Transcript Medicines Management in the Care Home Setting

Medicines Management in the
Care Home Setting
Your Care Home
29th At a date to suit 2012
Rob Hebdon
Bsc (Hons) MGPhC
Introduction
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Rob Hebdon BSc (Hons), M.R.Pharm.S.
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Community Pharmacist
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Senior Nursing Home Support
Primary Care Trust (PCT)
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Practice based pharmacist
Introduction
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Medicines management in the care home
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Good practice and record keeping
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Comply with the requirements of the drug
audit trail
Guide to the Drug Audit Trail
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what is the drug audit trail?
areas of responsibility
taking receipt of the monthly repeat order
drug administration procedures
prescription re-ordering
general points and guidelines
What is the Drug Audit Trail?
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The Nursing Homes and Mental Nursing
Homes Act Regulations 1984 –12(1)(0)
require:
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the person or persons registered to make adequate
arrangements for the recording, safekeeping, handling,
administration and disposal of drugs.
What is the Drug Audit Trail?
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in other words……
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It is the responsibility of the Care Home / Person in
charge to have a system(s) in place and in use, which
allows the Home (and other auditing and/or inspectorate
bodies) to account for the movement of every single
medicinal dose within that home, from the moment of
receipt upto and including its administration, destruction
or return.
What is the Drug Audit Trail?
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in other words……
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Accountability through good practice and good
record keeping
Monitored Dosage System (MDS)
Areas of Responsibility
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Diagnosis and Prescribing
Prescription collection
Prescription checking
Prescription declaration
Prescription to Pharmacy
Safe Dispensing / Audit
Delivery and notification of owings
Checking in
Identification and Notification of errors / changes
Administration
Safe keeping
Disposal
Re-ordering and obtaining prescriptions
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Reference:
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G.P.
Care Home
Care Home
Care Home
Care Home
Pharmacist
Pharmacy
Care Home
Care Home
Care Home
Care Home
Care Home
Care Home
- NMC guidelines to good practice
- Health Authority Nursing Home inspectorate
Taking Receipt of Medication
Taking Receipt of Monthly Repeats
1.
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Check all medication details on new MAR
sheets against those MAR sheets in current
use. List all queries or discrepancies with
new MAR sheets and discuss with your
CHEMIST or GP as appropriate.
Taking Receipt of Monthly Repeats
2.
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Complete “received” box with the amount
received and the date. Confirming the
“quantity” as that received.
Taking Receipt of Monthly Repeats
Taking Receipt of Monthly Repeats
2.
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Complete “received” box with the amount
received and the date. Confirming the
“quantity” as that received.
Taking Receipt of Monthly Repeats
3.
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Nurse’s initials to be added to “by” box (or
equivalent).
Taking Receipt of Monthly Repeats
Taking Receipt of Monthly Repeats
4.
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List all queries or discrepancies with new
MAR sheets and discuss with your CHEMIST
or GP as appropriate.
Drug Administration Procedures
DRUG ADMINISTRATION
PROCEDURES
[Supplementary to home drug administration policy]
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The law requires that medicines are given
to…
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the right person
at the right time
in the correct form
at the correct dose
via the correct route
DRUG ADMINISTRATION
PROCEDURES
[Supplementary to home drug administration policy]
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Check the identity of the resident.
Check the MAR sheet to confirm that medication is actually
due.
[The numbers at the top of the columns on each white sheet
represent the number of days treatment remaining in the 28day repeat cycle, NOT THE CALENDER DATE. Drug
administration, which starts at the beginning of the cycle, is
recorded under the ‘28’ column, and this corresponds with the
‘28’ on the CHEMIST blister pack, also clearly marked
‘START’. The actual calendar start-date of the cycle is specified
at the top of the MAR sheet.]
Having checked the dose is due, check in the appropriate box
on the MAR sheet that the dose has not already been
administered.
DRUG ADMINISTRATION
PROCEDURES
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Locate the blister pack, and check that the
instructions on the label exactly match the
instructions on the MAR sheet.
Locate the blister bubble that corresponds to the
current day.
Check the identification of the resident again before
pushing out the bubble contents into a suitable
container e.g. medicine pot, push from the front
through the foil and out of the back. Give the dose to
the resident.
When the medication has been taken i.e. witnessed,
initial the correct box on the MAR sheet.
DRUG ADMINISTRATION
PROCEDURES
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Any doses removed from the blister, but not
taken by the patient, can be placed in a
separate and specially marked container for
return to your CHEMIST and should not be
flushed into the drains.
This container should be returned when full.
Ensure that the MAR sheet is annotated
appropriately with one of the codes at the
bottom of the MAR sheet.
