Embed Size (px)
Citation preview
www.sps.nhs.uk
MEDICINES USE AND SAFETY WEBINAR
• Welcome to the MUS Webinar on Medicines Optimisation (MO) for
Adults in Social Care settings with Lelly Oboh Consultant Pharmacist
Care of Older People
• The webinar itself will start at 1pm – shortly before 1pm Jane Hough will be
doing sound checks – bear with her if you hear this more than once!
• To join the audio call 0203 478 5289 access code 954 792 784
• The webinar will be recorded and both recording and slide set will be
available on the SPS website – under Networks (you need to be logged onto
the SPS site to access the recording)
• If you want to make a comment or ask a question – please use the “chat”
function (you need to choose to direct your question to “All Participants” from
the drop down box)
• Lelly will answer questions at the end of the presentation
1
www.sps.nhs.uk
Upcoming MUS Events
Webinars:
14th March – Montgomery compliant conversations – Nina Barnett and
Claudia Carr
11th April – Topic TBC
9th May - De-prescribing in acute care – Emily Ward
7th June – CHS Learning Event in London – programme being
developed
12th July - MUSN Learning Event – programme being developed
Medicines Use and Safety Update January 2018 - link
Contact [email protected] to join
networks and receive mailings
15/02/2018 2
www.sps.nhs.uk www.sps.nhs.uk
The first stop
for professional
medicines advice
Medicines Optimisation (MO) for
Adults in Social Care settings
Lelly Oboh Consultant Pharmacist, Care of older people
14th February 2018
3
www.sps.nhs.uk 4
Overall aim
• To equip participants with basic knowledge and
information necessary to lead medicines
optimisation* for adults in domiciliary care
• To clarify statutory requirements and share
best practice guidance in this area
• To highlight local processes and cultures, that
facilitate and impede medicines optimisation
*Patients get the best experience and outcomes from taking
medicines and do not suffer unnecessarily from adverse
drug events.
www.sps.nhs.uk
The Health and Social Care Act 2008
(Regulated Activities) Regulations 2014
Fundamental Standards
5
www.sps.nhs.uk
The Health and Social Care Act 2008
(Regulated Activities) Regulations 2014
(Reg.12) Safe Care and Treatment
• Aim is to prevent people from receiving unsafe care and
treatment and prevent avoidable harm or risk of harm.
• Care and treatment must be provided in a safe way for
service users
• Providers should consult nationally recognised guidance
and implement as appropriate.
6
www.sps.nhs.uk
Case example of CQC judgement : The provider
was not meeting this standard.
7
People were not protected against the risks associated with
medicines because the provider did not have appropriate
arrangements in place to manage medicines.
www.sps.nhs.uk
(Reg.12) Safe Care and Treatment
• To comply, the registered person, must ASSESS the risks
to client's health and safety (a)
• When people enter, move or leave the service
• Balance clients needs/safety with their rights and
preferences
• Respond in a timely way to clients changing needs
• Do all they can to mitigate the risks (b)
• Ensure staff have the qualifications, competence,
skills and experience to keep people safe and must
only work within their scope (c)
8
www.sps.nhs.uk
(Reg 12) Safe Care and Treatment
• If ordering medicines, order sufficient quantities to
ensure safety of service users and to meet their needs (f)
• Staff responsible for the management and administration
of medication must (g)
Be suitably trained and competent
Be supervised if not yet competent
Must follow policies and procedures
• Policies and procedures should be in line with current
legislation and guidance (g)
9
www.sps.nhs.uk
(Reg 9) Personalised care
• Care and treatment of service users must be
appropriate, meet their needs and reflect their
preferences
• Providers must do everything reasonably practicable to
deliver person-centred care
Carry out an assessment of needs and preferences
Collaborate with the person and engage/involve them in
decisions
Plan care Jointly
Give adequate information
Liaise with others
Make reasonable adjustments
10
www.sps.nhs.uk
(Reg 13) Safeguarding service users
from abuse and improper treatment
• Home care providers must have robust processes for
medicines-related safeguarding incidents
• Commissioners and providers to review medicines
incidents over time to identify and address any trends
• Share learning internally, externally and with patients
and their families
11
www.sps.nhs.uk
(Reg 17) Good governance
Home care providers are required
•To securely maintain accurate and up-to-date records
about medicines support given
•To record the medicines support given to a person on
each occasion
12
www.sps.nhs.uk
The Controlled Waste (England and
Wales) Regulations 2012
• Home care providers are required to have
robust processes for disposal of unwanted,
damaged, out-of-date or part-used medicines, if
they are responsible for disposal
• Medicines can be returned to the community
pharmacist
13
www.sps.nhs.uk
Medicines Act 1968, and
Human Medicines
Regulations 2012
14
• In domiciliary care the label on the dispensed medicine is the ‘direction’
• Administer in this context means giving medicines orally, externally, injections, or into the body any other way
• In a work situation- the staff must be trained, competent, have patient’s consent and must be part of their job role
www.sps.nhs.uk 15
Handling Medicines
• Medicines prescribed for a person are that
person’s property and may not be used for any
other person
• Refusals No one can be forced to take
medication except under certain sections of the
the Mental Health Act or Mental Capacity Act
But….staff have a duty of care to encourage
people to take their medication
www.sps.nhs.uk
NICE guideline [NG67] Managing medicines for adults
receiving social care in the community. March 2017
For Social and health care practitioners, Commissioners and
providers of services, clients, their families and carers
Medicines support any support that enables a person to
manage their medicines.
