Medicines Optimisation Training and Assessment Schemes. Assistants (MMAs) Handbook

Transcription

1 Medicines Optimisation Training and Assessment Schemes Assistants (MMAs) Handbook A training scheme for medicines management assistants Website: Contact: Administration Team School of Medicines Optimisation, Health Education England, working across Yorkshire and the Humber Willow Terrace Road, University of Leeds, Leeds, LS2 9JL T: E: medicinesoptimisation.yh@hee.nhs.uk Document Reference Number: PDU/MMA/TR1 Review Date: Version: 1.2 May16 Test Supersedes: none 1

2 Medicines Optimisation Training Scheme MMA Training This Medicines Optimisation Training Scheme provides a flexible approach with optional and core modules to enable you to develop your skills and support your role as a Medicines Management Assistant. Core Skills For Regional Certification This three step programme is designed to support the varied roles involved in medicines optimisation and provide a variety of regional training modules which are all relevant to the medicines management assistant role today. Step 1 Management e-learning modules A series of e-learning units covering five main areas: o The essentials of medicines management o Patient safety in prescribing and supply o Safe administration of medicines o Safe handling of medicines o Calculating Drug Doses (with the Medicines Calculations Workbook) See: our website for more information Step 2 the introductory workbooks: o Introduction to Communication Skills o Introduction to Wards and Clinical Environments Step 3 Certification in Medicines Optimisation Modules o Module 1: Managing supplies for individual patients o Module 2: Assessment of Patients own Drugs To promote development and competence as a safe and effective Medicines Management Assistant, the following skills are also required: Excellent communication skills Focus on providing person centred care Awareness of limitations of role Awareness of the consequences of errors Team working Using this workbook-the training and assessment in this workbook should be adapted by each organisation to cover the necessary skills, knowledge, training and assessment required. As the role of the medicines management assistant has developed, our Medicines OptimisationTraining Schemes now include competencies and skills which should be assessed in all staff working in medicines optimisation. All learning is fully supported by further training and learning to help develop the necessary knowledge and skills and is available via our website. 2

3 Contents Introduction... 5 Guidance for Mentor... 6 Competencies... 7 Scope of Practice... 8 Aims and Objectives... 8 Chapter 1 Roles and Responsibilities...10 Aims and objectives...10 Patient Care and Patient Safety...10 Staff Roles and Responsibilities...11 Medicines Management Benefits...12 Team Working...12 Prioritisation...13 Patient Requests...14 Referrals...15 Chapter 2 Health & Safety...16 Aims and Objectives...16 The Acts...16 Your Responsibilities...16 Reporting Accidents and Incidents...17 Chapter 3 Understanding the ward environment...18 Aims and Objectives...18 Ward Layout...18 Admissions Procedure...19 Chapter 4 Law and Ethics...20 Aims and objectives...20 The General Pharmaceutical Council (GPhC)...20 The Health and Social Care Act 2008 (Regulated Activities) Regulations NHS Standards...20 Other Laws...21 Medicines (labelling) Regulations Misuse of Drugs Act CDs returns/destruction...23 Understanding Classes and Schedules...24 Ethical and Moral Obligations...25 Chapter 5 Management of Pharmaceutical Stock...26 Aims and Objectives...26 Ward Stock...26 Top-Up...26 What is on the Stock List?...27 Controlled Drugs...27 Stock Levels...28 Observe a top-up being performed...29 Top-Up Guide...30 Top-up Competency...31 Ward Stock List...32 Storing and Maintaining Stock...33 Stock Rotation...33 Quality Assurance...34 Chapter 6 Patient Drug Chart/Prescription...36 Aims and objectives...36 Your Organisations Documents...36 Approved Abbreviations

4 The Prescribing Procedure...38 Controlled Drugs on Discharge...38 Chapter 7 Patient Labelled Medicines...39 Aims and objectives...39 Patient s own Drugs (PODs)...39 Named Patient Labelled Medication...40 Green bags...41 Storage...42 Redistribution...43 Returns and Recycling...44 Disposal...45 Appendices...46 Task A Essential Reading Trust Procedures and Policies...47 Summary of Achievements...48 Confirmation of Completion of Module...49 Candidate Review Form...50 Assessment: Top Up Competency...51 Assessment: Managing Patient s Medicines...52 Acknowledgements Special thanks to the Training and Development Team, Pharmacy Department at the University Hospitals of Leicester NHS Trust for sharing and allowing the use of their Medicines Management Assistants Training Guide to produce this workbook. Thank you to the following organisations for sharing resources which have helped to produce this training module: Pharmacy Department, Harrogate and District NHS Foundation Trust Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust Pharmacy Department, Barnsley Hospitals NHS Foundation Trust 4

