To contact us please

Transcription

1 Issue 13, June 2015 Newsletter for Care Home staff, General Practitioners and Community Pharmacists The Caring for Care Homes team produced The Medicines Management Checklist in 2010 to provide care homes with guidance and support to meet the Care Quality Committee outcomes 9 standards. Following the launch of the National Institute for Health and Care Excellence (NICE) guidance: Managing medicines in care homes, we have reviewed this checklist. A lot of the information is now included in resources produced by NICE. We have redesigned our checklist to supplement NICE s Checklist for health and social care staff developing and updating a care home medicines policy (May 2014) and to avoid duplication. Using both checklists together will identify what should be included in your medicines policy and the systems that should be in place in your care home. It is advised that both should be completed annually. We have also reviewed the supporting audits that demonstrate whether policies and procedures are being followed at that point in time. These audits should be completed more frequently (recommended every one to two months). We are currently updating our websites and the checklist will be available soon. In the meantime to access our information for care homes including newsletters and guidance sheets please use the these website pathways: Plymouth City Council: Social care and health > Adult social care > Co-operative commissioning > Quality Assurance and Improvement Team > Care home medicines > management steering group Torbay and Southern Devon Health and Care NHS Trust: Home > Your Life > Adult Social Care > Information for Providers > Medicines Management: caring for care homes NHS NEW Devon CCG: Home > Information For Patients >Medicines And Treatments > Information For Healthcare Professionals > Care homes Devon County Council - Provider Engagement Network (PEN): Home > Health In March 2011, following the review of significant events involving repeat prescriptions for care homes (one of which had led to a death), the monthly medication ordering request process for Care Homes, GP Practices and Pharmacies was introduced. Four years on, we have now updated the process flowcharts to incorporate various changes including the implementation of NICE guidance on managing medicines in care homes and the increase of prescriptions being sent electronically. Across the country GP Practices are being encouraged to increase the number of prescriptions sent electronically. This will mean fewer prescriptions will be produced on paper, so care homes will find it increasingly difficult to collect prescriptions from the GP practice for checking before sending to the pharmacy. With this in mind it is important that everyone understands their responsibility in the checking process and that any queries and discrepancies are checked with the prescriber and information communicated to the relevant parties. It is recognised that one of the most vulnerable steps in a Care Home monthly medication ordering process is incorporating mid cycle medication changes. It is everyone s responsibility to ensure these changes are reconciled correctly. By working together we can improve the care of this vulnerable group of patients. Please can we ask you review your current procedures in line with the new process flowcharts to ensure we are working collaboratively? Thank you everyone for your continued support. To contact us please D-CCG.CaringForCareHomes@nhs.net

2 The Medicines Optimisation Team work closely with GP practices to review areas of prescribing where potential savings can be made with minimal effect on residents. Any changes which occur will be considered by the GP on an individual patient basis. Please see table on the right for recent changes. Please note that in some cases when a resident is discharged from hospital their medication may be prescribed generically. If you have any concerns or are unsure about any medications your resident is receiving please contact your pharmacist. We hope this summary of changes is of use to you and your staff in your day to day work and will ensure you are updated when relevant. Formulary preferred brand Accrete D3 Circadin (Melatonin MR 2mg tablets) Generic Calcium and Vitamin D All Melatonin Other brand names Adcal-D3 or Calcichew D3 Forte Bio-melatonin Eppinix Ropinirole MR Requip MR Luventa XL Galantamine MR capsules Reminyl XL Marol Sukkarto SR theical-d3 (Once a day) Vensir XL capsules Zaluron Tramadol 12 hourly MR Metformin MR 500mg and 1000mg Calcium and Vitamin D Venlafaxine modified release Quetiapine MR Zydol SR, Zamadol SR Glucophage SR Adcal-D3 or Calcichew D3 Forte Efexor XL Seroquel XL, Ebesque XL We have had several queries regarding asking visiting nurses or doctors to sign Controlled Drugs (CD) Registers in residential care homes if they are administering a CD to a resident. Whilst they will complete their own administration records they should also sign the CD register at the care home, witnessed by an appropriate member of care home staff. Visiting healthcare professionals may not remember the need to do this, but should be prompted by the care home staff to ensure the CD register entry is completed and all usage is correctly documented. Where supplies of CDs have been bought into the home by a community nurse (for example to set up a syringe driver) the supply should be recorded in the CD register, and the administration should then be recorded. Do you have clear guidance in place which sets out how to share a resident s information with your community pharmacy? How often do you share your resident s weight? The weight of patients is not frequently shared with community pharmacists and the majority of MAR charts do not have a specific box where this information can be recorded. However, many frail elderly patients may be underweight and this could affect how their medicines work. For example they may be more at risk of side effects. By sharing the patient s weight with your community pharmacy this will allow pharmacists to ensure the medication dose is appropriate for their weight. An example relevant to many care homes residents is the use of paracetamol; as the dose needs reducing in patients who weigh less than 50kg. It is also important to note, record and share the information with the pharmacy and the resident s GP of any noticeable changes in weight which may occur. Community pharmacists should consider how they will document this. One option could be having a pop-up message saying Underweight patient: Check doses. CD Incident? Report it to the CD Accountable There is a new Accountable Officer for Controlled Drugs in the NHS England, Devon, Cornwall and Isles of Scilly Area Team: Sue Mulvenna. Contact details for incidents: Telephone No: Mobile No: Don t forget that locally all Controlled england.southwestcontrolleddrugs Drug (CD) related incidents should be reported to the Deputy Accountable Officer for the Devon and Cornwall area: Darren Barnett.