Aim to ensure that people who receive social care are
supported to take and look after their medicines effectively and
safely at home.
Gives advice on
• assessing if people need help with managing their medicines
• who should provide medicines support and
• how health and social care staff should work together
16
www.sps.nhs.uk
Overview of
NICE NG67
17
www.sps.nhs.uk
NG67 Recommendations 1. Governance for managing medicines safely and effectively
2. Assessing and reviewing a person's medicines support needs
3. Joint working between health and social care
4. Sharing information about a person's medicines
5. Ensuring that records are accurate and up to date
6. Managing concerns about medicines
7. Supporting people to take their medicines
8. Giving medicines to people without their knowledge (covert
administration)
9. Ordering and supplying medicines
10. Transporting, storing and disposing of medicines
11. Training and competency
Lelly OBOH
www.sps.nhs.uk
Governance arrangements: Medicines policy based on
current legislation and best available evidence
Should include clear processes for
1.Assessing a person's medicines support needs
2.Supporting people to take their medicines, including 'when required', ‘Time
sensitive and over-the-counter medicines
3.Joint working with other health and social care providers
4.Sharing information about a person's medicines
5.Ensuring that records are accurate and up to date
6.Managing concerns about medicines, including medicines-related
safeguarding incidents
7.Giving medicines to people without their knowledge (covert administration)
8.Ordering and supplying medicines
9.Transporting, storing and disposing of medicines
10.Medicines-related staff training and assessment of competency.
19
www.sps.nhs.uk
Key Steps to ensure MO….
RIGHT DRUG PRESCRIBED
Health care ONLY
RIGHT DRUG DISPENSED
Health care ONLY
RIGHT DRUG TAKEN
Anyone
(with few exclusions)
20
Collect Rx
Collect medicines
• Assess needs
• Check medicines
• Support to take
medicines: 6Rs
• Storage & disposal
Order Rx
www.sps.nhs.uk
Processes needed for
medicines optimisation
21
IDENTIFY & ASSESS medicines support
needs incl medicines reconciliation
Individual CARE PLANNING
PROVIDE SUPPORT & IMPLEMENT CARE PLAN
MONITOR
REVIEW
Underpinned by…
•Governance processes:
Policies, 6 Rights, training,
incident reporting, quality
alerts, contract monitoring
•Good communication and
transfer of information:
between patients (their
families), practitioners, within
and across teams and
organisations
www.sps.nhs.uk
Collect information
Minimum information needed at entry/referral
• Discharge summary with medicines list or GP medicines
summary
• Direction must be clear for each medicine or can’t give
• PRN meds, Variable doses and Time sensitive
medicines must be clear and in a way that care workers
do not have to make their own interpretation e.g. ‘as
directed’, ‘Levothyroxine 75mcg daily’, ‘Warfarin 3.5mg’
22
www.sps.nhs.uk
1. Identify and assess
NICE NG 67
• Assess a person's medicines support needs as part of the overall
assessment of their care needs and treatment
• Engage with patient and consider their preferences
• What they are able to do and what support is needed
• How they currently manage their medicines e.g. ordering, storing
• Whether they have any problems taking their medicines, particularly if
taking multiple medicines
• Document Allergies
• Who to contact about their medicines
• The time and resources likely to be needed
• If capacity issues follow local process for capacity assessments
and best interest meeting
23
www.sps.nhs.uk
Medicines Reconciliation
• The process of identifying an accurate list of a
person's current medicines and comparing them with
the current list in use, recognising any discrepancies
and documenting any changes, thereby resulting in a
complete list of medicines, accurately communicated.
COLLECT
COMPARE
COMMUNICATE
• NICE NG5 1.3 Should be undertaken by healthcare
professional!
