NDP Community

Last Sunday, a resident in the shared house that I work tripped n fell, landing on his throat against the pointed edge of a side board. There's a bit of bleeding with voice affected plus an abrasion on the bridge of his nose. Call was made to 13SICK. We wanted to administer Panadol for his throat as he felt pain when swallowing but his PRN has expired. Procedures say we can't let him have Panadol from another resident's medication supply.

Question: what if nearby pharmacy is closed, do we really have to stick to such technicality? Your views please.

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Swee Ng
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Good morning Swee

Medication procedures are in place to ensure that residents stay safe and that medications are administered appropriately. All of the training clearly starts with "right person", however this is essentially a matter for your employer to make the call regarding whether it would have been okay to administer another person's medication as they carry the risk at the end of the day. 

The other question I have is - how is it that medication went out of date in the first place? Does your organisation have procedures in place to check such things to avoid something like this happening in the first place? 

I do hope your resident is okay as it sounds like it was a nasty fall.

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Melissa Bannerman
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Always follow protocol when it comes to medication or accidents . Should it be an accident call the appropiate emergency services . 
You say there was bleeding he felt pain and his swallowing was affected . As the health of the patient is outside your scope of practise . Do not administer medication that you have no knowledge on . Not even a panadol as you dont know what he is allergic too or how it may affect him with his recent injuries . If the near by pharmacy is closed, emergency services or ambulance  it is, he needs to be examined , he is in pain and you dont know what damage was done if any or if when you give him the panadol if it will become lodged in his throat. If a medication is out of date it may mean a few things eg he hasnt take it in a long time and he may have had his medication changed . 

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Ana Aguiar
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By PRN, I am referring to medication that the resident has been pre-approved by his doctor to be used on a need basis. So there is no worry about allergy. Calling 13SICK puts us in touch with doctor for house call or phone consult but it is not immediate, could be available only the next day as the incident happened on a Sunday and response was delayed due to high instances of Covid.

My concern is whether duty of care would take precedence over medication procedure in such instance when a resident is in pain but we can't give him panadol from his medication store because it is expired. If another resident has panadol in his PRN as well and not expired, can't we just administer 2 tablets to the person who is in pain.

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Swee Ng
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Original Message:
Sent: 03-01-2023 16:35
From: Ana Aguiar
Subject: Medication Procedures

Always follow protocol when it comes to medication or accidents . Should it be an accident call the appropiate emergency services . 
You say there was bleeding he felt pain and his swallowing was affected . As the health of the patient is outside your scope of practise . Do not administer medication that you have no knowledge on . Not even a panadol as you dont know what he is allergic too or how it may affect him with his recent injuries . If the near by pharmacy is closed, emergency services or ambulance  it is, he needs to be examined , he is in pain and you dont know what damage was done if any or if when you give him the panadol if it will become lodged in his throat. If a medication is out of date it may mean a few things eg he hasnt take it in a long time and he may have had his medication changed . 

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Ana Aguiar
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From my point of view for the case described duty of Care would dictate an ambulance be called. In a lesser case panadol has been listed as a PRN and isn't a prescription drug so I would get some from the local supermarket or petrol station. Other participants medications etc are theirs so unless they are happy to share I would find some elsewhere. ( I agree re comments about out of date anything).

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Mark Kulinski
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Original Message:
Sent: 06-01-2023 23:17
From: Swee Ng
Subject: Medication Procedures

By PRN, I am referring to medication that the resident has been pre-approved by his doctor to be used on a need basis. So there is no worry about allergy. Calling 13SICK puts us in touch with doctor for house call or phone consult but it is not immediate, could be available only the next day as the incident happened on a Sunday and response was delayed due to high instances of Covid.

My concern is whether duty of care would take precedence over medication procedure in such instance when a resident is in pain but we can't give him panadol from his medication store because it is expired. If another resident has panadol in his PRN as well and not expired, can't we just administer 2 tablets to the person who is in pain.

