Archive for the ‘assessment’ Category

Essential Standards Outcome 9 pt 7

January 31, 2012

9i. People who use services receive care, treatment and support from staff who:

●● Ensure they make a record of any medication taken or reminded by the person using the service where this is part of the plan of care.
Carer helping elderly lady
Good record keeping, once more is absolutely key to meeting the essential standards for medicines and should be kept whether you are administering at level 2 or just reminding someone to take their medicines at levels 1 or 2. Do you record the prompting of medication? You should be.

●● Follow clear procedures, that are monitored and reviewed, that explain:
— their role with regards to helping people take their medicines
— what staff should do if the person using services is unable, or refuses, to
take their medicines.

So here you need to review your policies and procedure to ensure that they clearly detail; the role of the carer in administering (or reminding) medicines and what they can and cannot do within the 3 levels of support outlined in the guidance in the National Minimum Standards and CQC guidance.
Do your staff understand what to do, who to notify and what to record when a client refuses to take their medicines? Your policies need to clearly state what to do when a client refuses medication. What to record, who to inform and what consequences might be encountered.
Staff need to be aware that they can inform the client of consequences, they can encourage them to take the medication, they can try in 5 minutes times, perhaps ask a colleague to administer instead, but they cannot force a client to take the medication. A client has the right to refuse whether we think it’s a the right decision or not.

9j People who use services receive care, treatment and support from staff who:
●● Ensure that patient safety alerts, rapid response reports and patient safety
recommendations disseminated by the National Patient Safety Agency and
which require action are acted upon within required timescales.

So there you have it – the last of the part for Outcome 9 in the Essential Standards.
I trust that you have found the information useful and that it has been the catalyst to review policies and training. If Momentum People can support you with either or both please email us or give us a call to discuss.

Essential Standards Outcome 9 pt 6

January 24, 2012

9g Where people who use services receive support with their medicines, the provider has:
●● Additional clear procedures followed in practice, monitored and reviewed for medicines handling that include obtaining, administration, monitoring and disposal. Wherever they are required these procedures include:
— how clinical trials are carried out in line with relevant laws, current guidelines and ethics committee approval
— sharing concerns about medicines handling.

Here you will required to have written procedure for all aspects of medicines management that include how to order medicines, how to receive them into the service including the records that need to be kept too. Detailed procedures for your team to follow with regards to administering medication in line with the National Minimum Standards and the RPSGB Safe Handling of Medicines in Social Care documents which detail the levels of support and administration that can be provided by a carer.

You will need to have procedures and appropriate records that show that you monitor both the administration of medication by your staff and that you monitor self-administration by clients to ensure that it is still appropriate.

When disposing of medicines always return the m to the pharmacy for safe disposal and ensure that appropriate records are kept, unless you are a nursing home, then you must make your own arrangements for safe disposal via a licensed waste carrier service. In both cases, if a resident dies in your care you must retain the medication for at least 7 days in case it is requested by a coroner.

All policies and procedures should be reviewed regularly to ensure that you keep abreast of changes n legislation or local policy. Do yours show a date last reviewed and/or next review date on them?

●● Established arrangements for obtaining pharmaceutical information by a
person who understands the care, treatment or support that is provided
by the service.
Ideally this would be an expert in medicines such as your local pharmacist, PCT pharmacist or GP practice pharmacist. Alternatively this may be an appropriate health professional such as a GP or Specialist Nurse or other health care professional.

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

●● Ensures medicines required for resuscitation or other medical emergencies
are accessible in tamper evident packaging that allows them to be
administered as quickly as possible.

Next time we’re exploring Outcomes 9i and 9j – the final of the outcomes for medication.

Essential Standards Outcome 9 pt 4

January 10, 2012

Promotes Rights and Choices

9D People who use services benefit from a service that:

●● Ensures that wherever possible, information is available for people about the medicines they are taking, including the risks.
Here you will need to think about how you get that information from reliable sources and deliver the information to the client in a way that they can best understand. This includes information about prescribed medicines and over the counter medicines where appropriate. http://www.BNF.org is a great source of information but will probably be too technical for clients. Ask the pharmacist for Patient Information Leaflets where possible a good medicines book that has been written for the public that puts it more in layman’s terms – jargon free.

●● Ensures information is available for people about medicines advisable for
them to take for their health and wellbeing and also to prevent ill health.
Do you have information available to provide to clients to enable them to be proactive in becoming more healthy and staying healthy. This information may be for supplements, vitamins, minerals, homeopathic or herbal medicines for foods that promote health and well being.