24
www.sps.nhs.uk
Exercise on needs assessment
Mrs Smith, 89 years old, lives alone. Recently diagnosed
with dementia and needs help to take her medicines.
Which of the following is the best support for
her?
A.Request MCA
B.Request liquid formulation
C.Give her a reminder chart
D.Care workers to give medicines
E.Unsure
25
www.sps.nhs.uk 26
Needing medicines support
Relates to patient’s beliefs, fears, values own rationale
about risks versus benefits
Aim to address concerns & change
behaviour
Relates to the impact of ageing & frailty on the practical aspects of taking medicines
Aim to provide practical solutions to address specific
need
Influenced by multiple factors in older people
Non-intentional or “cant” Intentional or
“wont”
www.sps.nhs.uk
Example of best practice
Older people will have medicines needs in 3 key areas*
1. Ensuring timely access to a supply of their medicines
(e.g. ordering, collecting prescriptions/medicines)
2. Ability to adhere to medicines prescribed (intentional or
non-intentional)
3. Therapeutic outcomes from their medicines (negative
or positive)
A robust medicines support needs
assessment should cover these areas! *Rosenbloom et al 2003
27
www.sps.nhs.uk 28
Example of Ten Prompts to screen or assess for
medicines support needs (GSTT Community Services)
1. Do you need help getting a regular supply of your medicines? Y/N
2. Do you remember to take all your medicines? Y/N
3. Do you always take your medicines in the way your doctor asks you to? Y/N
4. Can you use /swallow all your medicines and get them out of their containers?
Y/ N
5. Do you feel that your medicines are working well? Y/N
6. Are you experiencing unpleasant effects from your medicines? Y/N
7. Have you had your medicines reviewed in the last 6 or 12 months Y/N
8. Do you need more information or have concerns about your medicines? Y/N
9. Do they have a carer or relative to help them with taking medicines? Y/N
10. Do they have any compliance aids (e.g. Dosette, reminder charts etc) to help
them with taking medicines independently? Y/N
www.sps.nhs.uk 29
Assessing medicines needs: Summary
• When? At the point of entry into a service to establish whether patient can independently manage their medicines and identify support needs
• By? the first health or social care practitioner to come into contact with person to assess their overall health or social care needs
• Who? Trained & competent assessor*
• How? Locally agreed Tool
*e.g Social workers, field care supervisors
www.sps.nhs.uk
2. Care Plan
• Record discussions and decisions about the medicines
support needs, including
What support is needed for each medicine
How the medicines support will be given
Who will be responsible for providing medicines
support, esp. if more than one care provider is involved
When medicines support will be reviewed e.g. after 6
weeks
• Notify GP of support provided and dispensing pharmacy,
and appropriate others
30
www.sps.nhs.uk
3. Implement care plan
Care workers should only give a medicine to a person if its
agreed in Care Plan..
• There is authorisation and clear instructions to give the
medicine e.g. on the dispensing label of a prescribed
medicine AND
• The 6R's of administration have been met AND
• They have been trained and assessed as competent to
give the medicine
31
www.sps.nhs.uk 32
The 6 Rights of medicines administration
• Right PERSON
• Right DRUG
• Right DOSE
• Right ROUTE
• Right TIME
• Right to REFUSAL
Ensures that administered medicines produce the maximum benefits and
minimum risks to the client
www.sps.nhs.uk 33
Multi compartment compliance aids
(MCAs), “dosette boxes” or “blister packs”
• Medicines do not need to be dispensed in an MCA for a
care worker to support or administer medicines
• Medicines should normally be dispensed in standard
containers except there is a justified reason for doing
different following a robust assessment
• Risks must be balanced against benefits
• Labelled containers allow identification of what the patient
has taken, or not.
• Medicines are most stable in a standard container
• Do not give from family-filled MCA
www.sps.nhs.uk
Challenges with
medicines
dispensed in MCA • Instructions?
• Identification of drug
• What about medicines
outside blister?
34
www.sps.nhs.uk 35
Care workers cannot administer
warfarin, CDs, eye drops, inhalers
• Care workers providing support (level 2) should
be trained to
Give All oral medication, including CDs
Give specific formulations like, patches, creams,
inhalers, eye drops and liquid (NG67)
Use the correct equipment like oral syringes for
small doses of liquid medicines
www.sps.nhs.uk
Specific skills for medicines
administration (Level 3)
• When specific skills are needed (e.g. via PEG
tube, sub cut Insulin) health professionals
should delegate the task to care worker if
local agreement between health and social care
responsibilities of each person are agreed and
recorded
tcare worker is trained and assessed as competent
36
www.sps.nhs.uk 37
Levels of Medicines Support given by
care workers (Not in NICE NG67!)
