Archive for December, 2011

Essential Standards Outcome 9 pt 2

December 28, 2011

Manage risk through effective procedures about medicines handling

9B Where people who use services receive care, treatment and support that
involves medicines, the provider has:

●● Clear procedures followed in practice, monitored and reviewed for
medicines handling that include obtaining, safe storage, prescribing,
dispensing, preparation, administration, monitoring and disposal. Wherever
they are required these procedures include:
— how medicines which are prescribed ‘as required’ (PRN) are handled
and used
— ensuring that staff handling medicines have the competency and skills
needed
— the arrangements for giving medicines covertly where this is needed in
accordance with the Mental Capacity Act 2005
— the arrangements for requesting a second opinion in relation to
medicines for people detained under the Mental Health Act 1983
— the arrangements for recording when it is not possible for a person to be
able to self-administer their medicines
— the recording of when medicines are given to the person
— the arrangements for reporting adverse events, adverse drug reactions,
incidents, errors and near misses. These should encourage local and,
where applicable, national reporting, learning and promoting an open
and fair culture of safety
— the arrangements to implement and act upon the recommendations of
all relevant medicine-related patient safety communications issued via
alert systems within the required timescales
— an up-to-date list of medicines taken by the person being produced
when they begin to use the service
— the management of discharge medicine to allow for continuity of care
until a new arrangement is made
— the arrangements for medicines management following death.
●● Clear procedures, that are followed in practice, monitored and reviewed, for
controlled drugs, unless they are taken by the person themselves in their
own home, including:
— investigations about adverse events, incidents, errors and near misses
— sharing concerns about mishandling.
●● Systems in place to reflect on the findings of their service reviews and as it
does so, learns from adverse events, incidents, errors and near misses
relating to medicines that have occurred within the service and elsewhere,
so that the risk of them being repeated is reduced to a minimum.
●● Systems in place to ensure they comply with the requirements of the
Medicines Act 1968 and the Misuse of Drugs Act 1971, and their
associated regulations, the Safer Management of Controlled Drugs
Regulations 2006, relevant health technical memoranda and professional
guidance from the Royal Pharmaceutical Society of Great Britain and other
relevant professional bodies and agencies.

Children’s medicines advice website launched

December 19, 2011

Here was the news from the Royal Pharmaceutical Society’s Pharmacy Journal earlier this week……

Pharmacists have been involved in creating a new website offering children’s medicines advice to parents.

Launched this week (12 December 2011), “Medicines for children” gives information about how and when to give medicines to children and provides answers to common questions about dosage and side effects.

Users can search the online database according to the brand or generic name of the drug or look up the disease, condition or infection being treated.

Medicines advice leaflets can also be downloaded from the website, developed by the National Paediatric Pharmacists Group, the Royal College of Paediatrics and Child Health and national children’s charity Well Child.

Stephen Tomlin, NPPG secretary and consultant pharmacist at the Evelina Children’s Hospital in London, said that the website is in its infancy and will continue to be developed based on feedback from parents and carers.

He said: “At present the team is working to provide evidence-based and accurate information for further medicines through its rigorous, transparent and fully auditable production process.

“We hope that the leaflets stand alone as a quality information source, but also act as a catalyst for enhanced professional and carer engagement on the important topic of medicines and children.”

Consultant paediatrician at London’s Great Ormond Street Hospital William van’t Hoff said the website and leaflets cover a range of issues, from one-off treatments to medicines given for long-term and complicated conditions and disease.He urged healthcare professionals to direct parents to the resource, and pointed out that the leaflets are endorsed by the Department of Health’s Information Standard and are referenced on the British National Formulary for Children’s website.

Essential Standards Outcome 9 Pt 1

December 19, 2011

 Providing personalised care through the effective use of medicines

9A. People who use services receive care, treatment and support that:

Ensures the medicines given are appropriate and person-centred by taking account of their:

  • age
  • choices
  • lifestyle
  • cultural and religious beliefs
  • allergies and intolerances
  • existing medical conditions and prescriptions
  • adverse drug reactions
  • recommended prescribing regimes.