5 Introduction MMA Training All candidates will be required to apply to their employer to start the medicines management assistant training by completing a nomination form and learning agreement. A structured form of local medicines management assistant induction process should be followed in preparation for training and assessment. When completing the training will be provided by each organisation and adapted to meet the needs of each organisation. Each training module contains: Local training covering module specific information and allowing for variations in each organisations procedures and SOPs Practical activities o Tasks for the candidate to complete o Activities, factsheets, case studies, reflective exercises (in e-learning modules) o Essential reading, studies, work o Evidence gathering and portfolio building The candidate and Mentor should decide on an agreed time period for completing the training and modules. This will depend on each individual s needs and abilities, however training and assessment for the paper based module should be completed approximately 3 months from commencement of module. Assignment of Mentor Any person undertaking the role of mentor to the candidate during the whole training process, will be carrying out the duties of an approved Y&H Mentor. Throughout this handbook where the term mentor is used it refers to the role, duties and responsibilities explained and listed in Mentor Handbook. Certificates Certificates for paper based modules will be issued upon receiving the appropriate confirmation of completion documentation. A regional database will be maintained for quality assurance and data collection purposes. Record Keeping It is the responsibility of each organisation and the candidate to keep appropriate and up to date records, and manage re-training timescales. Documentation Access All module documentation is available to download via our website 5

6 Guidance for Mentor Documentation Please ensure the following documents are complete for this training: Candidate nomination form Learning agreement Candidate review form (to be used during all reviews and feedback on assessments) Question and Answer assessment form (optional assessment method) if used Workbook activities: sign off the activities when completed at the bottom of each chapter Workbook task A (SOPs) Assessment 1 Top Up Assessment 2 Managing Patient s Medicines E-learning- activities, factsheets, case studies from each module For a certificate of completion to be issued: Summary of achievements (send to medicinesoptimisation.yh@hee.nhs.ukwhen completed) Confirmation of completion of module (send to medicinesoptimisation.yh@hee.nhs.ukwhen completed) All documents, assessments, tasks and activities, including this workbook, certificates for the core skill training must be kept securely and added to candidate s portfolio of work. Referrals/Failures and Training/Development needs There may be situations where candidates have not performed as expected or appear to be failing. In these cases, local procedures must be followed. The candidate review form must be used to record interviews/discussions with candidate in these circumstances. Guidance on the outcomes of candidate reviews/the completion of workbook and assessment, should be based on a pass, referral or failing marking system for example: Pass = successful completion of modules and/or passed complete scheme. In this case the summary of achievements form will be completed (and a certificate issued). Referral required = candidate is in difficulty/has not passed all criteria or modules/and or assessment and has been referred back to Mentor/Educational Supervisor for further training in particular area. Details of why candidate is in difficulty/has not passed must be documented and discussed with candidate. Training needs must be identified. An action plan should be completed. Further training must be put in place. Fail/Failing = candidate is unable to/has not met the standards of the modules/criteria listed in the assessments and scheme and cannot/should not continue with training programme. Local procedures for dealing with failure of candidates at this point should be followed. Training and development needs/use of action plans Training and development needs identified during reviews of candidates must be recorded, followed up and completed by the Mentor/Educational Supervisor within an agreed timescale. The use of action plans with target dates may be a useful tool for candidates. Individual organisations should follow their own training and development procedures. 6

7 Competencies The following competencies will be covered during the full medicines management assistant training (this must include core skills steps 1,2 and 3). Competencies Core skills Step 1 Meds management e- learning Core skills step 2 Introductory modules Roles and responsibilities Health and safety Safe handling of medicines Law and ethics Understanding patient safety Understanding errors and medication incidents Communication skills Management of stock Understanding documentation Ward/clinical environments Supply of medicines to patients Patients own drugs (PODs) Core skills step 3 Certification in meds man: PODs and Supply Modules 7

8 Scope of Practice MMA Training It is recognised that the role of a medicines management assistant will vary across organisations; therefore, it is important that Mentors ensure that the modules to be undertaken are agreed with the candidate and reflect both the scope of the role and the training and assessment needs of each individual. Each candidate should have an agreed job description and person specification that defines their scope of practice. This will ensure that training providers and Mentors can verify that the training needs and assessment of that practice are met. The scope of practice outlined in the job description will form the basis upon which decisions will be made regarding the range of skills and situations that will be assessed within each module. It is important that the candidate fully understands their scope of practice. This must be agreed prior to the candidate taking part in any medicines optimisation training. Each organisation must have a clear referral process in place. Aims and Objectives To enable medicines management assistants to gain the skills, knowledge and experience to provide a safe, effective and efficient ward support service as part of the multidisciplinary team. Objectives Medicines management assistants will undergo a competency-based training programme in order to enable them to undertake medicines optimisation support duties. They will be able to: 1. Recognise all situations where a referral to a pharmacy technician or a pharmacist is required. 2. Understand ward/clinical environment structure and function 3. Demonstrate the safe handling of medicines 4. Understand the importance of patient safety and keeping patient s safe 5. Understand the importance of good record keeping 6. Understand the importance of following Standard operational procedures (SOPs) 7. Demonstrate excellent communication skills 8. Demonstrate the management of PODs within scope of role 9. Demonstrate the management of pharmaceutical stock within scope of role The training will involve several different methods including: Reading standard operational procedures (SOPs) One to one training with medicines optimisation pharmacy technicians/pharmacists Regular documented meetings with assigned mentor 8