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Swee Ng
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Original Message:
Sent: 03-01-2023 16:35
From: Ana Aguiar
Subject: Medication Procedures

Always follow protocol when it comes to medication or accidents . Should it be an accident call the appropiate emergency services . 
You say there was bleeding he felt pain and his swallowing was affected . As the health of the patient is outside your scope of practise . Do not administer medication that you have no knowledge on . Not even a panadol as you dont know what he is allergic too or how it may affect him with his recent injuries . If the near by pharmacy is closed, emergency services or ambulance  it is, he needs to be examined , he is in pain and you dont know what damage was done if any or if when you give him the panadol if it will become lodged in his throat. If a medication is out of date it may mean a few things eg he hasnt take it in a long time and he may have had his medication changed . 

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Ana Aguiar

I'm concerned that you don't seem to be taking on board the recommendations given. No, you can't just administer 2 tablets from someone else's medication to a person who is in pain. As has already been mentioned, if there was a significant enough concern for the person's welfare, then an ambulance could have been called which absolutely prioritises your duty of care to your client. 

Did you speak to your line manager about your organisations policy and procedures on this?

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Melissa Bannerman
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Original Message:
Sent: 06-01-2023 23:17
From: Swee Ng
Subject: Medication Procedures

By PRN, I am referring to medication that the resident has been pre-approved by his doctor to be used on a need basis. So there is no worry about allergy. Calling 13SICK puts us in touch with doctor for house call or phone consult but it is not immediate, could be available only the next day as the incident happened on a Sunday and response was delayed due to high instances of Covid.

My concern is whether duty of care would take precedence over medication procedure in such instance when a resident is in pain but we can't give him panadol from his medication store because it is expired. If another resident has panadol in his PRN as well and not expired, can't we just administer 2 tablets to the person who is in pain.

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Swee Ng
------------------------------


Original Message:
Sent: 03-01-2023 16:35
From: Ana Aguiar
Subject: Medication Procedures

Always follow protocol when it comes to medication or accidents . Should it be an accident call the appropiate emergency services . 
You say there was bleeding he felt pain and his swallowing was affected . As the health of the patient is outside your scope of practise . Do not administer medication that you have no knowledge on . Not even a panadol as you dont know what he is allergic too or how it may affect him with his recent injuries . If the near by pharmacy is closed, emergency services or ambulance  it is, he needs to be examined , he is in pain and you dont know what damage was done if any or if when you give him the panadol if it will become lodged in his throat. If a medication is out of date it may mean a few things eg he hasnt take it in a long time and he may have had his medication changed . 

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Ana Aguiar

Hi Swee,

Most providers have PRN protocols as part of their medication administration procedures, and these, combined with relevant medication administration procedures indicate the 'Rights' of medication administration eg right person, right medication, right dose etc.

Most medication policies and associated training reflect that i) you never administer someone else's medication to a person, and again, this wouldn't fit with the 'R' for right person, and/or ii) you would not administer medication from an original packet - the client may administer their own.

If the medication is a PRN, and as with any PRN medication, there is usually a correlating medication protocol for the person under which any particular medication is administered, stating the specific condition or symptoms. I do however recognise that this may not include pain as a result of an accident.

I agree with previous comments around the ethics of using medication another person has paid for.

Of broader note, now that the NDIS Quality and Safeguards Commission has issued a Practice Alert relating to 'safe swallowing' (though usually regarding more chronic type issues / swallowing problems) I believe that in this instance, medical assessment may have been required beyond that provided by phone/helpline. Additionally, if someone has swallowing difficulty as a result of an injury this may have additional implications for them, and, swallowing panadol may also have been difficult.

I agree with all previous responses regarding checking your company's policy and procedures relating to medication administration

Additionally, I would recommend that if you don't already have them in place, that you consider a regular weekly or monthly 'PRN Stock Check' to catch medications that are running short and/or expiring

You may also wish to consider a FRAT (Falls Risk Assessment) for your client if they haven't already had one - falls are a major factor relating to avoidable deaths in people living with disability.



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Paula Roberts
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Hi Swee,

Hope your Resident is okay!

We make sure that every Resident who can have pain relief medication has their own PRN procedure for it, which is developed with the Resident, their family and the GP who signs off on it,  they also have their own stock of whatever pain relief is documented.  We also audit our medication regularly to ensure it is not out of date.

Re what occurred, I probably would've arranged for the Resident to go to an emergency department.

Hope this helps,
Peter


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Peter Spyker
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