DRUG ADMINISTRATION
PROCEDURES
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If for whatever reason the medication is not
removed from the blister, e.g. resident in
hospital, clearly circle that particular bubble
on the front of the pack, and document the
reason for non-administration on the MAR
sheet using the appropriate code from the
bottom of the MAR sheet. This dose should
be left in the blister pack and then next one
used at the next administration time.
Re-ordering Procedure
RE-ORDERING
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Timing is important. Please ensure that requests for
prescriptions are ready to be sent to the surgeries by the
fourteenth day of the cycle at the latest. The following schedule,
or a similar version, should be typical;
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14 - 16 days from start date
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10 days from start date
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Prescriptions returned to home by surgeries and checked by
residential / nursing home staff
9 days from start date
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Prescription requests sent to surgeries
Prescriptions sent to your CHEMIST
2 - 3 days from start date
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All medication and MAR sheets delivered
RE-ORDERING
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If using pink and yellow copies of the MAR sheets!
They are self-carbonating, keep them together when
making out the requests on the pink copies.
Request 28 days of each repeat medication required
by writing ‘28’ in the column headed ‘no. of days
treatment’. If 28 days’ of treatment does not equate
to a definite quantity, state the quantity required. E.g.
Paracetamol tablets, 2 PRN, 100 tablets required.
RE-ORDERING
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Once the prescriptions have returned from
the surgery, which usually takes 2-4 days,
they should be checked against the yellow
copy of the MAR sheet to ensure that you
have been prescribed what you ordered.
RE-ORDERING
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Surgeries that have not sent prescriptions back to you within 5
days should be followed up. Your CHEMIST may collect
prescriptions from the home once they have been checked, or
may occasionally ask for them to be forwarded by first-class
post. Please ensure that either the pink / yellow copy of the
MAR sheet request, or a photocopy of the of the prescription
request slip, is sent with each prescription in order that the
computer records can be updated at the pharmacy.
This is extremely important as the following month’s MAR
sheet information may not be correct, as the pharmacy will
not have received all the relevant information to amend the
sheets accordingly. I.e. items that have been discontinued,
directions altered etc.
Acute Treatments and Alterations
ACUTE TREATMENTS AND
ALTERATIONS
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Prescriptions should be obtained for all for short courses,
additional items or changes to regular monthly medication.
Where possible the following procedure should be followed to
minimise errors.
Fax the prescriptions to your CHEMIST (or your delegated local
pharmacy).
Pharmacy will contact you if the fax is incomplete or if there is a
query.
Request the GP to make, or endorse, the written instructions on
the MAR sheet, to acknowledge their accuracy. Alternatively
attach the spare label supplied by the pharmacy with the
prescription to the next available blank line on the MAR
sheet.
ACUTE TREATMENTS AND
ALTERATIONS
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Alterations to existing treatments should be
recorded on a new line on the MAR sheet,
and not made in hand to the printed
instructions already on the sheet.
The existing item on the MAR sheet should
be annotated as changed and referred to the
new item. Report all alterations in treatment
to your CHEMIST so that computer records
can be kept up to date.
Disposal
Disposal of Medicines
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Use your Pharmacy
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Don’t flush down sink / toilet
Returns Policy
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Returns book
Use MAR sheets
General Guidance
General Guidelines
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100% compliance with all necessary
paperwork
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Appliance / environment maintenance
Care Notes
CD register
MAR charts
- the first thing I will inspect
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If you havent recorded it – you havent done it
General Guidelines
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Paperwork is there to protect you!
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It provides evidence of the good job that you do!
If you haven’t recorded it
– you have not done it
General Guidelines
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CORRELATION BETWEEN BLISTER
PACKS AND MAR SHEETS.
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The reverse numbering system on the back of the
blister pack correlates with the numbering on the
MAR sheets. THESE DO NOT CORRESPOND
WITH THE CALENDAR DATE.
General Guidelines
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SHELF LIFE
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Medication supplied in blister packs should not be
administered 8 weeks after the date on the label.
Any such packs should be returned your
CHEMIST for destruction.
General Guidelines
ITEM
EXPIRY
Tablets or Capsules
6 months
Liquids
3 months
Insulin
28 days when opened
Creams / Oint in tubes
3 months when opened
Cream / Oint in pots
28 days when opened
Eye drops / oint
28 days once opened
Special
Refer to Pharmacy!
General Guidelines
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REMEMBER
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IF THERE ARE EVER DOUBTS OR
CONCERNS RELATING TO ANY ASPECT OF
MEDICATION, OR MEDICINE MANAGEMENT,
PLEASE CONTACT YOUR CHEMIST
IMMEDIATELY