Ensures the person’s prescription for medicines, for which the service is responsible, is up to date and is reviewed and changed as their needs or condition changes.

Includes monitoring the effect of their medicines and action when necessary if their condition changes including side effects and adverse reactions.

Includes supporting and reminding them to self-administer their medicines independently where they are able and wish to do so by minimising the risk of incorrect administration.

Follows clear procedures in practice, which are monitored and reviewed, which explain how up-to-date medicines information and clinical reference sources for staff are made available.

My thoughts:-
Does the person who does the care needs assessment have medicines training to ensure that all of these things are taken in to consideration?
In my experience specialising in medicines in care the answer to that question is more often than not a resounding NO! That is usually reflecting in the care plan produced, giving providers little information about medication, it’s use, personalisation, promoting independence, allergies etc. Quality training for assessors in Medication Needs Assessment is essential to ensure that our assessors know exactly what information is required to gather from the client AND to give to the client.

A community or primary care trust pharmacist can help support you with medicines use reviews – a free service that would provide you with so much information and and advice – make sure you take advantage of it!

Promoting independence with medicines is a subject dear to my heart as many of you who have trained with me will know. There are so many wonderful compliance aids available to enable clients to take or use their medication more easily and yet the care industry seem to have missed out on this information.  I’ll make sure this appears again in later newsletters to empower you to enable your service users too.

Clinical reference sources and medicines information can be found in the BNF or go to http://www.BNF.org and use the Royal Pharmaceutical Society of Great Britain’s publication The Safe Handling of Medicines in Social Care

Next week we’ll cover Standard 9b – Manage risk through effective procedures about medicines handling. Hope you’re finding this useful 🙂

NHS fails to provide basic healthcare for up to half of people with diabetes

December 16, 2011

New article from Diabetes UK

12 December 2011

 

Diabetes UK today made a direct call for the Government to put diabetes at the top of the health agenda, as new figures from the Department of Health revealed that up to half of people with diabetes in England are missing out on the basic health checks recommended by NICE, the Government health watchdog.

The NHS Atlas of Variation in Healthcare, published today, reports that two thirds of people with Type 1 diabetes (68 per cent) and almost half of people with Type 2 diabetes (47 per cent) did not receive all the nine recommended healthcare checks between 2009 and 2010.

This shows no improvement from when the Atlas was first published in 2010, when it stated that 68 per cent of people with Type 1 and 49 per cent of people with Type 2 diabetes failed to receive the relevant healthcare checks.

Regional variations

The level of care received also varied greatly depending on where people lived. People with Type 1 diabetes were found to be more than two-and-a-half times more likely to receive all their basic healthcare checks if they lived in some areas of England when compared to others. A similar figure was reported for people with Type 2 diabetes, where people living in some Primary Care Trusts (PCTs) were more than twice as likely as others to receive all the basic healthcare checks.

It is vital that people with diabetes receive all the nine NICE recommended healthcare checks and the education they need to help them manage their diabetes effectively.

The Atlas also reported a great variation in the number of people with diabetes having major lower limb amputations, with those in some areas being nearly four times more likely to undergo an amputation as those under other PCTs. This is of great concern, as diabetes causes 100 amputations a week, of which around 80 are potentially preventable.

Healthcare essentials

Barbara Young, Chief Executive of Diabetes UK, said, “Diabetes is one of the biggest health challenges facing the UK today, so the Government needs to stand up and make this their top priority. It is appalling that even after seeing similar results in last year’s report, people with diabetes are still not receiving the basic level of care that they need. This must change. People with diabetes need and deserve to receive high-quality care, regardless of where they live, so it is scandalous that we have to fight for this basic right.