• Level 1: General Support or Assistance is given when
the patient takes responsibility for their own medication
• Level 2: Administration of medication is the support
given when the patient is unable to take responsibility for
their medicines and needs help usually due to impaired
cognition or other disability
• Level 3: Administration of medicines by specialised
techniques is the support given where a specialised
technique is needed to administer the medicine. The task
is “delegated” by a nurse.
www.sps.nhs.uk
Specific medicine administration situations
Giving time sensitive and ‘when required’ medicines
•Providers to prioritise visits for people taking time
sensitive medicines and record additional information in
care plan
•Prescribers and supplying pharmacists to provide clear
written directions
•Variable doses like warfarin, prednisolone- use
supplementary dose authorisation like INR booklet
•Verbal changes to medicines prescribers should give
written confirmation as soon as possible by an agreed
method e.g. secure fax or email
38
www.sps.nhs.uk
NICE NG67: Records
• Must record the support given for each individual
medicine on every occasion incl. details of support
• No documentation needed when a person is managing
their medicines independently.
• Use a medicines administration record (MAR) chart for
recording medicines support. Ideally printed and
provided by the supplying pharmacist or social care
provider (if they have resources to produce them)
39
www.sps.nhs.uk
Example of poor records of
medicines given from MCA
40
www.sps.nhs.uk
Ordering
• Document name of person responsible for ordering in
care plan
• Sufficient quantities should be ordered
• Don’t delegate to community pharmacist except agreed
with patient/carer
Storage • Special storage instructions on dispensing label
transferred to care plans
• Agree storage plan for covert administration or if risk of
patient overdose
41
www.sps.nhs.uk
NG67 Training
42
www.sps.nhs.uk
Skills for Care: Recommendations for CQC
providers (Medicines pages 33-35)
Medication administration training
• Depending on their role, care workers may be required
to administer medication, monitor the effects or have
knowledge and understanding of common medication
• Some providers only use more senior care workers to
administer medication
For staff undertaking any medicines related task
• Training must meet Care Certificate Standard 13
minimum requirements Achieve the learning
outcomes as part of staff induction
43
www.sps.nhs.uk
Training: What and Who?
• No definitive list of what - depends on organisation
needs, risk assessment done by employer and care
worker’s role.
• Training may be complemented with e-learning and
videos, but not the main delivery method.
• Care Certificate Workbook (Free) provides a basic
introduction
• Additional training should be arranged based on the
service user’s needs and the care works role
• Trainer can be external, but must be suitably trained
• Staff competencies must then be signed off by the
provider, not an external agency
44
www.sps.nhs.uk
Care Certificate Basic Induction
13.5 Understand medication and healthcare tasks
a. Describe the agreed ways of working in relation to
medication
b. Describe the agreed ways of working in relation to
healthcare tasks
c. List the tasks relating to medication and health care
procedures that they are not allowed to carry out until
they are competent
45
www.sps.nhs.uk
Competency sign off
• Competency sign off needed after observation and
supervision by an occupationally- competent person
before staff do the the task for the first time.
• Person must be working for the provider, not an external
trainer.
• Managers, supervisors and assessors are responsible for
judging the competence of their care workers’ ability to
safely administer medication for people who use the
service.
46
www.sps.nhs.uk
Common challenges and barriers
• Supporting with OTC medicines
• When care workers are the first staff to visit patients
• Supporting with medicines if no other need for a care
package
• Health focused medicines reconciliation
• Communication and information systems/management
especially at handover/ToC
• Variance in how medicines support is accessed in health
and social care
• Limited support interventions (mostly MCA available)
47
www.sps.nhs.uk 48
Thank You
Any Questions?
www.sps.nhs.uk
Poll Question Number 1
Overall I found the webinar content useful to me:
• Agree strongly
• Agree
• Disagree
• Disagree strongly
15/02/2018 49
www.sps.nhs.uk
Poll Question Number 2
I would recommend this learning event to others:
• Agree strongly
• Agree
• Disagree
• Disagree strongly
15/02/2018 50
www.sps.nhs.uk
Upcoming MUS Events
Webinars:
14th March – Montgomery compliant conversations – Nina Barnett and
Claudia Carr
11th April – Topic TBC
9th May - De-prescribing in acute care – Emily Ward
7th June – CHS Learning Event in London – programme being
developed
12th July - MUSN Learning Event – programme being developed
Medicines Use and Safety Update January 2018 - link
Contact [email protected] to join
networks and receive mailings
15/02/2018 51
