ASSESSING AND USING PATIENT S OWN DRUGS (PODS): STANDARD OPERATING PROCEDURE SEPTEMBER 2017

Transcription

1 ASSESSING AND USING PATIENT S OWN DRUGS (PODS): STANDARD OPERATING PROCEDURE SEPTEMBER 2017

2 Procedure title Procedure reference Relevant to Assessing and using Patient s Own Drugs (PODs) PHA66 Date Published September 2017 Implementation Date Date Last Reviewed Next review date Procedure lead Medical, nursing and pharmacy staff September 2017 August 2017 August 2020 Audrey Coker Contact details Audrey.coker@candi.nhs.uk Telephone: Accountable director Approved by Dr Vincent Kirchner, Medical Director Lucy Reeves, Chief Pharmacist Document History Membership of the Review Group Consultation 2014 Version 1 (MP07) 2017 Version 2 Andrew Huggard, Pharmacist, Neelam Sharma, chief Pharmacy Technician, Audrey Coker, Lead Pharmacist, David Rogalski, Lead Pharmacist, Krishna Amin, Lead Pharmacist, Allison, Whyte, Lead Pharmacist. Members of DTC I STANDARD OPERATING PROCEDURE: ASSESSING AND USING PATIENT S OWN DRUGS (PODS)_PHA66_ AUGUST

3 Contents Page 1 Introduction 1 2 Responsibility 1 3 Scope of the procedure 1 4 Process 2 Appendix 1: Assessment criteria for Patient Own drugs (PODs) 6 Appendix 2: Algorithm for Patients Own Drugs(PODs) Procedure 7 II STANDARD OPERATING PROCEDURE: ASSESSING AND USING PATIENT S OWN DRUGS (PODS)_PHA66_ AUGUST

4 1 Introduction To ensure medicines brought into hospital by the patient (PODs or Patients own drugs/medicines) are assessed correctly to determine their suitability for use. A procedure for handling PODs is needed to ensure that: Patient medication reconciliation is accurate. The continuity of patient medication is not disrupted. Wastage is reduced by minimising unnecessary destruction of PODs and redispensing of medicines. Use of PODs will allow ward staff to administer medication over the weekend and a bank holiday until pharmacy is open. 2 Responsibilities All clinical staff (i.e. Pharmacists, Medicines Management Technicians, Doctors and Nurses) that are suitability qualified to prescribe, dispense or administer medicines, are authorized to operate within this procedure and must first familiarize themselves with the correct medicine related procedures contained in the Trust Medicines Management Policy. The overall availability and administration of medicines within the ward/team base is the responsibility of the registered nurse in charge of the shift. Refer to the Medicines Management Policy for further details on: Storage of medicines and medicine key handling Transportation of medicines Administration of medicines Controlled Drug (CDs) Standard Operating Procedure (SOP) and Policy. Service medicines management standard operating procedures. 3 Scope of the procedure This procedure covers the process of assessing PODs to determine their suitability for use and the appropriate action to take including the disposal of such medicines. It also covers the process of using patient s own drugs on admission. It must be used in conjunction with Medicines Reconciliation Procedure. PODS (Patients own drugs/medicines) are medicine(s) which patients bring in with them to hospital. Patients own drugs include: Prescribed medicines (by GP or clinical trials, medicines transferred with patient within Camden & Islington Foundation Trust, or transfers from external organisations e.g. acute trust hospital, nursing home). Prescribed medicines from specialist medical clinics, e.g. HIV Clinics. Over the counter (OTC) medicines. Herbal or alternative medicines. 1

5 4 Process 4.1 On Admission Ask the patient/representative if they have brought their medicines into hospital If the patient has brought in their medicines, each medicine must be assessed for appropriateness and suitability, to ensure the medicine is safe for administration If the patient has not brought in their medicines, ask relatives/carers to bring in the medicines. If the patient is under e.g. a crisis team, an assertive outreach team the team can support obtaining the medicines to bring into hospital. 4.2 Consent All patients own drugs (PODs) deemed suitable for use that are clinically appropriate and prescribed on the medicine chart must be used by nursing staff for administration to that individual patient only Verbal consent must be sought from the patient to use their PODs during admission The patient/representative must be informed that their own medicines will be administered / self -administered to them during admission. This must be documented in patient s electronic record (i.e. Carenotes) If the patient does not have capacity to make an informed decision then assume consent to use PODs. The patient must be informed when they have capacity (if applicable) and allowed the opportunity to make a decision regarding the use of their PODs If the patient has capacity and does not agree to the use of PODs during admission, ensure they have been informed of the benefits and reasons of using PODs during admission If patient still does not agree to the use of PODs, place the medicines in a clear plastic bag labeled. Patient s own medicines not in use and store in the medication cupboard/trolley If it is a controlled drug (CD), place in CD cupboard. Make an entry in the ward CD stock register in accordance with the Trust Controlled Drugs Policy PODs not authorized by the patient for use during admission must be sent home and recorded in the patient electronic record. Any PODs stored at home must be taken into account during the supply of discharge TTO medication The patient must be informed of any PODs not suitable or no longer clinically appropriate for use and advised to consent to destruction of the medication. See section 4.8 2