9 Shadowing the medicines optimisation pharmacy technician and ward pharmacist Observations Questioning and documented reviews Completion of activities and tasks Completion of e-learning Assessments and feedback MMA Training 9

10 Chapter 1 Roles and Responsibilities Aims and objectives MMA Training Understand your responsibilities in terms of patient care and patient safety To be able to differentiate between the roles of the different members of staff in the delivery of a medicines optimisation service. Understand the importance of working as part of a multidisciplinary team. This chapter is linked to Medicines Management e-learning Essentials Unit This chapter is linked to Medicines Management e-learning Patient Safety and Administration of Medicines Patient Care and Patient Safety Activity 1a: What do you understand by the terms duty of care and patient centred care? Question Find a definition for the terms Answer duty of care to patients providing patient centred care Discuss your answers with your mentor Activity 1b: Patient safety checks-keeping patients safe-look at the four points below and write some brief notes on what these mean to you in your role as a medicines management assistant You should always: Perform patient identification checks Perform medicines/prescription checks Complete documentation Act on errors immediately 10

11 Staff Roles and Responsibilities Activity 2: For each member of staff briefly describe (1) their roles and (2) their responsibilities Member of staff Medicines management assistant Job roles and responsibilities Ward Pharmacist Medicines Optimisation Pharmacy Technician 11

12 Medicines Optimisation Benefits Activity 3: The benefits of a medicines optimisation service and your role in the team Question List three benefits of a medicines management assistant Answer Team Working Activity 4: Question List all the different types of health care professionals which you think you may come into contact with during your role as a medicines management assistant Answer 12

13 Prioritisation When you are caring for patients medicines you will encounter situations where you need to work out which is the most urgent and what will be the impact on the patient in terms of their safety. Activity 5: Explain how you would deal with the following scenarios assuming they occurred as soon as you walked on to the ward at 9am: Scenario An amoxicillin dose which was missed at 8am which was due to the stock running out. Answer A patient has run out of their Ranitidine tablets and they next need a dose at 8am tomorrow. A CD order for Oxycodone injection needed for a patient who has had Oxycodone tablets this morning but is now unable to swallow and her next dose is due at 20.00hrs today. A requisition sheet filled out by the pharmacy technician which is pre-empting the likelihood of take home meds later on today. A requisition slip filled out by a nurse for some stock dressings for a patient who has serious burns and they do not have the dressing on the ward as they do not stock it. Discuss your answers with your mentor 13

14 Patient Requests Activity 6: When working on wards and in clinical environments you will be asked by patients to help with their medication, what should you do? Discuss your answers with your mentor What would you do in the following situations? Patient: I m in absolute agony, my tramadol is in my locker, please give me some, I need some now! Answer Patient: Pass me my GTN spray, I ve got chest pain! Answer: Patient: Can you get me some water please? Answer: Patient: I m feeling cold; can you put that blanket over me? Answer: Patient: I m fed up of sitting in this chair; can you help me get back into bed? Answer: Scenario: A patient asks where her medication is as her relatives have arrived to take her home. You know that her take home medicines have not been written up yet. What do you do? Answer: 14

15 Referrals There are four main people who you should refer to regarding any problems encountered within your role. These are: Ward Pharmacy Technician Ward Pharmacist. Nursing staff. Medicines optimisation service manager/your manager. Activity 7: For the following scenarios please state who you would refer the problem on to: Scenario Dispensing error made by pharmacy. Answer When a drug is out of stock in pharmacy and is needed for an afternoon dose. Missed doses, when a supply was available on the ward. Stock level issues. When a drug is likely to be out of stock for several weeks. Activities for this chapter: 1a and 1b, 2,3,4,5,6,7 Mentor signature: 15

16 Chapter 2 Health & Safety Aims and Objectives To ensure your own actions reduce risks to health and safety. To understand your legal duties for health and safety in the workplace as required by o the Health and Safety at Work etc Act 1974 o the Management of Health and Safety at Work Regulations 1999 To be able to deal with or promptly report risks. This chapter is linked to Medicines Management e-learning Safe Handling of Medicines Unit The Acts Activity 1 You can find out more at the Health and Safety Executive website 1a What are the key points covered in the Health and Safety at Work etc Act 1974? 1b What are the key points covered in the Control of Substances Hazardous to Health (COSHH) Regulations 2002? Your Responsibilities Activity 2 How does health and safety at work relate to your role? What hazardous substances may you come into contact with in your job role? How can you identify these substances? What special precautions do you need to take when working with these substances? 16

