IMPLEMENTING QIPP IN CARE HOMES A COMMUNITY HEALTH TRUST APPROACH. Medicines handling, Systems and Governance

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1 IMPLEMENTING QIPP IN CARE HOMES A COMMUNITY HEALTH TRUST APPROACH. Medicines handling, Systems and Governance Cherise Howson Care Homes Pharmacist Care Homes Support Team, Community Health Services Cherise.howson@gstt.nhs.uk

2 THE CARE HOMES SUPPORT TEAM From 1 st April 2011, the management of community health services in Southwark and Lambeth transferred from the local Primary Care Trusts to Guy s and St Thomas NHS Foundation Trust. The Care Home Support Team comprises of 5 Older People s Specialist Nurses, 3 Older People Nurse Assessors and 3 Consultant Geriatricians. The role of the Care Homes Pharmacist is to provide clinical leadership to ensure optimisation of medicines in Lambeth and Southwark care homes with nursing (0.4wte).

3 KEY DRIVERS Care Home Alert was issued in January 2010 by the Department of Health in response to the Care Homes Use of Medicines Study (CHUMS) which highlighted: Polypharmacy High prevalence of medication error Poor communication between the key stakeholders Lack of understanding of roles and responsibility No individual took overall responsibility for medicines management in care homes Leading and facilitating the implementation of the recommendations highlighted in the alert, working closely with Commissioners and Providers

4 KEY DRIVERS QIPP Medicines optimisation Preventing hospital admissions More efficient use of resources Service and pathway redesign Improving quality of service Promoting high quality, safe and cost effective prescribing informed by clinical evidence, best practice and national guidance such as NICE

5 KEY DRIVERS Care Quality Commission (CQC) CQC guidance on compliance; Essential Standards of quality and safety has 28 outcomes. Outcome 9 focuses on the management of medicines. The registered person must protect service users against the risks associated with the unsafe use and management of medicines. People should be given the medicines they need when they need them, and in a safe way.

6 MEDICINES HANDLING, SYSTEMS AND GOVERNANCE Identifying the current medicines management practices, policies and procedures in care homes. Supporting good medicine handling practice. Improving compliance with CQC standards relating to handling and storage of medicines. Identifying issues relating to pharmaceutical services provided to care homes. Identifying training needs relating to medicines and medicines management. Enhancing the service provided by Community Pharmacists.

7 CASE STUDY 1 Reviewed the medication regime according to the MAR charts and audited the medication trolley and controlled drugs cupboard. Gaps in the administration records. Medication found in blister despite MAR chart indicating it had been administered. Variable doses not recorded. No documented reason for administering PRN medication No communication with GP regarding patient who was regularly refusing their medication. Insufficient medication to complete medication cycle.

2 nd visit to synchronise medication and order repeat medicines Repeat medication ordered by Agency Nurse before my visit Prescriptions processed by Temp at surgery 38 interventions for 18 of the 21

8 2 nd visit to synchronise medication and order repeat medicines Repeat medication ordered by Agency Nurse before my visit Prescriptions processed by Temp at surgery 38 interventions for 18 of the 21 residents Digoxin missed from prescription Discharge summary not actioned Losartan issued that had been discontinued in May 2012 Simvastatin instead of atorvastatin Insulin supplied but not requested

CASE STUDY 2 The system comprises of a tray which provides 28 days supply of medication. A tray is available for each medication round i.e. morning, lunchtime, teatime and night time.

9 CASE STUDY 2 The system comprises of a tray which provides 28 days supply of medication. A tray is available for each medication round i.e. morning, lunchtime, teatime and night time. Medicines are provided in sealed pots which can be removed from the tray. Each pot can contain multiple medicines alongside each other. Staff continued to administer medication from the original trays when they were discontinued. Relying on prompts attached to the tray. The image of the tablet or capsule provided was used to identify and remove the medication. Staff have resorted to double checking with each other when they are identifying a discontinued medicine. During an audit of the medication stock a dose of sulpiride 200mg/5ml was missing from one of pots of in the tray. The seal was unbroken and there was no evidence of spillage; during the dispensing process the pot had not been filled.

10 Recommendations: Guidelines should be developed for Pharmacies providing medicine administration systems to care homes; these should outline training procedures as well competency standards for those involved in the dispensing process as well as the care home staff administering from them. The transition from one medicines management system to another should be managed, consideration should be given to the implementation and integration. Care homes should seek independent advice from a Pharmacist when procuring medicines administration systems, the Care Homes Pharmacist can offer such advice and assist in the implementation.

11 EMERGING THEMES AND ISSUES Current practice does not reflect policy Medicine management performance indicators need to be an integral part of contract monitoring. There needs to be more effective systems of communication between the Care Homes, GP practices and Community Pharmacies. There is a wide variation in pharmaceutical services provided by the Community Pharmacies The implementation of new technologies to assist in the medicines management process need to be managed

12 SUCCESSES Integration with Care Homes Support Team 15 out 16 homes visited so far Development of RAG rated self-assessment document for care homes Relaunch of care homes newsletter Good working relationship with Social services and Commissioners

13 CHALLENGES Time management and prioritising work Demonstrating equity Being accessible Support Inspection

14 FUTURE WORK Develop good practice guidance for Care Homes, General Practitioners and Community Pharmacists. Develop training material for Care Home Staff. Enhance the service provided by Community Pharmacists. Identify current practice in relation to medicines reconciliation and seeking ways to improve systems of work. Improve the management of type 2 diabetes through appropriate monitoring and administration of medication.

15 TOP TIPS Communication skills as well as knowledge of the care home setting are just as important as clinical skills. Scope out the role, identify a few homes (choose well) and evaluate impact of pharmaceutical input Know your key stakeholders, get a Champion Set SMART goals Gather case studies particularly those that demonstrate improved patient outcomes

Best Practice Guidelines - BPG 9 Managing Medicines in Care Homes

Best Practice Guidelines - BPG 9 Managing Medicines in Care Homes Medicines in Care Homes 1 DOCUMENT STATUS: Approved DATE ISSUED: 10 th November 2015 DATE TO BE REVIEWED: 10 th November 2017 AMENDMENT