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People with a learning disability can have complex health needs and often have overlapping long-term conditions such as epilepsy, mental health problems, gastrointestinal issues, diabetes, and dementia.
As a result, the treatment regimens of people with a learning disability can be complex, involving several different prescribers with medicines frequently used outside their product license. This can lead to medication-related problems such as over dosage or giving the drug at the wrong time. The most common cause of medication errors is lack of pharmacological knowledge.1
Staff working in learning disability services such as care homes will often be required to administer medicines, so it is important that they have the necessary knowledge and skills. Accredited medicines training from recognised companies such as Opus Pharmacy is therefore essential for unqualified staff involved in the care of people with a learning disability.
What is a learning disability?
According to the Department of Health, a learning disability affects the way a person understands information and how they communicate. This means they can have difficulty understanding new or complex information, learning new skills, and coping independently.2
People with a learning disability have a diverse set of health and social care needs depending on the degree of disability. Around 1.5 million people in the UK have a learning disability with up to 350,000 people having a severe learning disability that requires care in the community or a learning disability service.
The majority of people with a learning disability known to local authorities live in one of three types of accommodation: with family and friends (38%), in a registered care home (22%) or in supported accommodation (16%). 12% live as tenants in accommodation provided by a local authority or housing association and 3% in privately rented accommodation.3
How care staff provide medicines support?
An important element of staff medicines training is enabling and supporting people to manage their medicines and helping them to take a full part in making decisions.4
The Care Quality Commission (CQC) says that medicines support is any support that enables a person to manage their medicines. In practical terms, this covers:
- Prompting or reminding people to take their medicines
- Helping people remove medicines from packaging
- Administering some or all of a person's medicines.5
It says that care staff should assess what medicines support a person needs as part of their general assessment and this should be recorded in the care plan. This would also include the person's needs and preferences, how to seek consent, what support they need for each medicine, and how the medicines support will be given.
It is also important to record who provides medicines support, particularly when more than one care provider is involved and when the medicines support will be reviewed - for example, after six weeks.
Medicine competence training for care home staff
NICE guidance recommends that care staff and social care providers who support people’s medicines needs have an annual review of their knowledge, skills and competencies relating to managing and administering medicines.4,6
There should also be robust processes for medicines‑related training and competency assessment for care workers, to ensure that they:
- Receive appropriate training and support
- Have the necessary knowledge and skills
- Are assessed as competent to give the medicines support being asked of them, including assessment through direct observation
- Have an annual review of their knowledge, skills and competencies.
New staff should not be allowed to manage or administer medicines before assessing their competence.
Social care providers are also required by law (The Health and Social Care Act 2008 [Regulated Activities] Regulations 2014) to securely maintain accurate and up-to-date records about medicines for each person receiving medicines support.
Poor record keeping can put people receiving medicines support and care workers at risk. Records should include information about who is responsible for ordering medicines, covert administration of medicines, as well as self-management plans.
Effective processes for identifying, reporting, reviewing and learning from medicines-related problems should also be in place, along with procedures to report refusals and side effects.
Over medication issues in people with learning disabilities
Monitoring patients is an essential component of the prescribing process, but a recent CQC analysis found that people who were prescribed antipsychotic medicines were not always receiving the necessary health checks.7
Research from Public Health England that estimated that every day between 30,000-35,000 people with a learning disability are taking prescribed antipsychotic or antidepressant medication, or both, without appropriate clinical justification. Long-term use of these medicines can lead to significant weight gain, organ failure and, in some cases, death.
The CQC says that for medicines used to manage a person’s behaviour, care home staff should know how to support a person in a different way before using a medicine. For example, changes to the person’s environment. This information should be accessible to staff at the time of medicines administration. It states that providers should follow the principles laid out in:
- STOMP (stopping overmedication of people with a learning disability, autism or both)
- STAMP (supporting treatment and appropriate medication in paediatrics).
More than 250 social care provider organisations, including The Voluntary Organisations Disability Group (VODG), recently pledged to take measurable steps to tackle over-medication of people with a learning disability.
This should therefore be included in the training of staff working in settings were antipsychotic or antidepressant medication is prescribed.
What types of medication training are available?
The CQC says that medicines training needs should be relevant to the type of care setting staff are working in and the tasks to be undertaken. Additional training might also be needed to administer medicines using specialist techniques such as inhalers and nebulised medicines, oral syringes, eye drops, or buccal administration.4
There are numerous training courses available and a key part of selecting the right learning package for an organisation is finding the right learning provider. Independent charity Skills for Care has an endorsement scheme that helps employers to easily identify high quality training providers without the need to search through the minefield of existing providers.
Most training programmes will help staff administer medication safely, minimise medication errors and increases awareness and understanding of medicines. It also provides organisations with peace of mind that their medication policy is effective, and their team is trained proficiently to fully protect those in their care.
- Cheragi MA, et al. Types and causes of medication errors from nurse's viewpoint. Iran J Nurs Midwifery Res. 2013 May-Jun; 18(3): 228–231
- Managing medicines in care homes. https://www.nice.org.uk/guidance/sc1
- Managing medicines for adults receiving social care in the community. https://www.nice.org.uk/guidance/ng67
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