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1 Trust Monitored Dosage System /05

2 Boots Monitored Dosage Service Group home service offer Trust

3 contents Summary of offer 3 Monitored Dosage System 5 The Boots service 6 Provision of the MDS system 7 Distribution 8 Storage 9 Training requirements 10 Pharmacist advice 12 Communication and support 13 Agreement review process 14 Policies and procedures 15

4 summary of offer Unrivalled nationwide coverage of the UK Boots The Chemists has over 370 stores able to provide a specialised service to care homes. Each of these separate units operates with its own dedicated pharmacy team ensuring a local, personal service tailored to the individual requirements of each care home. Our experience we were the first major pharmacy chain in the UK to provide the Monitored Dosage System to care homes and ours is widely accepted as the standard system. We currently service over 30% of the total care home market. We have an excellent internal structure of store, area, regional and national staff to support the business, giving you peace of mind. Recognised system the MDS is the system of choice for over 50% of all care homes. We own and operate the Manrex system, which we also sell to independent pharmacies and other multiple pharmacies nationwide. The system is approved by the Royal Pharmaceutical Society of Great Britain, and meets the requirements of CSCI and the NMC, giving your staff confidence. An unrivalled market leading training package fulfiling the training need at every stage. - Comprehensive systems training, including certification and a competency assessment tool for the home manager. - On-going and refresher training for new and existing staff, ensuring continuity. - In-house topical training folder for carers self development. - Accredited (to national minimum standards), Care of Medicines training, helping you to meet standard 9.7.

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6 MDS Boots Monitored Dosage System The Boots Monitored Dosage System is a compliance aid system introduced in 1989 to help care homes better manage service users medication. The system follows the current guidelines set by the Royal Pharmaceutical Society of Great Britain (RPSGB) and the National Association of Health Authorities and Trusts. The National Care Standards Commission (CSCI) also approve the system. The Boots MDS System is a unit dose system, which means that we do not mix medication, making identification of medicines easier at the time of offering. The system also incorporates the five rights of medication offering, i.e. right person, right medication offering, ie. right person, right medication, right dose, right time and right route. It is organised on a regular 28-day cycle making it easier to plan for the re-ordering of new drugs, without the worry that you might run out. In addition our Regional Dispensing Services Advisors provide support to our new and existing homes and oversee the operating procedures within our MDS stores to ensure a high quality service is maintained. The Dispensing Service Advisor would also be involved in any issues that the MDS store and the home were unable to resolve. The MDS system reduces the time taken in drug rounds as medication is specifically packed for the relevant time of day, in the order you require them. We also provide each home with a full set of computer-generated Medication Administration Records (MARR sheets) every 28 days. The MARR sheets facilitate a robust auditing procedure for record keeping, ordering and receiving repeat prescriptions and stock control. 5

7 the Boots service The Boots service was introduced in We offer a high quality, professional service that our customers compliment us on, and the fully trained teams in each of our MDS stores are always ready to provide help and advice. The Boots Monitored Dosage System is available nationally through approximately 370 of our stores. Each store has a member of the pharmacy team known as a Key Contact who is dedicated to ensuring all of their homes receive the best service and attention at all times. In most cases the service that we offer can be adapted to suit each individual home. Every effort will be made to produce a tailor made package to incorporate the preferences of the Home Manager (this would be done at a local level) at the time of implementation. Our Regional Dispensing Service Advisors provide support to both our new and existing homes and oversee the operating procedures within our MDS stores to ensure a high - quality service is maintained. 6

