Archive for the ‘prompting’ 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.

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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 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.

 

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


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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

                                                          

Medicication Administration Records

December 5, 2007

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Medication administration records have been widely used in residential care for many years but not so regularly in domiciliary care until quite recently. It’s great to see that they are being used much more widely now in home care and I look forward to the day where they are used in every agency I visit or train.

 

Why? Because they are essential to good medicines management and to provide you with evidence of medicines support or administration. They are your back up should anything be challenged. They are your way of ensuring that you meet the responsibility that you have under the law of ensuring that the 5 checks are made:-

 

Right patient

Right medicine

Right dose

Right route

Right time

 

CSCI have published a guidance document that addresses medicines administration record sheets – what information should be recorded and how they should be used. However, in practice it would appear that very few organisations are aware of this guidance and/or how to interpret it and as a result I see a wide variety of different interpretations. My concern is that the vast majority of record sheets either do not contain the required information and/or they are not being completed appropriately by the agency staff. This may be that the agency staff have not received proper training on how to use the forms, it might be that forms need to be reviewed or it might be that the agency policy is out of date or in need of review by an expert. When any of these scenarios apply – it leaves the agency wide open to litigation should an error occur that is not documented properly.

 

So let’s clear up some myths shall we!

 

It is the responsibility of the agency to provide medication administration records for their care workers to use.

The form should contain:-

The name and address of the service user

Date started

Medication details including name, strength and dose of medication

Time given/prompted/observed

Signature of care worker

Code for Administration or prompting or observing

 

It’s worth pointing out here that the medication details must be given for each individual medicine. It is not sufficient to simply put “Contents of Nomad” or “Dosette box” .  Whilst it is the responsibility of the pharmacy to ensure that the correct medication is dispensed – you are responsible for making your own checks – you cannot abdicate this responsibility and therefore you need to know that what is in the compliance aid is what is being given to the service user. Now you may not know which tablet or capsule is which – however you should know that the names on the box match the names on the chart (which have been checked against the prescription details) and that there are the correct number of tablets or capsules there to be given.

 

 It might also be useful to have space for the name of the GP, any allergies, and comments.

 

For further advice and information about medicine Administration records or if you have any questions please contact tracey.dowe@momentumpeople.co.uk