6 4.3 Assessment of Patients Own Drugs Retrieve all PODs available on the ward from the relevant storage areas Look at each medicine prescribed on the medicine chart and in turn identify if there is a POD available. Where there are PODs available, assess each medication to determine if it is suitable for use by following the POD assessment criteria in Appendix If there are any doubts about the appropriateness of any POD, discuss this with the relevant ward/team pharmacist before use Any assessment of PODs must be documented in the electronic patient record. 4.4 Pharmacy responsibility following assessment of PODs If the POD is deemed suitable for use: If the POD is suitable for use, but needs to be repackaged and/or relabelled: Request for the POD to be relabeled and/or repackaged by dispensary. Send the POD to the dispensary for relabeling and /or repackaging accompanied by the transcription sheet. All relabelled medicines must indicate that it is a patient s own drug and where it has been relabeled, i.e. Patients Own Drugs relabelled at xxx xxx pharmacy The name and address of the original dispensing pharmacy must remain clearly visible on the container/packaging. The original container or packaging where appropriate, may be replaced. PODs which are loose foils/strips must be repackaged and relabeled for use if they are identifiable and have a legible batch number and expiry date. Loose tablets/capsules may be relabeled if contained in an original pack and the expiry date is evident. Endorse medicine chart with POD, the number of dosage units, the initials of assessor and date. A sticker stating the POD has been assessed with name and date should be attached. If there is no facility to relabel or repackage the medicine, it must not be used on the ward and must be disposed of accordingly If the POD is unsuitable for use or not clinically appropriate (no longer prescribed). Explain to the patient/representative why the medicine is not suitable for use or why the prescription has been discontinued. Document in the patient electronic record, the discussion with patient/representative to dispose of PODs unsuitable for use. Dispose of medicines in the correct manner, either on the ward or returned to Pharmacy, in accordance with the Medicines Management Policy. For the disposal of Controlled Drugs refer to the CD Policy and SOP. 3

7 4.5 Assessment of PODs outside of Pharmacy opening hours by clinical staff Outside normal working hours when no pharmacist is on-site, the assessment of PODs can be carried out by ward clinical staff (doctors and nurses) using the POD assessment criteria in Appendix If the PODs are suitable to use, they may be administered at the discretion of the nurse in charge of shift until the Pharmacy department is open If PODs have been assessed by clinical staff outside normal working hours, the ward/team technician/pharmacist must be informed of this when normal pharmacy services resume, so that a final assessment can be performed by pharmacy Any assessment of PODs by clinical staff must be documented in the electronic patient record. 4.6 Administration of PODs Nurses must administer PODs in accordance with Trust medicine administration process defined by the Medicines and the Controlled Drugs SOP/Policy. 4.7 PODs on Discharge If the PODs are still deemed appropriate for use and prescribed, then PODs will be returned to the patient on discharge as part of their TTO supply Check with patient if they have enough supply of medication at home and if further supply is required. Encourage the patient to bring in any supplies still at home so the medicines can be checked for appropriateness. If the medicines are not brought into the hospital, the patients should be advised the medicines are brought to a community Pharmacy for checking against the current prescription. Ensure there is an average of two weeks supply available to the patient when discharged If the patient did not consent to use their PODs whilst in hospital, and they are suitable and clinically appropriate for use, then they must be returned to the patient as part of their discharge medication Measures to avoid patients having excess or unnecessary medicines at home must be taken, in the best interests of the patient, and may require staff to negotiate with the patient/representative If the medicines were assessed and found not to be suitable for use, or are no longer prescribed,the pharmacist and multidisciplinary team clinician must make the clinical decision based on the best interest of the patient as to whether they should be returned to the patient on discharge, preferably with the patient/carer agreement. This decision must be documented in the electronic patient record. 4