8 provision of the Boots Monitored Dosage System (MDS) Boots will provide each home with the following equipment to ensure the system runs effectively and efficiently. Pharmafiles, with pillpacks already racked in the order required by the home, making it easy to work in a logical order. Pillpacks in the appropriate colour for the time of day: pink (morning), yellow (lunchtime), orange (teatime), blue (bedtime) and white for PRN medication, so you only need to pick the relevant file/s for that medication round. Medtime cards to identify the correct pharmafile for that time of day and incorporating any extra details such as unit number or name. Divider cards to identify the correct person and reduce the risk of error. Reminder cards for non-blistered items, incorporating all medications into the system. Alert strips which give you greater flexibility within the drug round. Computer-generated MARR sheets to record drug administration. The MARR sheets also provide an audit trail and a Review and Request of the next supply cycle, making sure all aspects of legislation are complied with. MARR sheet folders. MARR sheet divider cards. Security system for deliveries of medication to the home and returns from the home to the pharmacy. Returned/disposed medication book for recording of refused medication. Returned/disposed medication bags. Fridge line labels to identify items that need to be stored in the refrigerator. Controlled drug delivery book. These items need to be checked at the time of delivery and a signature obtained. MDS procedures manual, for on-going reference and training purposes. Quick reference guide, acting as a prompt for staff unfamiliar with the system. Spare equipment. Wall planner, which acts as an aid for drug re-ordering. 7

9 distribution of the MDS system In accordance with the guidelines set by the Royal Pharmaceutical Society of Great Britain (RPSGB), all prescriptions should be ordered by the home from the surgery. Once the prescriptions have been generated and received by the home, they should be checked and signed ready for collection by Boots no later than 10 days prior to the next start date. This procedure ensures that the home has full control of its own ordering process and demonstrates compliance to best practices. Boots will deliver the next 28-day supply of medication in the MDS system to the home no later than 3 days before the next cycle is due to commence. This gives the person checking the medication in enough time to intervene should it be necessary to do so, and gives the home flexibility for staff planning. The monthly medication will be supplied in security sealed bags and a representative at the home will be required to sign for each bag and hand a portion of the tag back to the driver as proof of delivery. All controlled drugs will need to be checked and signed for separately upon receipt. Boots provides each home with its own controlled drug delivery book to make this process quick and easy. All fridge lines will be clearly marked so that they can be easily identified by the home staff and quickly checked and stored away in the refrigerator. The Pharmafiles will be delivered to each home in the order requested, making the drug round as smooth as possible. The MARR sheets will also be in the same order, to facilitate the checking in process. Collection of empty files On a monthly basis, Boots will arrange with each home a mutually convenient time to collect the empty files. This would usually happen a few days after the start of the new cycle, giving the home time to complete the audit trail for the previous 28 day cycle. Returns and disposal of medicines will be made available for Care Homes to return to the Pharmacy (Residential Homes only) or Pharmaceutical Waste Carrier for Homes with Nursing. Mid Cycle Prescriptions Any prescriptions for interim medication should be faxed to Boots by an agreed cut-off time, for delivery the same day. The original prescription must be handed over upon receipt of the medication, so that the faxed copy can be checked against the hard copy, to ensure that the item/s are correct. A separate MARR sheet for the new item/s will be issued, for ease of record keeping. 8

10 storage of the MDS system Boots will undertake an initial assessment of the storage available in the home. If the home has a suitable trolley that could be adapted to hold the MDS system, Boots may be able to provide the equipment for doing this. The home would need to carry out the fitting of the adapting panel. In the event of a home having no storage of their own, Boots may be able to provide a trolley/s on loan to accommodate the MDS system whilst the home continues to receive their medication supply from us. An equipment agreement would need to be signed at this time by the home, and it would remain the responsibility of the home to ensure that any medication trolleys on loan from Boots were maintained and fit for their purpose. 9

