it ain’t necessarily so – the drugs trolley
– with JOHN BURTON email@example.com_autolink_uri:9ee682aa5b630e96aa6587fcb0996a56----
The handover’s finished and everyone’s gone off to help residents to get up, dressed and ready for the day. You – the most senior person on duty and possibly the manager of the home – go off to the medical/clinical room (or whatever you call it) to get the drugs trolley and to start the “meds round”.
Depending on the size and layout of the care home, you may be returning the trolley to its safe place about two hours later. Meanwhile you’ll have pushed said trolley all around the building, in and out of the lift, locked it and unlocked it dozens of times (if you follow the rules), squinted at the MAR charts, wrestled with bubble packs and bottle tops and scribbled your initials over and over again for every medication given; measured spoonfuls of syrup, administered eye drops . . . and those are just some of the jobs that trolley carries with it.
If you’re the most senior person on duty, leading the team, it won’t surprise you that while you’re giving out the medication, you’re in demand for all sorts of reasons from residents and staff. And you may notice things that need your attention as you go round; the phone may ring; and a resident may feel ill or have a fall; and, and, and . . .
. . . and did you remember to lock the trolley each time you walked away from it to take someone their medicine? And what about washing your hands? And those bubble packs and bottles and beakers go in and out of people’s rooms, and the trolley ends up looking more like a central collection and distribution hub of possible contamination rather than the trusted guardian of therapeutic medication.
Like many other standard practices, this drugs trolley is beginning to seem like not such a good idea after all. It’s time-consuming, institutional, a potential source of cross-infection, and it takes the team leader or manager away from their prime task of giving leadership, support and guidance.
Most smaller homes for younger people never had a drugs trolley, and many progressive homes for older people don’t have one either. There are ways of managing medication more safely, more efficiently, and more privately and individually. The medication belongs to the person it’s prescribed to, and they should have as much ownership and control of it as they are able and willing to take.
In most homes medication should be kept locked with the record in a cabinet in people’s own rooms, so those who are able can manage their own medication as they would have done at home, and those who can’t manage at all can have it done for them by staff who are trained with medication just as they are trained in all other aspects of care. And some residents, possibly most, will manage with varying levels of support – all part of their regularly updated care plan.
Thus, medication becomes the normal part of everyday life that it should be: important, certainly, but not the most important task in the home to be entrusted only to the most senior person on duty.
We found a different way:
Caring Times readers tell their stories
DLB (care home with nursing manager, Surrey): At the home I’ve recently moved to, I see nurses with the drugs trolley avoiding their responsibilities by saying “Don’t disturb me, I’m doing the meds.” Staff and residents want help. Even if there’s a minor emergency, some nurses refuse to get involved because they’re tied to the trolley.
I’d like to change this. In a previous home I managed, we did away with the trolley and, with the help of our pharmacist (supplying cabinets and training), we put cabinets into every room.
It made such a difference to the home. No more dishing out pills at meal times which was very disruptive and institutional. Why should everyone know you’re taking medicine for this, that and the other? It’s private and it should be kept private. And, as for the security and infection control, the trolley is a big risk when you think about it.
And it’s very good for the staff to be trained and take the responsibility. Good care is holistic. You don’t want different people doing different things for you – one waking you; another one washing you; one coming in to talk to you, another helping you to get dressed, and then a nurse walking in with your medicine, pills and eye-drops.
The sooner the drugs trolley goes the better.
MS (care home manager, Staffordshire): I get so fed up with doing the medication round, wheeling that trolley around. I’m very used to it but you have to concentrate and it’s so easy to get distracted. I dread the day when I get pulled into an urgent situation that demands my immediate attention and I leave the trolley open, and someone comes along and takes something. You might not even know anything was missing until you came to administer those particular drugs.
It takes some of my senior staff much longer than me because they are so frightened of getting it wrong. They check and check, and check again. Well, that’s what you’re meant to do. If you start rushing through it, or initialing everyone at the end, you’ll make mistakes but it may look as if it’s perfect.
Yes, I’d love to get rid of the trolley and go for individual cabinets in rooms. I just have to persuade my proprietor.