17 Activity 3 Training Attend your organisation s induction training for new employees. This training covers aspects of health and safety. Put your attendance certificate or letter in your portfolio as evidence. Fire training is a statutory requirement which you need to attend yearly. Record your attendance in your portfolio. It is a mandatory requirement for all staff to attend a lifting and handling (Manual Handling) training session. Put a copy of the attendance certificate or letter into your portfolio as evidence. It is a mandatory requirement that all staff attend Safeguarding children and vulnerable adults training (appropriate to role). Familiarise yourself with the fire evacuation procedure and other emergency procedures for all wards which you may be covering MMA Training when completed Reporting Accidents and Incidents Activity 4: Recording and reporting accidents in the workplace With your Mentor/Assessor, describe the process and forms to be completed when an accident occurs in the work place. Identify where the forms are kept for recording accidents. Processes and forms Checked by mentor (initials) Activity 5: Complete the Introduction to Wards/Clinical Environments Workbook to cover Infection control and hand hygiene (tasks 1 and 2) Ward based tasks and activities ((where applicable to your role) tasks 3-7) Activities for this chapter: 1, 2,3,4,5 Mentor signature: 17

18 Chapter 3 Understanding the ward environment Aims and Objectives To understand the layout of the wards To understand an ideal patient journey through the admissions procedure This chapter is linked to Introduction to Wards/Clinical Environments Module Workbook Ward Layout Activity 1: Visit the wards/clinics you will be covering with your medicines optimisation pharmacy technician/pharmacist and ensure you cover the following points: Training Location of ward in relation to pharmacy Number of bays, how many beds in a bay and side rooms Different nursing teams and how to identify them Location of the ward medicine cupboards Patient boards, including which bed a patient is in, which consultant and nurse is looking after them Patient handover sheets Patient folders, including location of drug chart/epma system details Patient s medication locker Notes trolley Bleep numbers Pharmacy communication tray / book Location of emergency boxes Location of the controlled drug cupboard and controlled drug order book Clinical room Storage areas Pharmacy returns when completed Other notes: 18

19 Admissions Procedure MMA Training Activity 2 Add in your organisations admission procedures here (write or draw a flow chart, or insert document) pay particular attention to what happens to patients and their medicines, patients own drugs, medication reviews and the transfer/discharge process (patients moving with their medicines). Activity 3 Discuss the admissions procedure for the wards that you cover How does this impact on your work? Activities for this chapter: 1, 2,3 Mentor signature: 19

20 Chapter 4 Law and Ethics Aims and objectives Understand the practical aspects of the laws relating to the provision of a pharmacy service. Demonstrate an awareness of other Laws that may affect the work of pharmacy staff. State the legal categories of medicines. Understand the ethical and moral obligations of pharmacy staff. This chapter is linked to Medicines Management e-learning Prescribing and Supply Unit This chapter is linked to Introduction to Communication Skills Module Workbook There are specific rules and regulations which state how a pharmacy service should be provided. The General Pharmaceutical Council (GPhC) The General Pharmaceutical Council is the independent regulator for pharmacists, pharmacy technicians and pharmacy premises in Great Britain. It is their job to protect, promote and maintain the health, safety and wellbeing of members of the public by upholding standards and public trust in pharmacy. This is done by inspecting pharmacy premises, maintaining a register of pharmacists and pharmacy technicians, providing standards of conduct, ethics and performance and standards for training and education. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 The Health and Social Care Act 2008 established the Care Quality Commission (CQC) as the regulator of all health and adult social care services. The Act contains the commission s powers and duties, and contains powers of enforcement. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 contain definitions of the services and activities that people must be registered to provide and details of the standards that people registered to provide and manage services will have to observe: People who use services will: Have their medicines at the times they need them, and in a safe way. Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf. Providers who comply with the regulations will: Handle medicines safely, securely and appropriately. Ensure that medicines are prescribed and given by people safely. Follow published guidance about how to use medicines safely NHS Standards The NHS Constitution Confidentiality: NHS Code of Practice The Medicines Code (organisation specific) 20

21 Other Laws MMA Training You should also be aware of: Human Rights Act 1998 The Human Rights Act came into effect in October 2000 in the UK and all public authorities, including NHS organisations, have a positive obligation to respect and promote peoples human rights Mental Health Act 1983 (amended 2007) Sets out various legal rights that apply to people with severe mental health problems. They also contain the powers that, in extreme cases, allow some people with mental health problems to be compulsorily detained in a psychiatric hospital. The Mental Capacity Act 2005 The Act applies to England and Wales and provides a statutory framework to empower and protect vulnerable people who are unable to make their own decisions. It applies to those aged 16 and over and will include those with dementia, learning disability, brain injury, mental health problems and autism. (from NMC) The Mental Capacity Act (2005) Deprivation of Liberty Safeguards (DOLS) The safeguards cover patients (aged 18 and over) in hospitals, in care homes registered under the Care Standards Act 2000, whether placed under public or private arrangements. They are designed to protect the interests of an extremely vulnerable group of people. Data Protection Act 1998 The Data Protection Act controls how your personal information is used by organisations, businesses or the government. Everyone responsible for using data has to follow strict rules called data protection principles. They must make sure the information is: used fairly and lawfully used for limited, specifically stated purposes used in a way that is adequate, relevant and not excessive accurate kept for no longer than is absolutely necessary handled according to people s data protection rights kept safe and secure not transferred outside the UK without adequate protection ( Don t forget this includes medical records and you have a legal duty to adhere to the Data Protection Act This is not a full list-there are many other laws applicable to your work-your employer will cover all the necessary information during your induction. 21