11 training requirements Boots is able to offer a unique 6 tier training system to homes using our MDS service. Tier 1 Initial set-up system training Training will be provided to all relevant home staff prior to starting the Monitored Dosage System. This training covers all aspects of operating the system accurately within the home and in accordance with current legislation. The trainer, usually the Dispensing Services Advisor, will provide a certificate of attendance for each member of staff who has participated in the session. The session normally takes about 1 hour to complete and comprises of safe administration of medication and accurate and meaningful record keeping. Audit trails, including receipt and the returning of medicines are also covered. There will be time to discuss the comprehensive service that you will receive from the supplying MDS store and details of the Key Contact and support staff will be given at the session. We usually train all staff involved with medication administration at the same time, at a time to suit the home, to minimise disruption. A Systems Training Package encompassing the above will be left at the home for the use of the Home for any staff unable to attend the initial training session. Tier 2 On-going training For the purpose of refresher training or new members of staff, the training package provides comprehensive instructions on how to use the MDS system effectively. In addition, Boots can provide each home with a copy of our training video. There is a workbook to complete after viewing the video, consisting of a question and answer type document. There is also a competency assessment sheet for homes to use. As further back up each home will each receive a manual to use as an on-going source of reference, and a quick reference guide inserted into the front of the MARR sheet folder, which acts as a prompt when adjusting to using the MDS system. 10

12 Tier 3 Further training Each home that uses Boots MDS automatically receives a copy of our Care to Train folder and related inserts. The Care to Train folder consists of six single modules: Pain and its management Depression Dementia Heart Disease Continence Sleep This is a topical, relevant information pack used for the continuation of education within the care home environment. The package can be used for self-study and there is an assessment to complete at the end of each module. Tiers 4, 5 and 6 Care of Medicines Training We can also offer our homes additional training packages for both nurses and care staff. These packages are called Care of Medicines and include foundation courses aimed at care staff and advanced for nurses or senior carers. The courses last half a day and are run by a suitably trained pharmacist. There is also a workbook and certificate provided following the assessment. The courses are usually chargeable but for large numbers of delegates or for group homes, we may be able to negotiate a preferential rate. The Care of Medicines Foundation Module is accredited to National Care Standards by ASET (an affiliated body to the National Curriculum Authority and partners with The Learning Skills Council). medication handling system training Carer name Home name monitored dosage system monitored dosage system Trust us to help you handle medicines safely safe handling of medicine work book safe handling of medicine answer book

13 pharmacist advice Boots The Chemists will provide access to pharmacist advice for all group homes. This would be carried out regularly, in either a visit to the home or during a telephone conversation. It is routine practice for the advising pharmacist to give feedback on all procedures associated with medication management within the home. They make recommendations in order to assist homes with preparation for visits from the National Care Standards Commission, ensuring that homes comply with all legal and good practice aspects of storage, handling and administration of medicines. All visits would be documented and a copy sent to the home. In addition Boots can provide a pharmacist to deliver topic specific training. 12

14 communication and support In addition to our store pharmacists, a number of key personnel will be available to all homes during provision of our services. Each home will be allocated a Key Contact whose role is to ensure the smooth running of the system on a day to day basis. The Key Contact will be the main person dealing with the everyday issues involved with the medication management of a home, and will be an expert in operating the system. At a regional level a Dispensing Services Advisor (DSA), will be responsible for the initial contact and implementation of the system. The role of the DSA is to ensure a smooth transition of service and continued maintenance throughout. The DSA can also be contacted should there be any concerns relating to the service provision. In the unlikely event of the home not being satisfied with the service they receive from our store team, the DSA will intervene to reach a solution. 13

15 agreement review process Regular reviews will be held with both parties at either a national or regional level to ensure the continued success of these arrangements. The DSAs are available at all times should any issues arise outside these meetings. 14

16 policies and procedures Boots may be able to advise homes when developing a medication policy across the chain. This would include advice on all current legislation and guidance, ensuring compliance with the National Minimum Care Standards. The above forms the core of service that care homes can expect from Boots The Chemists in the provision of the MDS service. Should you like any further information please contact me at the address below: Lisa Hallam National Accounts Manager The Boots Company PLC Dispensing Operations D90 West F17 Nottingham NG90 1BS Tel: Fax: lisa.hallam@boots.co.uk