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Self-administration, independence and choice are considerations that need to be supported and encouraged. When talking about medication, as we've mentioned throughout the course, it's very important to remember that the right person, receives the right medication, at the right time, in the right dose, by the right route and that the person has the right to refuse. When administering medication, the client or service user must have the choice as to where and when they have their medication, within reason. We need to respect their choice, their independence and their dignity at all times.

We need to give the service user as much control as possible. So, if they are not able to take their medication at a certain time, they still need to be able to be given an alternative. For example, if we need to administer a suppository, we need to make sure that their privacy and dignity is maintained. This isn't something we're going to be doing in the living room in front of the TV. Also, if we need to administer injections, it needs to be in a clean, safe environment, also with privacy and dignity maintained.

If the client or service user refuses to take their medication, we have no rights to force them to take it. We can try and encourage them, explain why they're taking it, but if they still refuse, then we're unable to give it. If the client refuses to take the medication this needs to be documented, the line manager informed, and if necessary, the GP informed.

Where a service user is able to self-administer, this must be encouraged. It may be that the service user who's self-administering will have their own key to a lockable cupboard. If this is not possible or they choose not to have the key, then you may be the one who goes and unlocks the cupboard. But from that point, the service user will take their own medication out and dispense it. We may need to help encourage the service user. For example, we may need to give them a gentle reminder at times that they need to take their medication. Or it may be that we need to help open boxes. There are various compliance aids that can be used to aid a service user to do this.

If you have a service user in hospital and they want to self-administer when they return to your workplace, this process will be commenced in hospital. The hospital staff will assess their capabilities and commence the self-administration process. They will be observed to ensure that they are administering the correct medication at the correct time and that they understand what they are taking. This will then continue when they return to your workplace. They will still need to be monitored when they initially return to ensure that they understand what they are taking. This will be risk assessed by a suitably qualified member of staff.

When a service user or client is self-administering, records still need to be maintained. Staff may not have seen the service user take the medication, but if they're self- administering, then they have been risk assessed and they are capable of understanding when and why they're taking it. So, staff would document that the service user stated that they took their medication. Ensure that the records are clear, and you have not implied that you have seen the service user take the medication.

The way in which we administer medication must always be around the service user's needs and not what's best for the workplace. I've seen examples in hospital where patients have been woken up at 6 o'clock in the morning to be given medication. There's no medical reason why this needs to happen. Obviously, in certain circumstances, there will be medication that has to be given at a specific time or perhaps a certain amount of time before breakfast and in this case there's not an awful lot that can be done about it. But for the most part, always work around what is best for your service user.

Other exceptions to these rules are individuals with diabetes. Diabetics have to have their insulin at certain times when they eat, but if they don't have their breakfast until 8 o'clock in the morning, we don't need to wake them up and give them insulin before this time. We always need to be aware that if you're taking service users or clients out for the day, ensure that medications have been prepared. For example, if somebody needs their insulin, make sure that you have everything you need. Sharps boxes, needles, syringes and the insulin itself.

So, to summarise, always ensure that the needs of the service user or clients are paramount, work around what suits them and not what suits staff needs or shift patterns.