Archive for the ‘MDS’ Category

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!

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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.

Top 5 Myths about Compliance Aids in Social Care Dispelled

March 6, 2008

j0390523.jpg  Compliance aids are used extensively in social care and I would like to take this opportunity to clear up a few myths about them if I may.

Myth #1

In order to support a service user with his or her medication it must be in a monitored dosage system (MDS)

This is incorrect. There is absolutely no legal or ethical reason why medication needs to be in a monitored dosage system. It can just as easily and safely be supported from bottles, boxes and original packs as long as the correct checks are made, the dose instructions followed and good records kept. Incidentally these things have to happen for MDS too.

Myth #2

All tablets and capsules can be put into a MDS

This is incorrect. Not all tablets and capsules will remain stable once out of their original packaging and therefore must be dispensed in their original packs.

Myth #3

You can legally support a service user who has their medication put into the MDS by a friend or relative

This is incorrect. All monitored dosage systems must be filled by a pharmacist (or dispensing GP in rural areas). Supporting medication in trays filled by friends or relatives is not legal. If this is happening in your service you should take steps to make changes. Inform relatives or friends that from a certain date (e.g. a month’s time) that you will no longer be able to support the service user if they continue to fill the trays themselves. They should go to the pharmacy and request an assessment under the Disability Discrimination Act in order to have the medication dispensed by the pharmacy into a suitable MDS. If the service user meets the criteria of the Disability Discrimination Act they will be entitled to this service free of charge from the pharmacy.

Myth #4

All MDS systems are appropriate for use in social care.

This is incorrect. Any MDS system used in both care homes and domiciliary care must be dispensed by the pharmacy into a system that is able to be properly labelled to identify it’s contents on the actual pack containing the medication. The system used should also be tamper evident and secure.

Any system that does not meet this requirement should not be dispensed into by the pharmacy for use in social care. This includes the little “finger” type systems that have a different “finger” per day that can be taken separately from the pack. These systems have historically been purchased by the service user and filled by the pharmacy which is fine if they are assessed and unsupported, for you though as care staff supporting service users they are not suitable. If you have clients using these systems please ask the pharmacy to provide a system that meets labelling and security requirements.

Myth #5

The pharmacy dispensed the medication into the tray and therefore it’s nothing to do with me, not my responsibility to make any checks.

This is not correct. You have a legal obligation to check that the right patient receives the right medicine by the right route in the right dose at the right times. So, you then need to check the name on the pack is the right service user. You need to check that the contents of the pack match both what was ordered on the prescription and what is on the medication administration record. You need to check that the strength of the medication is what was expected and that the instructions for use are the same. Do the time slots in the pack match the administration times and do you know exactly how this medication is to taken, used or applied?

I do hope that this has cleared up many common misperceptions about monitored dosage systems and that as a result you will check your policies and procedures and update where necessary.

If you have any further questions about compliance aids or would like support in writing or reviewing polices please contact:-

Tracey Dowe

Email training@momentumpeople.co.uk

Tel 01793 700929

http://www.momentumpeople.co.uk

Prompting Vs Administration of medicines…..

December 17, 2007

j0178847.jpgA topic close to many of our hearts if we are in the business of caring for people who take or use any form of medication. It’s a mine field isn’t it? If you or your care staff were administering medicines to your service users – you would want to ensure that they were fully trained and competent to do so wouldn’t you? Me too.

Supporting people in taking their medication is all a bit scary. What if you get it wrong? The results could be disastrous and therefore many agencies prefer to think they are acting on the safe side by not getting involved in medicines administration at all.

As a result care organisations are still not training their carers in this vitally important area of care. Why? Because they are under the misperception that because they only prompt the administration of medicines, and do not (in their eyes) administer it, they therefore do not need to go to the trouble or expense of training their team.

BUT – did you know that in the eyes of the law Administration means to both personally administer AND to prompt the administration of medicines?

Therefore, if you are prompting medication you are actually administering it, there is no difference in the eyes of the law. The same checks need to be in place, the same record keeping needs to be completed, the same level of knowledge is required to fully support the client – even if you only prompt from a monitored dosage system. The monitored dosage system must be prepared by the pharmacy or a dispensing doctor for you to legally prompt or administer from it and whilst they have a responsibility to ensure that it leaves the pharmacy with the correct medication inside, you still have the responsibility to ensure that the right person gets the right dose of the right medicines by the right route at the right time.

So – if you are supporting service users who use medication you must ensure that you give your care workers the best possible training, relevant to your sector of care, that meets CSCI and Skills for Care requirements in order to safe guard your clients, your care workers and your business.

For further information about administration vs prompting or training requirements contact Tracey Dowe at Momentum People Ltd on 01793 700929 or email training@momentumpeople.com

Secondary Dispensing – Still an Issue in Care

December 13, 2007


j0390523.jpg

This is an issue that I came across recently whilst delivering training in medicines management to a domiciliary care.  I was surprised to hear how much it still happens out there and feel that it’s an area that needs to be highlighted and discussed – put out in the open if you like.

What is secondary dispensing?

Let me give you an example.

You have service users who visit a day centre and will be there for there lunch time medication. The medication is dispensed by the pharmacy into a monitored dosage system which you feel is a bit big for the service user to take to the day care centre with him or her so you take out the lunch time doses and put them into an envelope with their name on it for him/her to take with them.

Or

You have a service user who goes home occasionally for the weekend. You don’t want to send the whole cassette with their medication in with them, perhaps you’re not sure it will be returned when they come back, so you put the weekend medication in to another container with their name on it and brief instructions as to when they should be taken.

What’s wrong with that you might say?

The issue is that you are not qualified to dispense medication. You are giving out medicines that are not labelled properly or legally and the medication is not identifiable in any way. It also does not give the service user proper dose instructions or warning instructions or safe storage instructions. By giving someone medication in this way you are taking responsibility for it, if some thing goes wrong you are liable because you acted outside of the law.

So that’s all very well you say – but what is the solution? How do you ensure that the service user gets the medication at the day centre or during home visits?

There are two possible solutions. The first is to send the service user with the medication in the original pack, be that the boxes and bottles dispensed by the pharmacy or the monitored dosage box (e.g. nomad tray, blister pack, dosette).
If your policies do not allow this to happen at present, then in order to operate with in the law perhaps it is time to review those policies.

The second option is to speak with the GP practice and the pharmacy to arrange to have the doses needed for outside your care dispensed in to separate containers that the service user can take with them. The medication must be dispensed by either a pharmacy or a dispensing doctor though, not by your staff.

But we’ve been doing this for years you cry! Yes…I know but it doesn’t make it right.

But our inspectors have never said anything about it you tell me……yes…..but perhaps as knowledgeable as they are they are in legislation and guidelines they are not experts in medicines and do not know that what you’re doing is not legal. When something goes wrong ignorance will not be a defence so better to put things right as soon as possible rather than hoe it will be ok and continue to break the law.

For further information or any questions about this or any other medication issues please contact tracey.dowe@momentumpeople.co.uk