“We must see change, and that’s why we’ve launched our new 15 healthcare essentials campaign to ensure people with diabetes receive the care they need to stay healthy. There is no reason why people with diabetes cannot live long and healthy lives if they have access to high-quality care. We will be holding the NHS to account wherever it fails to deliver high-quality diabetes care.”

The nine NICE recommended healthcare checks for people with diabetes include measurements of HbA1c, cholesterol, creatine, micro-albuminuria, blood pressure and BMI; a record of whether or not the person smokes (or has ever smoked); and eye and foot examinations.

We believe that healthcare checks are important, but on their own they are not enough. People with diabetes also need access to specialist support, co-ordinated care, structured education and emotional and psychological support. This is why we have introduced our 15 healthcare essentials campaign to ensure people with diabetes are receiving all the relevant care they need to effectively manage their condition.

http://www.diabetes.org.uk for more on this and other diabetes topics

Meeting Essential Standards – Managing Medicines

December 12, 2011

What do the regulations say?

Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

Management of medicines
13.The registered person must protect service users against the risks associated with the unsafe use and management of medicines, by means of the making of appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines used for the purposes of the regulated activity.

What should people who use services experience?
People who use services:

Will have their medicines at the times they need them, and in a safe way.

Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf.

This is because providers who comply with the regulations will:

Handle medicines safely, securely and appropriately.

Ensure that medicines are prescribed and given by people safely.

Follow published guidance about how to use medicines safely.
My thoughts:-
Unsafe and management of medicines is usually the result of a lack of understanding of the legislation and guidance which governs medicines administration in all care settings.

  • Policies become out-dated as legislation changes and time whizzes by so fast you don’t realise just how out of date they have become.
  • A nervousness around taking responsibility for administering medication often leads to policies which are full of don’t and can’ts where medication administration by carers is concerned. Unfortunately, often this leaves your carers and clients at risk in not being able to fully support the client with their medication when they require it. As a result, companies who think they are protecting themselves from the responsibility of administering medicines often leave themselves inadvertently in a very vulnerable position legally.
  • Policy writers are stuck in the “old ways” of doing things assuming their way is the right way and maybe it’s not!
  • Policies around medication are not detailed enough to give clear guidance to nursing and care teams
  • A lack of quality training updated at least every 2 years if not annually given to all levels of the care and nursing teams.
  • Our nurses may be nurses but they need to be kept up to date too!

Service users should expect to have their medicines at the times they need need them and in a safe way. This becomes even more important as we move forward into the personalisation agenda – does your organisation ask the client how and where they would like to recieve their medication and at what times? (within reason to meet the requirements of the prescription)
Do you have a system in place to ensure that clients are informed about what they take medication for, possible side effects etc.? How will you make this information available to them? Do you have patient information leaflets for all the medication the client takes?

Ensuring that your current training arrangements provide expert knowledge will ensure that you get the policies that you work to right,  and that your teams are trained so that they are competent and confident in their role is essential to meet the new standards. May be now would be a good time to start taking a look at these things.

Next week we’ll take a look at Standard 9a in a little more detail – Providing personalised care through the effective use of medicines to guide you through it.

 

CQC Criticised – Have they put patient care at risk?

December 6, 2011

Criticism has been levelled at the Care Quality Commission for apparently putting its registration responsibilities ahead of its duty to inspect hospital trusts and social care providers.

The Pharmaceutical Journal reports today that…

Labour MP Margaret Hodge, chairman of the House of Commons Public Accounts Committee, accused the CQC of “significant failures that [have] put patient care at risk”. She said the organisation — which formed following the merger of three statutory regulators in 2009, and is responsible for regulating nine health profession regulatory bodies, including the General Pharmaceutical Council — is too focused on “box ticking, and not enough on crossing the threshold and assuring quality of care”.

Her comments follow a report on the CQC published last week (2 December 2011) by the National Audit Office, which concludes that the commission is an underfunded organisation chasing to catch up with Government inspection targets.