22 Medicines (labelling) Regulations 1976 The Medicines (labelling) Regulations 1976 is an amendment to the Medicines Act It gives clear instructions on how medicinal products must be labelled both during manufacture (original packaging) and when being dispensed. In addition, those medicinal products which are Schedule 2 or 3 controlled drugs must also be labelled in accordance with the Misuse of Drugs Regulations Original packaging for Pharmacy products must be labelled with a P in a rectangular box with appropriate warnings for certain ingredients e.g. Aspirin. Prescription Only Medicines must be labelled with the letters POM in a rectangular box. There are also items which are on the general sales list (GSL) which can be sold in most shops. Activity 1 Questions 1. Name several medicines stocked on your ward that are P category 2. Name several medicines stocked on your ward that are POM category 3. Name several General Sales List (GSL) medicines stocked on your ward 22

23 Misuse of Drugs Act 1971 The Misuse of Drugs Act 1971 controls the export, import, production, supply and possession of dangerous or otherwise harmful drugs known as Controlled Drugs. It includes advice on the treatment of drug addicts and promotes education and research on drug dependence. The Misuse of Drugs Act ensures that access to potentially harmful substances is regulated. Manufacture, distribution and supply are monitored to ensure that all quantities of the substance are accounted for. Registers are kept where all transactions are recorded in indelible ink, providing a permanent record of stock levels and supply details. This is a legal requirement. The Home Office, the pharmacy inspector and the police can check these registers at any time. Controlled drugs come under special legislation that governs the ordering, storage, prescribing and destruction of all controlled drugs. The legislation varies for the different schedules. If controlled drugs are destroyed (e.g. expired stock) specific regulations must be followed. Activity 2 1. Read the SOP on destruction of controlled drugs and discuss with the pharmacy team 2. Read the section in the BNF which refers to controlled drugs CDs returns/destruction Controlled drugs can be returned to pharmacy under various circumstances depending on the organisations policies and procedures. Activity 3 Find out who can carry out the following tasks: Task Ordering of CDs for ward stock Answer Delivering CDs to the wards Returning CDs to pharmacy Destroying patients own CDs 23

24 Understanding Classes and Schedules Special prescribing requirements are in place to prevent people obtaining controlled drugs illegally and misusing them either on themselves or others. Misuse of Drugs Act 1971 (introduced to prevent the misuse of controlled drugs) Misuse of Drugs Regulations 2001 (the schedules) Misuse of Drugs (Safe Custody) Regulations 1973 (imposes controls on the storage of CDs) o There are different classes of controlled drug. o There are five different schedules of controlled drugs Activity 4 Different levels of security exist for each of these. Discuss controlled drugs classes and schedules with your pharmacist and technician team. Give an example of a drug that falls into each of the following categories Schedule one (CD LIC) Schedule two (CD POM) Schedule three (CD no register) Schedule four (Part 1 and Part 2) Schedule five (CD inv) Class A Class B Class C 24

25 Ethical and Moral Obligations Let s look at the standards for registered pharmacy professionals from the GPhC Standard of Conduct Ethics and Performance The seven principles in this standard are as follows As a pharmacy professional, you must: 1. Make patients your first concern 2. Use your professional judgement in the interests of patients and the public 3. Show respect for others 4. Encourage patients and the public to participate in decisions about their care 5. Develop your professional knowledge and competence 6. Be honest and trustworthy 7. Take responsibility for your working practices. There is also guidance on things like gaining consent, maintaining confidentiality and about raising concerns about other workers where a patient may be at risk from a co-worker s behaviour. Activity 5 Much of this subject will have been covered in the Introduction to Communication Skills Module, where you will have worked on activities concerning ethical and moral issues. Complete the Communication Skills module to cover the aims and objectives of this chapter Ask a pharmacist or pharmacy technician to explain what being a registered professional means to them and their work, and how they maintain the seven principles. Activities for this chapter: 1,2,3,4,5 Mentor signature: 25

26 Chapter 5 Management of Pharmaceutical Stock Aims and Objectives State the aims of an efficient top-up service Demonstrate effective stock management skills Demonstrate effective communication of stock issues This chapter is linked to Medicines Management e-learning Safe Handling of Medicines Unit This chapter is linked to Medicines Management e-learning Prescribing and Supply Unit Assessment for this chapter: You will be required to perform a minimum of three observed ward top ups Ward Stock It is important that medicines and pharmacy products are available to patients when they are required. Many of these medicines are identified for specific patients and are known as namedpatient medicines. We will deal with these in a later module. In many ward and clinic areas there are some types of medicine that are used regularly and for more than one patient in that area. To ensure there is a minimal delay in the patient receiving these medicines the ward will hold their own stock supply. Members of the pharmacy team and the ward staff will agree the types and quantities of medicines kept as ward stock. These agreed medicines will form the Ward Stock List. Top-Up To ensure the ward area has a ready supply of medicines it is important that the quantity available is regularly checked and if required additional supplies made. This is known as Ward Stock Top-Up. As part of your role as a Medicines Management Assistant you will be responsible for ensuring this top-up is performed. Activity 1 Question Which ward areas will you be responsible for topping up? How often is the top up performed? Answer On which days is this top up performed? Is the box of medication delivered the same day? What happens if your top up falls on a Bank holiday? What happens with regards to your top up when you are on Annual Leave? What happens with regards to your top up if you are unable to come to work due to sickness? 26