3 Ordering process for Care Home Care Home collects together MAR charts, the most recent repeat slips and any new hospital discharge documents or medication change forms. Remember: Check carefully for changes that may have been made mid-cycle as they are often contributing factors in medication errors. For as required items and dressings, check if more stock is required (these items should not be returned if still in use). On the repeat slip mark clearly against all required items. Do not mark against any items not required this month (unmarked items will still appear on the repeat slip next time). On the repeat slip cross through items no longer being taken and mark remove. If the repeat slip does not match the MAR sheet (e.g. different dosage directions), mark the item required and clearly write the dosage currently being taken next to the item. Highlight the item and add a note to say dosage different, please clarify with prescriber. If an item is not listed on the repeat slip, add the full details to the bottom of the repeat slip. Include the drug name, strength, form, dosage and quantity required. If there is not enough room to write on the repeat slip, staple an additional sheet with the patient s name, date of birth and address as well as the details of the item required. Inform of any changes in allergy information. Care Home sends completed repeat slips (and where agreed, a copy of the MAR) to the GP surgery to generate the prescriptions. GP sends prescriptions to the pharmacy / dispensary to be dispensed. Medication is received by Care Home for checking against the original order and the current MAR sheet for accuracy. Care Home retains repeat slips ready for next month s ordering. Care Home Ordering Process_v2_2015_Ordering Process for Care Home_Review date: June 2015

4 Prescribing process for GP Practice Repeat slips / requests (and where agreed, a copy of the MAR) are received from the Care Home for monthly medication order. Repeat slips are checked carefully against the screen to ensure drug, strength, dose and quantity details match. Remember: The care home may have made amendments to the repeat slip to include medication changes made during the month and since the last repeat slip was issued. Any such changes must be checked with the prescriber. Ensure only the items marked on the repeat slip are issued the care home may not need everything. Ensure any differences from the repeat screen and any requested additions, amendments or discontinued items are highlighted to the prescriber and are clarified before continuing. Remove medication from the repeat screen if no longer required, ensuring only current therapies are listed on the repeat slip. Update any allergy information received. Prescriptions are generated, checked and signed by the prescriber. Prescriptions sent to the pharmacy / dispensary for dispensing. If any discrepancies are found by the Pharmacy they will contact the GP surgery for clarification and a new prescription should be generated if appropriate. Care Home Ordering Process_v2_2015_Prescribing process for GP Practice_Review date: June 2015

5 Dispensing process for Pharmacy / Dispensing Practice Pharmacy / Dispensary receives care home prescriptions (and where agreed, a copy of the MAR). Pharmacy / Dispensary checks carefully the prescription against the patient medication record (PMR) to ensure drug, strength, dose and quantity details match. If a copy of a hospital discharge document has been received, ensure medicines have been reconciled correctly. Ensure any mid-cycle changes have been incorporated by checking the PMR and any medication change forms. Update any allergy information received. Ensure any differences from the PMR, additions, amendments and deletions are confirmed with the prescribing GP. Any differences must be clearly documented. In a Pharmacy these must be highlighted to the Pharmacist undertaking the clinical check. Contact the care home to ensure they are aware of any outcomes. Where informed and confirmed, discontinued items should be removed from the current medications listed on the PMR (ensuring only ongoing therapies are visible on the MAR). Medication is dispensed for Care Home in line with own standard operating procedure (SOP). Remember: Check carefully for changes that may have been made mid-cycle as they are often contributing factors in medication errors. Completed monthly medication order is sent to the Care Home for checking. Ensure repeat slips are included to enable the care home to request the following month s medication. Care Home Ordering Process_v2_2015_Dispensing process for Pharmacy / Dispensing Practice_Review date: June 2015