●● Ensures there is access for staff to up-to-date legislation and guidance
related to medicines handling.
Training and continuing professional development and or competency assessment is key to this point. Training that meets the requirements for the CQC, Skills for Care and Essential Standards. Ensuring that staff are aware of and have access to not only your own medication policies but to the actual legislation and guidance documents as well. Do your policies and procedures actually reflect legislation and guidance or would now be a good time to review them to make sure that they do?

●● Ensures best interest meetings are held with people who know and
understand the person using the services when covert administration of
medicines is being considered, to decide whether this is in the person’s best
interest.
Medication may only be given covertly with certain consent. A team of multidisciplinary health professionals must come together to discuss the individual case and give consent in writing. I highly recommend that a pharmacist is part of this team to ensure that if medication is being given covertly because it is in the best interest of the client and they do not have capacity that that medication is put in to food that is appropriate and that that medication can be crushed if that is the proposal. I have heard some interesting and frightening stories recently of medication being authorised to be given covertly and instruction given by the doctor to put it in a hot drink, or hot food or even medication that needs to be swallowed whole being wrapped in toast! How would you not chew it??? So whilst a doctor is an expert in diagnosis and disease, the majority are not experts in medicines – please keep your clients safe by involving the pharmacist who is an expert in medicines.
I’m sure at some point we will cover covert administration and medicines in food as a separate article – please let me know if this would be useful to you.

Next week we will look at Outcome 9e and 9f – so more good stuff to come!

Essential Standards Outcome 9 pt 3

January 3, 2012

9 C People who use services benefit from a service that:

Takes into account relevant guidance set out in the Care Quality
Commission’s Schedule of Applicable Publications

As you know – I don’t normally put links intomy blogs but I thought for this part of the Outcomes it would be useful to put links in for the relevant documents and you can choose to click them to take a look at them or download them for later.

●● Relevant evidence-based guidance and alerts about medicines management and good practice published by appropriate expert and professional bodies, including:
National Patient Safety Agency
National Institute for Health and Clinical Excellence
Medicines and Healthcare products Regulatory Agency
Department of Health
Royal Pharmaceutical Society of Great Britain (RPSGB)
Social Care Institute for Excellence
— Medical and other clinical royal colleges, faculties and professional associations
●● The safe and secure handling of medicines: a team approach (RPSGB, 2005)
●●●● Safer management of controlled drugs: Guidance on strengthened governance arrangements (DH, 2007)
●● Safer management of controlled drugs: Guidance on standard operating procedures forcontrolled drugs (DH, 2007)
●● The handling of medicines in social care (RPSGB, 2007)
●● Research governance framework for health and social care: Second edition (DH, 2005)

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.

 

Consent and Medicines Management

March 6, 2008


Forms Before any support with medication can happen in care the service user must give their consent. In order to give informed consent they must first be given all of the information they require to make a decision about their level of care. It is important that information is shared freely with the service user, this will include providing patient information leaflets to your service users, and if necessary reading and explaining these to them if they are not able to do this themselves.

A service user can agree to treatment and care verbally, in writing or by implying (by co-operating) that they agree. Even though verbal consent or consent by implication would be enough evidence in most cases written consent is always preferable and probably expected in most care agency policies.

Service user consent should be obtained and recorded in the care plan during the care assessment. Both the service user and the assessor should sign and date the document. Written consent stands as a record that discussions have taken place and of the service users choice. however, the service user had the right to refuse consent and may do so at any time during his or her care. This may be detrimental to their care and you must provide them with the information they require to be fully informed I making their decision but if they still refuse to consent then you must respect that decision. You should make a record of the refusal and document what information was given and who else you involved such as your line manager or GP in the service users records.

What you should never do is hide the medication in food or beverages for the service user to take without knowing that it is there. This is covert administration of medicines and is considered to be abuse.

In an emergency situation were treatment is necessary to preserve life and the service user cannot make a decision (for example because they are unconscious), the law allows you to provide treatment without their consent, providing you are sure you are always acting in their best interest.

You should also know that if the service user is an adult, consent from relatives is not sufficient on its own to protect you in the event of a challenge, as nobody has the right to give consent on behalf of another adult unless the service user has passed over the power of attorney to another person. In this case the other person can give their consent for you to administer medication

As you can see gaining consent may not be as straightforward as it first appears. Nonetheless, it is a vital part of caring for people. The reason it is so important is that it is assumed that the service user is the best person to be in control of their care. So any procedure that may affect them can only be given once they have consented to the care and this includes medication.

 

For further information Contact

Tracey Dowe

email training@momentumpeople.co.uk

Tel 01793 700929

http://www.momentumpeople.co.uk