worker is to administer the medication under video observation by the RN.
6. Where the medication is administered via the subcutaneous route using a butterfly device, the Support Worker is to show the RN the insertion site on the video call and observe for any redness.
7. The Support Worker is to attach the syringe to the Luer-lock butterfly with the prescribed medication, followed by a normal saline flush.
   • The volume of the normal saline flush is to be in accordance with the Doctor’s instructions. Where no specific instruction is documented, a 0.5 mL flush is to be administered.
8. The Support Worker is to document the administration on the relevant signing charts.
9. The RN is to document the time of administration, any visible inflammation, and the drug and dose given.
10. The RN is to telephone the Support Worker after 30 minutes to review efficacy.

Documentation#

When the client's medication (DAA) is delivered, the pharmacy will make available medication-signing sheets aligned with the Medication Chart (list) provided by the client's GP. 

1. Where the pharmacy cannot provide medication signing sheets, the HWH medication signing sheet is used.
2. Once the medication signing sheet is completed, it will be uploaded directly to Basecamp.
3. RN will review medication signing sheets and log clinical incidents as they arise. 
4. Consumer Medication Information (CMI) for prescribed medications is accessible via the Basecamp online resource, the Australian Medicines Handbook or the TGA website

Over-the-counter (OTC)and PRN medications#

1. The pharmacy will pack routine OTC meds in the client’s DAA with other regular medications.
2. PRN prescriptions must be listed on the GP’s medication chart/health summary, showing dose and frequency.
3. The support worker must get CCM approval before giving any PRN dose.
   • CCM checks back post-dose to confirm effect.
   • If PRN use repeats over several days, CCM consults the client/decision-maker and the GP for review.
   • Where consent is delegated, the CCM liaises with the GP directly.

Medication Side Effects#

If a client’s condition or behaviour changes after medication, signs of possible side effects—act according to the severity of the situation. 

1. Emergency Response: If the client is unresponsive or has obstructed breathing, immediately dial 000 and place the call on speaker. Follow the instructions provided by the ambulance contact centre agent.
2. Consultation: Contact the CCM, who will provide guidance and communicate the event to the client’s responsible person.
   1. CCM may contact the pharmacist who has provided the DDA. If the pharmacist is not available, contact the Poisons Information Centre at 13 11 26 for advice.
   2. CCM may contact the GP: Consult with the client’s GP regarding the situation.
   3. Documentation: The CCM must document the event in Basecamp under the client’s case notes.

Storage of Medications #

1. Store medications to stay effective and safe for everyone in the home.
2. Keep blister packs or original packages in a cool, dry, secure spot—kitchen cupboards often work if away from heat and light.
3. Refrigerated medications should be placed in a sealed, labelled container, preferably on the fridge's door.
4. Ask the CCM for safe carry options when taking meds on outings.

Disposal of Medications#

1. All expired or unused meds ➜ return to a pharmacy.
2.  Blister packs / DAA strips: Seal in a labelled zip-lock bag → pharmacy.
3. Who can return? Preferably family, but any responsible person may return meds, including Schedule 8 drugs.
   • Schedule 8 drugs: hand straight to the pharmacist.
4. Loose tablets (found on the floor or missed dose)
   • Call CCM and send the photo.
   • Drop tablets into the yellow sharps' container. provided by HWH
5. Sharps containers
   • Available from the office; cost added to the client invoice.
   • When full, take the sealed container to the pharmacy for safe disposal.

Peg Tub Administration#

Refer to the client’s medication chart to obtain the prescribed directions.

Prefer liquid formulations.
Request the GP to prescribe medications in dispersible or liquid form whenever possible.

Avoid crushing.
Crushing tablets is a last resort—it increases tube-block risk.

• Never crush enteric-coated or sustained-release products.
• If crushing is unavoidable, the GP/pharmacist must approve an alternative or give written, signed instructions.

If crushing is approved:

• Administer one medication at a time.
• Flush the tube before, between, and after each dose.

Bulk-forming laxatives:

•  Do not give via PEG—they clog tubes.
•  Use a high-fibre enteral feed instead.

Incident Reporting and Management#

The person who identifies a medication incident must create a clinical incident form. The CCM oversees the investigation, management, and resolution of the incident.

Medication incidents include:#

• Wrong medication administered
• Incorrect timing (including "punching out" the wrong day in the blister pack)
• Missed dose
• Medication not signed for
• Packaging error (wrong medication dispensed or missing medications)