Archive for the ‘medication’ 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 5

January 17, 2012

9e People who use services detained under the Mental Health act 1983

●●  Receive medicines that are duly authorised and administered in line with the Mental Health act 1983 Code of Practice.


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

  • follows clear procedures in practice, which are monitored and reviewed and that explain how staff may be permitted to administer homely remedies.

Homely remedies are those medicines that can be purchased by the client or a relative over the counter from a pharmacy, general store of health food shop. Guidance says that carers may support clients with over the counter medicines in the course of their care. And after all, who are we to take away their choice o use these things?

If our care teams are to support our clients with this group of medicines there are certain criteria that need to be met and it is these criteria that you need to be clear on and give clear guidance in your procedures and training for.

If the client purchases the medication themselves (or a relative buys it on their behalf) they should let the care agency know, especially if they require assistance with it from a member of the care team. The care organisation then has a responsibility to check with a pharmacist that that medication is appropriate and safe for that client to take with any other medicines they take and the medical conditions that they have. They should make a record of this conversation and the outcome.  The medication belongs to the client and would be kept by the client (in their room in a lockable cupboard or drawer in a care home) and a record of the administration made on the medication administration record.

I n a care home (residential or nursing) you may choose to buy over the counter remedies to keep in stock in case a resident needs something for a minor aliment such as pain relief, indigestion, sore throat, a cough mixture, a laxative etc. In this instance you must keep these medicines locked away centrally in a separate place to the prescribed medication. You must have authorised in advance by the GP which over the counter medicine can be taken by which resident.

You must also have for each over the counter medicine that you choose to keep, a record of the recommended dose i.e. How much can be taken or used at one time?
How long should you wait before it is taken or used again? Is there a set number of doses allowed with in a set time e.g. no more than 8 in 24 hours? How long do you continue to use that medication if the resident is not getting any better before you refer to the GP? What each medicine is to be administered for and in what circumstance may it be administered?

Once again, these medicines if given or used must be recorded on the medicines administration record at the time of administration.

Next time we’re exploring Outcomes 9g and 9h so watch this space!

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 🙂

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

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