27 When providing a top-up services there are various points to consider to ensure that it is efficient, safe and cost-effective. What is on the Stock List? The first thing to look at is the type of medicines that are kept as stock. These usually fall into one of two categories: A. High volume, low cost medicines. These are medicines that are used frequently within that ward area, have no particular legal or formulary restrictions. By allowing these to be kept as stock on the ward area they are available for use when they are needed and also help prevent repeat requests for supply from the dispensary. B. Low volume emergency medicines. Although these may be used infrequently they are kept as stock because if needed, they should be available without unnecessary delay. Activity 2 Question Give three examples of category A medicines. Give three examples of category B medicines. Give two examples of medication which is frequently used on your ward but not kept as stock. For each one of the above write a brief explanation as to why they are not kept as stock. Answer Some things will not be kept as stock. These may be due to formulary or legal restrictions e.g. Named patient medicines, restricted antibiotics. Controlled Drugs What happens to controlled drugs in your organisation? Ordered by Nursing staff or the pharmacy technician/pharmacist on the ward? Is there a CD order book? Where are they kept? Where is the CD cupboard and CD register? 27

28 Stock Levels MMA Training How much should we keep? Once we have decided what medicines will be kept as stock we then need to think about how much of each medicine is needed. Most ward areas are topped-up on a weekly basis however some areas may be done more frequently, some less so. When deciding how much of a particular medicine a ward area should stock we should ensure that they have at least the amount that they would reasonably be expected to use during the period between to-ups (e.g. one week). This amount is known as the Stock Level. If the stock level is set too low then the ward may run out. This is known as a Under stocked If the stock level is set too high then the ward may receive too much and become Overstocked. Activity 3 Question What problems could Under stocking cause? Answer What problems could Overstocking cause? 28

29 Observe a top-up being performed Activity 4 Accompany your trainer to one of the ward areas that you will be expected to top up. Ensure you have a copy of the ward top up documentation and make yourself familiar with it Observe your trainer and think about who they communicate with, what information they need to gather and any information they need to give. Ask your trainer to explain the layout of the room where the medicines are kept and indicate whether any of the medicines have special storage requirements. Once your trainer has started looking through the medicines cupboard ask them to explain what they are checking for and which details they need to record. Draw a diagram below of the clinical room, indicate which types of medicines are kept in which cupboards and write down any questions you may have regarding the top up process 29

30 Top-Up Guide Here are some points to consider when demonstrating/performing a Top Up in the ward environment. Comply with Infection control policies. On arriving on the ward inform ward staff of your presence and explain the purpose of your visit Obtain necessary keys Check with the nursing team and check notices/communications about any stock supply information/problems or known requirements for additional stock. Check with the Pharmacy Team regarding any stock supply information and discuss any known requirements for additional stock. Check the top-up sheet look at the stock level quantity and the quantity that that needs to be ordered. Check through stock cupboards and annotate on the stock sheet the quantities in the cupboard and any amounts which are required from the pharmacy stores department. What is the process used for checking stock? Ensure that expiry dates are checked and that stock rotation is carried out. What is the process for dealing with expired/damaged/excess stock? o Record quantities required: how is the top-up sheet is completed? What about the stock level quantity and the quantity that needs to be ordered? o What about different strengths or formulations of the same medicine? If these are on the stock list then these need to be checked carefully and if required ordered. Completion of top up: ensure that you lock the cupboards and give the keys back to an appropriate member of staff. Other points to note: Layout of stock and storage areas Specialist storage areas e.g. fridge, flammable cupboards, CD cupboards Ensure you know what to do if there is an emergency on the ward Ensure you know what to do if you see a patient in distress/difficulty 30

31 Top-up Competency Activity 5 You must now be observed by your trainer carrying out a ward stock top-up. Use your notes from activity 4 to help you. You must be able to show that you are competent in completing the criteria as detailed on the competency sheet. You need to complete a minimum of 3 top ups fulfilling all the criteria. Your mentor/assessor will record what they have seen and discuss anything that they think you may need to know using the Candidate Review Form. You Will have the opportunity to comment on this assessment and record the meeting on this form. Forms to be used: Top up Competency Form in appendix section Candidate Review Form 31