8 4.8 Destruction of PODs Medicines brought in by the patient remain the property of the patient. When no longer required or suitable for use, with prior agreement of the patient/representative must be destroyed on the ward in the pharmaceutical waste bin. Controlled drugs must be destroyed in accordance with the current controlled drugs SOP Verbal consent for destruction must be obtained by clinical staff before PODs can be destroyed. This must be documented in the electronic patient record. If verbal consent is not obtained, a multidisciplinary team (MDT) decision must be made as to whether the medicines should be returned to the patient. Advice from the pharmacist must be sought. If the decision is the medicines are unsafe, the decision (and rationale) must be documented in Care Notes and then the medicines can be destroyed. If the decision is harm is minimal, then this decision (and rationale) must be documented in Care Notes and the medicines returned to the patient The patient or their care-coordinator must be contacted by the ward nurse and requested to collect any PODs (suitable and clinically appropriate for use) left on the ward following discharge If PODs are not collected within a week after the nurse has contacted the patient or care-coordinator, the PODs will be removed by Pharmacy or nursing staff for destruction (unless there is a specified arrangement made to collect PODs at a later date) PODs not collected by the patient/representative after discharge must be disposed of in accordance with the Medicines Policy. If the medicine is a controlled drug, then it must be disposed of in accordance with the CD Policy/SOP. 4.9 Record Keeping All medicines and the quantity brought in must be recorded in the electronic patient record. A record of whether the medicines were administered / returned / destroyed must also be made in the electronic patient record to ensure a clear audit trail of the patients own medicines When PODs are assessed, the following must be recorded: medicine name, strength, formulation, quantity, a statement as whether the medicine is suitable for use and storage location and whether or not consent for use has been obtained from the patient A record of patient consent to use or destroy any of their medicines must be made in the patient electronic records. 5

9 Acknowledgements This document is based on the CNWL NHS Foundation Trust SOP for Assessing Patient s Own Drugs. 6

10 Appendix 1: Assessment criteria for patient s own drugs A: Check the product Suitable: The product can be identified and is a tablet, capsule, inhaler, patch, nebule, spray, cream, ointment, drops, suppository, pessary or liquid in original container. Unsuitable: Liquid is not in the original container. Nose/Ear drops expired Eye drops/ointment expired Medication known to have been stored at an inappropriate temperature. B: Check the presentation Suitable for use if: All the following apply: In a suitable container. Note: A multi-compartment aid (MCA) or dosette box is not a suitable container and must not be routinely used for administration during inpatient stay. MCAs can be used in exceptional circumstances if the contents can be identified accurately and there is no doubt regarding the expiry dates. Clean and dry No signs of deterioration. Unsuitable: Mixed tablets/capsules in a single container Broken product Dirty product. Multi-compartment aid or a dosett box. C: Check the expiry date Suitable: The date is within the manufacturer s printed expiry date. Loose BLISTERS dispensed within one year (unless product specifies an expiry date which is less than this from the date or opening). Unsuitable: The date is not within the manufacturer s printed expiry date. D: Check the packaging and dispensing label Suitable for use: Packaging is intact Label is legible Patient name is correct Medicine details match the prescription name of medicine, dosage form and strength. Instructions are present and match the prescription. Note: If all criteria in A, B and C are fulfilled the product can be used. If D is not fulfilled, then the medicine may be used but must be relabelled or repackaged by pharmacy before use. Verbal consent where appropriate must be obtained from patient or carer and documented in the electronic patient record before administering patient s own drugs. 7

11 Appendix 2: Algorithm for Patient s Own Drugs (PODs) procedure ADMISSION No PODs Ask patient s carer/relative to bring in POD PODs brought in on admission Assess PODs for suitability using criteria in Appendix 1 Not suitable Suitable Verbal consent to use PODs must be sought from patient and documented on Carenotes. Outside normal working hours, clinical staff can assess PODs. Pharmacy must be informed on the next working day, so a final assessment can be completed. Explain to patient the POD is unsuitable for administration; obtain verbal consent to dispose of POD and record on Carenotes. If verbal consent is not obtained, a MDT decision must be made as to whether the medicines should be returned to the patient. Advice from the pharmacist must be sought. If the decision is the medicines are unsafe, the decision (and rationale) must be documented in the Care Notes and then the medicines destroyed. If the decision is harm is minimal, then this decision (and rationale) must be documented in Care Notes and the medicines returned to the patient. Patient has capacity and does not agree to the use of PODs Patient agrees to the use of PODs Label as Patient s Own Medication not in Use and place in medication storage area. If appropriate, return to patient s home or on discharge. Post assessment of POD by pharmacy Administration of PODs If PODs are left on ward after discharge, the nurse must contact the patient/care-coordinator to collect PODs. If PODs are not collected within a week, they will be removed by Pharmacy. If appropriate, PODs used in discharge TTO supply. PODs not suitable Follow procedure for removal and destruction of POD from ward in accordance with Medicine Management Policy and waste management policy. 8

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