Archive for the ‘management’ 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)

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

 

Completion of Medication Administration Records (MAR’s)

August 6, 2009
Completing medication records

Completing medication records

One of the biggest challenges care organisations have is in ensuring that they have good Medication Administration Records and that their nurses and care staff actually complete them correctly. I recently had the pleasure of the company of a gentleman from the Care Quality Commission who told me that  medication issues are still the greatest area of concern during inspection visits and particularly record keeping. So what are the issues and how can we get it right?

What information should be on a MAR?

The guidance states that a MAR should contain the name and address of the service user, a start date so that I know which record is current or for reference should I need to go an look back at a certain date, the medication details i.e. the name, strength, form, clear dosage instructions and times of day – to state “contents of box” or nomad or dossette etc.is not acceptable, if you have codes for administration then the key for those codes needs to be clearly stated on the MAR, some where for the nurse or carer to either sign or initial, if initials are used there needs to be a master record kept in the office of whose initials tally with which carer or nurse. Any other information on the MAR is not necessary but may make the MAR more robust when in use and so may have quantities received and returned for example, or GP details etc.

Who is responsible for providing the MAR and entering the information?

Legally it is the responsibility of the care organisation to provide the MAR and to put the information on it. Many care homes will have their MAR’s provided by their pharmacy but it actually is a complimentary service to them, pharmacy have no legal or contractual obligation to provide MAR’s at all. There is no official template or recommended format for a MAR and so there are many different types and as long as they meet the requirements above and are filled in correctly it’s what works best for your organisation. The medication information for each client should be entered by the company and any changes to medication should also be made by the care company, written in legibly in ink, if the medication has changed, put a line through the old medication and re-write the new on a new line of the MAR, preferably checked by another person, signed, dated and a note to say on who’s authority was the change made.

Codes for Administration

There are no official codes for administration or guidance given as to what they should be so it is up to the care organisation to decide what information it requires the nurse or carer to record. Good practice would be to have codes for administered, reminded, observed, not taken, refused, dose measured, on leave, in hospital,etc.

Record keeping at the time of administration

Training in how to complete MAR’s is essential if you are to ensure that your teams do it correctly at all times. You should have in place a system to identify where mistakes are being made or records are not being completed properly so that that carer or nurse can be spoken to, given additional guidance and training and standards enforced.

At the time of administration team members must sign or initial the MAR in the appropriate space and an indication of how they supported, this may be by using a code as discussed above. If the person did not require medication the carer or nurse should still sign and add a code to explain that the client didn’t require it. Please do not leave records blank as gaps create questions and uncertainty about what happened at that time. If it was a controlled drug administered by two people both should sign. If it was a variable dose for example “give 10ml or 20ml”  exactly what dose was given should be recorded. If a dose is refused by the service user record that it was refused and why. Any over the counter remedies or homely remedies that you administer should also be detailed on the MAR.

For further information, training on record keeping or examples of good MAR’s you might model contact training@momentumpeople.co.uk or call 01793 700929

Get the Most from Your Pharmacy Services

April 10, 2008

How much do you know about the services that pharmacies offer which make could make life easier for both you and your service users?

Most pharmacies offer some form of prescription collection and/or delivery service. Many pharmacies will also order the prescription on the patient’s behalf too, they keep the repeat and you let them know what you need – cutting out yet another step of the process for the service user. Ask your pharmacy about repeat medication services.

As well as prescription services, the pharmacy, under it’s new Pharmacy Contract, is able to offer a range of other services which you, or your service users might find particularly useful.

Compliance Aids and the DDA

One of these services is the provision of compliance aids under the Disability Discrimination Act (DDA). Under new contract, the pharmacy is required to carry out an assessment with any service user who requests a compliance aid. This assessment helps to ascertain whether the service user is disabled and therefore qualifies for free support in the form of compliance aids.

Compliance aids, as we discussed in unit 1 of this course include the following:-

· Dosette or similar boxes

· Non-child proof tops

· Large print labels

· Braille labels

· Talking labels

· Provision of medication administration record charts

· Colour coding of labels to time of day

The purpose is to enable the service user the necessary support to get the most from their medicines and remain as independent as possible.

Medicines Use Reviews

A medicines use review is an appointment with a pharmacist to focus on how the an individual is getting on with their medicines. It usually takes place in the local pharmacy, but with permission from the Primary Care Trust, may take place in a service user’s home. It is an NHS service – and is free to the service user.

The meeting is to:

· Help the service user to find out more about the medicines

they are taking.

· Pick up any problems they are having with their medicines.

· Improve the effectiveness of their medicines.

· There may be easier ways to take them, or the service user may find that they need fewer medicines than before.

· Get better value for the NHS – making sure that the medicines are right for the individual to prevent unnecessary waste.

The pharmacist will have questions and may suggest changes to the

medicines. The service user may have concerns or questions that they want to ask about.

A medicine user review can be requested by ay the service user or any health professional or carer as long as the service user gives their consent.

Repeat Dispensing

Under the new contract you don’t have to go back to the doctor every time you need to renew a prescription. Instead, your doctor can give a prescription lasting up to a year and the pharmacist can dispense the medicines as and when they are needed. This service is called “Repeat Dispensing” and is available to patients who are stable on long term medication. More and more pharmacies and surgeries are offering this service and it may well be worth asking about.

Public Health Advice

In order to help reduce health inequalities and improve health the pharmacist can give you and your service users clinical and lifestyle advice on how to become healthier. This includes advice and information on how to stop smoking, reducing high blood pressure, lose weight and improve your diet. This will help to proactively tackle national diseases such as obesity, coronary heart disease and cancer. Pharmacies will be taking part in local and national health promotion campaigns

Signposting

If you have a health problem and are not sure where you should go to get advice or treatment, your pharmacist can help put you in touch with the appropriate service.

Self Care

Your pharmacist is be able to advise on which over the counter medicines are best for self-limiting conditions as well as give help on other things you could do to help you or your service user feel better.