Medication Competency Assessment for Care Workers: A Checklist for England

A medication competency assessment is a check that a care worker has the knowledge and skill to support people with their medicines safely, ideally including a direct observation of them doing it. In England, the Care Quality Commission (CQC) expects staff to be competent for the care they provide, and NICE guidance recommends that providers assess care workers as competent, including through direct observation, and review their knowledge, skills and competencies every year. This post turns that guidance into a practical checklist. It applies to England. CQC is the regulator of health and adult social care in England only, so providers in Wales, Scotland and Northern Ireland should check their own regulator's rules.

What the rules and guidance actually say

There are two layers: a legal duty, and good-practice guidance from NICE.

The legal duty. CQC's Regulation 12 (safe care and treatment), made under the Health and Social Care Act 2008, requires providers to ensure that people providing care or treatment have "the qualifications, competence, skills and experience to do so safely". It also requires "the proper and safe management of medicines". CQC's guidance on the regulation adds that staff who manage and administer medication must be suitably trained and competent, and that this should be reviewed.

The NICE guidance. NICE publishes two social care guidelines that matter here: NG67, Managing medicines for adults receiving social care in the community (last reviewed 30 March 2017), and SC1, Managing medicines in care homes (last reviewed 14 December 2017, with a May 2020 update on reusing medicines during COVID-19). NICE says its recommendations are not mandatory, but CQC's own medicines pages draw on NG67. NG67 says that when providers are responsible for medicines support they should have robust processes for medicines-related training and competency assessment, so that care workers:

• 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; and
• have an annual review of their knowledge, skills and competencies.

The NICE checklist for care home medicines policies makes similar points for care homes. It says only trained and competent staff should administer medicines, requires annual review of the knowledge, skills and competencies relating to managing and administering medicines, and says staff who lack the skills to give medicines, even after completing the required training, must not be allowed to administer them.

One honest limit: in the CQC and NICE texts we reviewed, we found no single prescribed assessment form, pass mark or named qualification. Providers design their own process, so write yours down and apply it consistently. We could not open CQC's dedicated page on training and competence in medicines optimisation for adult social care, so check it directly for any further detail.

Medication competency assessment checklist

Use this as a starting framework and adapt it to your own medicines policy, the care settings you run and the tasks each worker is asked to do.

1. Before the assessment

• The worker has completed medicines training that matches their role.
• The task is written into the person's care plan. CQC's home care guidance, which draws on NICE, says care workers should give medicines only when this is documented in the care plan.
• The worker knows your medicines policy, including where it covers ordering, storage, administration, disposal and recording. These are the areas CQC lists for policies.
• You have decided which tasks the worker will be assessed for. Assessment should cover the support they are actually asked to give.

2. Direct observation

NICE specifically calls for assessment through direct observation. An assessor watches the worker support a real medicines round, or a realistic one, and notes what they do. Typical things to look at are listed below. These are our suggestions for what to observe, not an official CQC or NICE list.

• Preparing safely, such as hand hygiene and a clear workspace.
• Confirming the right person and checking the medicine against the record.
• Supporting the person in line with their care plan and preferences.
• Responding properly if the person refuses, or if something does not match the record.
• Recording what happened.

3. Records

• Medicines support is recorded for each individual medicine on every occasion. This is a NICE NG67 recommendation.
• Entries are signed, legible and accurate. CQC's guidance on medicines administration records says entries should be made as soon as possible after the person has taken the medicine.
• Only people who are trained and assessed as competent create or change a record. For care homes, CQC says a second trained, skilled person should check a new record and sign it before anyone uses it.

4. Raising concerns and errors

• The worker knows to raise any concerns about a person's medicines with the provider, as NICE recommends.
• The service has a "fair blame" culture that encourages reporting, and reviews medicines-related problems over time to spot trends. Both come from NG67.

5. Outcome and sign-off

• Record the date, the assessor, the tasks assessed and the result.
• If the worker is not yet competent, do not let them carry out that task alone. The NICE care home checklist says staff who lack the skills must not administer, even after training.
• Agree actions and a date to reassess.

6. Annual and event-driven review

• Review each worker's knowledge, skills and competencies at least once a year, per NICE.
• Consider an earlier reassessment after a medicines error, a change in a person's medicines or a new task. This one is our suggestion, not a NICE requirement.

Quick reference

Tasks that need more than the basics

Some tasks go beyond routine support. CQC's home care guidance, drawing on NICE, says that for delegated tasks such as injections or giving medicines through a feeding tube, staff will usually need extra training and competency checks before they undertake them. It adds that the healthcare professional delegating the task must assess that the care worker is competent and trained. Treat these as separate competencies with their own sign-off, not as part of a general medicines tick-box.

Keeping the evidence in one place

An assessment only helps you if you can show it. Keep the signed observation, the date and the next review date for each worker, and make it easy to see who is overdue. Our training matrix template for compliance training is one way to track this alongside your other mandatory training, and our CPD hub has wider guidance on professional learning.

Frequently asked questions

How often should care workers be assessed for medicines competency?

NICE NG67 recommends an annual review of care workers' knowledge, skills and competencies for medicines support, in addition to assessing them as competent initially. The NICE care home checklist also asks for an annual review.

Does a care worker need a specific qualification to give medicines?

Regulation 12 refers to qualifications, competence, skills and experience. In the CQC and NICE material we reviewed, no single named medicines qualification is specified, so your policy and risk assessment should set what you require.

Who should carry out the assessment?

The NICE text we reviewed requires assessment of competence, including direct observation, but does not name a job title for the assessor. Choose someone who is themselves competent and trained, and record who assessed.

Is this the same across the UK?

No. CQC regulates in England only. The NG67 text cites English law, so treat NICE's guidance as England-focused unless NICE says otherwise. Check your own regulator's requirements elsewhere in the UK.

Can staff give injections after the standard assessment?

Not on that basis alone. CQC's guidance says delegated tasks like injections will usually need extra training and competency checks, and that the delegating professional must assess the care worker is competent and trained.

In short

Train, observe, record, review every year, and tie each assessment to the tasks the worker actually does. If it is written down and applied consistently, you can show an inspector how you know your staff are competent.

This article is general information, not regulatory, legal or compliance advice. Check current CQC and NICE guidance, and take advice on your own service's circumstances.