32 Management of Ward Stock: The Supply Process The ward stock topping-up system ensures that the regularly used medicines are available for use when required. To ensure this system remains effective and to prevent errors from occurring there are some things we need to consider: Ward Stock List The contents of the ward stock list will mainly consist of medicines that are regularly used within that ward area. There may also be medicines that are not used very often but may need to be readily available in case of emergency. The ward stock list will need to be reviewed and updated on a regular basis (at least 6 monthly). Things that need to be considered when reviewing a stock list include: Has the ward started using a new product regularly? Is a currently listed product being used less frequently? Is there a supply problem with an item on a stock list? does an alternative need to be added temporarily? this will be something to consider as an ongoing process. You may need to investigate usage on the pharmacy system (training will be given) Any items that fall into these categories should be considered, any changes to the stock list should be discussed with the ward team and pharmacy team. These changes should be reflected in the stock list. In addition to this a stock cupboard review of expiry dates, overstocked items etc. should be done on a regular basis according to SOPs. Remember: Any items that have been removed from the stock list need to be also removed from the ward 32

33 Storing and Maintaining Stock MMA Training Once the required stock has been delivered to the ward area we must consider how it is stored. Some things that should be taken into consideration include: Health and Safety Weight If the item in question is bulky or heavy then we must ensure that they are kept at a suitable level for lifting and also ensure that they are not put in a position where they could fall or cause injury Hazardous substances If the product is corrosive, flammable or poses any other type of risk then we should ensure that manufacturer s guidance is adhered to and that they are stored appropriately e.g. flammable cupboard Security As medicines and medicinal products pose a hazard to health and their supply are controlled by law we must ensure that they are kept in secure locked cupboards. Access to these cupboards should be restricted to identified personal e.g. Nursing and Pharmacy staff. Storage Conditions As some medicines requires specific storage conditions to maintain their efficacy e.g. fridge items then we must ensure that these are put away in the appropriate place and also that the storage condition is maintained (e.g by monitoring the temperature of the refrigerator) Activity 5 Question Where would you expect to find Glucagon syringes stored? Answer Where would you expect to find Sorbaderm spray stored? Where would you expect to find Morphine injections stored? Where would you expect to find Diprobase cream stored? Stock Rotation An important part of maintaining stock is ensuring effective stock rotation takes place. Stock rotation is ensuring that newly delivered stock gets put away in such a way as to ensure that stock with the least amount of remaining shelf life will get used first. This should always be done by the most appropriate member of staff available on the ward at that time. In the majority of cases the stock that has recently been delivered has a longer expiry date than the stock that is already in the cupboard although this is not guaranteed. For this reason it is always essential to check the expiry dates of new and existing stock and ensure that the shorter dated stock is put at the front to be used first. 33

34 Activity 6 Question What will happen if effective stock rotation does not occur? Answers Quality Assurance Once we have established the correct type and quantity of medicines that are kept as stock we must also ensure that they are fit for use. This can be done by carrying out routine checks and ensuring that any problems are dealt with quickly and effectively. Removing, Disposal or Returning of Redundant Stock From time to time it may be necessary to remove stock from the storage areas as well as supply new stock. There may be several reasons why stock needs to be removed, these include; Out of Date Stock Stock that has passed its expiry before it has been used. Damaged Stock Damaged or leaking packaging. Redundant Stock Medicines that are no longer likely to be used as treatments. Recalled Medicines Medicines that have been recalled by the pharmacy or by the manufacturers. Out of Date Stock If the stock is being maintained effectively then the amount that goes out of date should be kept to a minimum. Sometimes it is unavoidable as some stock may be short-dated when it was supplied, or may be low use but needs to be kept for emergency situations. To minimise the risk of out of date medicines being given to patients and to avoid the cost of waste, checking of expiry dates is incorporated into the stock management role Damaged Stock Medicines that have damaged containers may have become contaminated and no longer fit for use, consider what sort of products are kept in the area that you are topping up and the type of containers they are in. 34

35 Activity 7 Discuss with your mentor which types of medicines should be removed if their packaging is damaged. Write some examples below: Activity 8 As with all Pharmaceutical waste, any damaged or expired stock must be disposed of properly. Discuss with your mentor the SOP for disposal of pharmaceutical waste. Write some notes below: Activities for this chapter: 1,2,3,4,5,6,7,8 Mentor signature: Assessment for this chapter: Ward top up 35

36 Chapter 6 Patient Drug Chart/Prescription Aims and objectives Know the importance of a clear, legible prescriptions. Understand the importance of a legal prescription, which adheres to the medicines code. This chapter is linked to Medicines Management e-learning Prescribing and Supply Unit Your Organisations Documents Activity 1 1) Insert a copy of your organisations drug chart here 2) Indicate where the following should be on the drug chart: Patient details, including hospital number. Patient s allergy status. Hospital Site and Ward. Any other charts in use. Where you would find if a take home prescription had been completed for that patient. Consultant name / code. Any additional notes from pharmacy team 36

