Archive for the ‘Uncategorized’ 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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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 2

December 28, 2011

Manage risk through effective procedures about medicines handling

9B Where people who use services receive care, treatment and support that
involves medicines, the provider has:

●● Clear procedures followed in practice, monitored and reviewed for
medicines handling that include obtaining, safe storage, prescribing,
dispensing, preparation, administration, monitoring and disposal. Wherever
they are required these procedures include:
— how medicines which are prescribed ‘as required’ (PRN) are handled
and used
— ensuring that staff handling medicines have the competency and skills
needed
— the arrangements for giving medicines covertly where this is needed in
accordance with the Mental Capacity Act 2005
— the arrangements for requesting a second opinion in relation to
medicines for people detained under the Mental Health Act 1983
— the arrangements for recording when it is not possible for a person to be
able to self-administer their medicines
— the recording of when medicines are given to the person
— the arrangements for reporting adverse events, adverse drug reactions,
incidents, errors and near misses. These should encourage local and,
where applicable, national reporting, learning and promoting an open
and fair culture of safety
— the arrangements to implement and act upon the recommendations of
all relevant medicine-related patient safety communications issued via
alert systems within the required timescales
— an up-to-date list of medicines taken by the person being produced
when they begin to use the service
— the management of discharge medicine to allow for continuity of care
until a new arrangement is made
— the arrangements for medicines management following death.
●● Clear procedures, that are followed in practice, monitored and reviewed, for
controlled drugs, unless they are taken by the person themselves in their
own home, including:
— investigations about adverse events, incidents, errors and near misses
— sharing concerns about mishandling.
●● Systems in place to reflect on the findings of their service reviews and as it
does so, learns from adverse events, incidents, errors and near misses
relating to medicines that have occurred within the service and elsewhere,
so that the risk of them being repeated is reduced to a minimum.
●● Systems in place to ensure they comply with the requirements of the
Medicines Act 1968 and the Misuse of Drugs Act 1971, and their
associated regulations, the Safer Management of Controlled Drugs
Regulations 2006, relevant health technical memoranda and professional
guidance from the Royal Pharmaceutical Society of Great Britain and other
relevant professional bodies and agencies.

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 🙂

Side Effects and Adverse Reactions

April 10, 2008

What are they and what should you do?

Side Effect – An unpleasant effect of a drug that happens in addition to the main effect of that drug.

Adverse Reaction – A negative or harmful effect caused by a medicine

Interaction – When one medicine affects the way that another medicine works in the body, potentially to a harmful effect.

Contra-indication: – A sign that someone should not continue with a particular medicine or treatment because it is or might be harmful.

Side effects and adverse reactions can occur with any medicines. The more medicines a person takes, the more likely it is that an interaction between medicines will occur, making the person unwell. In the section above, some of the side effects of the different types of drugs were listed and whilst it is not expected that you know all the side effects of all the different types of medicines by heart, it is very useful to know the kinds of things to look out for when a service user is given a different medication than he or she normally has.

Common side effects

The most common side effects seen with medicines are:-

  • Nausea
  • Vomiting
  • Diarrheoa
  • Drowsiness
  • Rashes
  • Indigestion/heartburn
  • Headache
  • Constipation
  • Dizziness

If a service user has had a change in medication and you notice that they are unwell or not their usual selves in some way this could be an indication that they are experiencing a side-effect, adverse reaction or interaction with their medication.

What do you do?

  1. Make a note of the symptoms on the medicines administration chart or other service user records.
  2. Report the concern to your line manager
  3. Seek advice from the doctor or pharmacist
  4. If out of hours – call NHS direct
  5. Record the advice given on the medicines administration chart or other service user records.
  6. If the service user becomes seriously unwell you may need to contact the emergency services.

Do not:-

  1. Stop the medication
  2. Give the service user any advice without first seeking advice from a health professional
  3. Do not recommend other medicines to treat the symptoms without first seeking advice from a doctor or pharmacist.

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

Consent and Medicines Management

March 6, 2008


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

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

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

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

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

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

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

 

For further information Contact

Tracey Dowe

email training@momentumpeople.co.uk

Tel 01793 700929

http://www.momentumpeople.co.uk

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