Between October 2010 and April 2011, the CQC was struggling to meet its inspection obligations and had achieved only 47 per cent of them, the NAO report says. Despite working with a budget smaller than the combined budgets of the organisations it replaced, the CQC also fails to represent value for money, the report adds.

Commission has since taken steps to improve

NAO comptroller and auditor general Amyas Morse welcomed steps the CQC has since taken to improve its service, adding: “Against a backdrop of considerable upheaval, the CQC has had an uphill struggle to carry out its work effectively and has experienced serious difficulties.

“There is a gap between what the public and providers expect and what [the CQC] can achieve. The commission and the Department of Health should make clear what successful regulation of this critical sector would look like.”

CQC chief executive Cynthia Bower said the commission faced a “difficult task” in its infancy, but is now on track to deliver real benefits for people who use health and social care services.

Here’s the report from the National Audit Office

 

Categories of Medicines

December 5, 2011

Categories of Medicines

Why can you obtain some medicines from a pharmacist, or even buy them from a supermarket, while others can only be obtained with a prescription from your doctor or other healthcare professional?
The difference depends on the level of supervision that experts in medicines consider is needed before you use a particular medicine.
Under laws governing the supply of medicines, there are three categories determining how you obtain medicine:

Prescription-only medicines

(POMs) are available only on a prescription issued by a doctor or other suitably qualified healthcare professional, such as a nurse or pharmacist. You need to see the healthcare professional before they give you a prescription. You’ll then have to take the prescription to a pharmacy or, in rural areas, a dispensing GP surgery for your prescription to be dispensed. Examples of POMs are inhalers to treat asthma or medicines to lower high blood pressure.

Pharmacy (P) medicines

are available from a pharmacy without a prescription, but under the supervision of a pharmacist. You need to ask the pharmacy staff for this type of medicine as it will be kept “behind the counter” and will not be available for you to pick up from the pharmacy shelves. The pharmacist or another member of staff will check that the medicine is appropriate for you and your health problem, and will ask questions to ensure that there’s no reason why you shouldn’t use the medicine. An example of a medicine that you can buy from a pharmacy without a prescription is chloramphenicol eye drops to treat an eye infection.

General sales list (GSL) medicines

can be bought from pharmacies, supermarkets and other retail outlets without the supervision of a pharmacist. These include medicines to treat minor, self-limiting complaints that people may feel aren’t serious enough to see their doctor or pharmacist about, such as the common cold, headaches, other aches and pains, minor cuts and stomach-related upsets.

Can medicines change their status?

New medicines tend to be licensed in the POM category so that healthcare professionals can supervise their use during the first few years they’re available. If a medicine proves safe in large numbers of patients over several years, the regulatory agency may consider changing it from POM to P.
EU regulations encourage switching medicines from POM to P as long as there’s no danger to health if the medicine is used without a prescriber’s supervision and the medicine is unlikely to be used incorrectly.
If a P medicine has shown no problems after several years, it may be considered for a switch to GSL status, so that it can be sold directly from retail outlets.
The UK is currently leading the world in making medicines available over the counter (OTC). A wide range of medicines have switched from both POM to P and P to GSL over the past 20 years, including ibuprofen for pain relief, nicotine replacement therapy (NRT) for stopping smoking, emergency hormone contraception, and clotrimazole and fluconazole for vaginal thrush.
More recently, simvastatin, a medicine that reduces cholesterol as a means of reducing the risk of heart attack, and chloramphenicol eye drops for eye infections have also switched from POM to P.
The government has said that it’s committed to increasing the availability of OTC medicines for common complaints, including treatments for long-term conditions, such as high blood pressure, where it’s safe to do so.
Are medicines I can buy from a pharmacy just as effective and safe?

If a medicine switches from POM to P, or from P to GSL, the active drug remains exactly the same. This means that it’s just as effective as when it had to be prescribed by a qualified prescriber. It also means that there’s the same risk of side effects if you take too high a dose or if you don’t follow the instructions on the label, so it’s important to follow the instructions carefully. Your pharmacist will be able to advise you about any side effects