37 Approved Abbreviations MMA Training Abbreviations on prescriptions, though generally used should be kept to a minimum. The following are the some of the most common standard acceptable abbreviations. Activity 2-explain what these abbreviations mean: Abbreviation BD BNF CD g/mg/ml INH IM IV M/R or S/R NKDA O/A OD OM ON / nocte PO PR PRN QDS SC SL STAT TDS TOP TTO Answer What other common abbreviations are used/have you found? Write them down below: 37

38 The Prescribing Procedure All medication should be prescribed in accordance with organisations Medicines Code. These standards encourage consistent and safe prescribing to improve patient care. 1) Black ink must be used. 2) All patients details should be written in BLOCK CAPITALS to include: Patient s name Patient s Hospital Number Patient s Date of Birth Patient s Weight Patient s allergy status Addressograph labels can be used. MMA Training 3) Medication details should be written in full, in BLOCK CAPITAL LETTERS to include: Generic name for medication (no abbreviations to be used). Proprietary names can be used for preparations containing multiple ingredients. Dose of medication in correct units (micrograms and Nanograms to be written in full). Numbers should only be used when it is not possible to express a dose. e.g. Laxido Avoid use of decimal points where possible. Example: 3mg instead of 3.0mg. The route of the medication should always be stated. Administration to the eye(s), ear(s) or nostril must state whether for the left, right or both. Times of administration should be done using the 24 hour clock. Starting date for administration, if a chart is rewritten the original start date should be indicated on the current drug chart or On admission (O/A). The indication and maximum frequency for PRN drugs. A legible signature of the prescriber and print name. Bleep number of prescriber. Topical preparations, inhalers and eye drops should have strength. Controlled Drugs on Discharge Incorrectly prescribed controlled drugs on TTOs are often a common causes of delays in the patient discharge process. This is often due to missing requirements as below (controlled drugs requirements): In prescribers own handwriting Patients name and address Drug name Form e.g. tablets, liquid Dose and frequency Total number of dose units to be supplied (e.g. tablets, capsules, patches) in words and figures Signed and dated by the prescriber Or The storage of controlled drugs means the prescription is stored in the CD cupboard or part of the prescription has been stored in the CD cupboard. This can lead to prescriptions being misplaced or recorded as missing/lost. Activities for this chapter: 1,2 Mentor signature: 38

39 Chapter 7 Patient Labelled Medicines Aims and objectives MMA Training How to identify medication for a particular patient, to include patient own drugs (PODs). Appropriate storage requirements for medication. What to do if medication is missing. Understand the transfer process of medicines with the patient. The returns and recycling process This chapter is linked to Medicines Management e-learning Safe Handling of Medicines Unit This chapter is linked to Patients Own Drugs Module This chapter is linked to Managing Supply for Individual Patients Module Assessment for this chapter You will be observed up to five times on managing patient s medicines using a set criteria Patient s own Drugs (PODs) Patient s own Drugs (PODs) are often brought into hospital on admission. These need to stay with the patient throughout their hospital stay. Activity 1: Question How can we identify PODs from medication supplied in the hospital? Answer What are the benefits to us and the patient of using PODs on the ward? What do we do to ensure that PODs brought into hospital remain with the patient throughout their stay? Who can check PODs when the patient arrives on the ward to authorise that they are safe to use? How do we destroy expired PODs? 39

40 Named Patient Labelled Medication When identifying medication labelled for a particular patient, we need to establish if the hospital has supplied the medication during the patient s current stay, or if the patient brought it into hospital with them. Check the container- is there a label on it? Is the label from your organisation? Is it dated today / yesterday? Activity 2: Which of the following do you think could be PODs? Medication POD? or Lactulose for Mr Smith labelled by Boots chemist dated 2 weeks ago Paracetamol for Mr smith labelled with your organisations details and dated today Clopidogrel for Mr Smith labelled with your organisations details and dated 2 weeks ago Lactulose for Mr Smith in the bedside locker for Mrs Jones Paracetamol for Mr smith labelled with directions but in the stock cupboard with the rest of the stock paracetamol If the medication has been identified as patients own and has not been checked by the pharmacist or pharmacy technician for the ward, then this must be followed up at the earliest opportunity by the pharmacist / pharmacy technician. Activity 3: Question Why is it important for the PODs to be checked by either a pharmacist or pharmacy technician at the earliest opportunity available? Answer 40

41 Green bags Green bags are for keeping all the patient s current medicines together when they are admitted, transferred between wards and discharged the Green Bag should have a patient label on the bag and should stay with the patient throughout their journey through hospital. The Green Bags should be kept in the bedside medicine locker during the inpatient stay. Further supplies can be obtained from Pharmacy Stores. MMA Training What are the benefits of using the Green Bags? Using the Green Bag to transfer medicines with the patient when they move between wards / get discharged will reduce: missed doses pharmaceutical waste ward staff time spent chasing up drugs the need for re-dispensing in pharmacy Encouraging patients to bring their medication into hospital in the Green Bag will allow continuation of regular medicines without delay, allow a fuller medication history to be taken and allow hospital staff to check for any compliance issues. Note: You need to be careful not to mix up PODs with ward stock. 41