Community Health Services Pharmacy Market Place

Transcription

1 Medicines Use and afety Community Health ervices Pharmacy Market Place Are there any National tandards or Guidelines around which emergency medicines should be held in community and mental health services? We have found CQC guidance for GP practices and further information available for dentists and sexual health services, but nothing for all other services. Do you have a standard list of emergency medicines which should be held on each ward or department within your organisations and would anyone be willing to share this? Many thanks Kym Lowder shared her list from the Out of Hours service Adrenalin Inj.1:1000 (anaphylaxis pack) Benzylpenicillin Inj. Chlorphenamine Inj. Dextrose Gel Diazepam rectal tubes Glucagon Inj. Kit Hydrocortisone Inj. albutamol nebules Naloxone inj Becky White Community Health ervices Pharmacist, Berkshire Healthcare NH Foundation Trust Work Mobile: CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 1

2 Medicines Use and afety Does anyone provide HIV services in the Community? If so, what arrangements do you have for procurement and dispensing? Do you use Homecare supply companies and have you negotiated a gain-share agreement with NHE / Acute Trust? If you don t use local Acute Trusts, do you have access to NH contract prices, and if so, how? Not aware of many community trust with HIV services uggest contact: Kent Community Health CNWL community health Trust Ann Darvill ann.darvill@ccs.nhs.uk CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 2

3 Medicines Use and afety We have written a elf-administration of Medicines (AM) policy for our community hospital wards and have the scheme up and running but have a few teething problems. Has anyone else got a AM scheme up and running smoothly? Can I contact anyone to discuss their scheme in more detail please? Do you include all patients on the scheme even if they are level 1 or are the patients who are not administering their own medicines given their medicine from stock? No replies were received for this but at the May 2015 meeting the following indicated that they had resources they were willing to share Emma Tang - emma.tang@nhs.net Tini Maher tini.maher@nhs.net Trevor Jenkins - trevor.jenkins@sept.nhs.uk Claire Jackson, Hounslow and Richmond Community Healthcare NH Trust claire.jackson@hrch.nhs.uk CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 3

4 Medicines Use and afety Do any areas allow nurse administration of first/second dose antibiotics in patient s homes as part of routine community nursing service/opat/first or rapid response services? We have adult and children s services and variation in practice. Also does anyone have limits on the number of visits required each day for IV administration and/or length of visits (i.e. no infusions/only those requiring a visit of less than 30 minutes etc.) Thank you! We have maximum tds visits with maximum 30 minutes administration time (can push to 45 minutes in exceptional cases). We do infusions but gravity only (no pumps). All first does currently in acute setting. Happy to share policy matthewhuntley@nhs.net During the day delegates were asked if their organisations allow first dose administration of IVs in patient s homes a number of organisations indicated that they did. It was acknowledged that the risk of anaphylaxis may be greater with second or subsequent doses. It was asked if the risk is any different if a doctor gives the first dose or a nurse The final decision was for organisations to make based on a local risk assessment. Jo Jenkins/imon Wan Hertfordshire Community NH Trust jo.jenkins@hchs.nhs.uk/simon.wan@hchs.nhs.uk CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 4

5 Medicines Use and afety Do other trusts have CD requisitions for community hospital wards/clinics (where CD supplied by an external trust pharmacy) signed by a doctor as well as the ordering nurse? Does anyone have this countersignature but use an NMP rather than a medical prescriber? Following discussion with arah Dennison CQC Regulation 14(5)(a) of the MDR 2001 states: (5) A requisition furnished for the purposes of paragraph (2) shall (a)where furnished by the person in charge or acting person in charge of a hospital or nursing home, be signed by a doctor or dentist employed or engaged in that hospital or nursing home; Nurse independent prescribers are authorised to requisition CDs in their own right in the community under Regulation 14. However, this authority is limited to requisition activity within their competence. If the requisition is to be furnished by the person in charge or acting person in charge of a hospital or nursing home, then it must be signed by a doctor or dentist employed or engaged in that hospital or nursing home. o in effect the NIP cannot order on behalf of the hospital or care home but can order stocks needed for their own use and within their competence. Jo Jenkins jo.jenkins@hchs.nhs.uk CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 5

6 Medicines Use and afety : PGDs and electronic sign off We are considering using (JPEG) electronic signatures to streamline the PGD signing process in our Trust this is for our executive /sign off process. This can be problematic with executives being located across our Trust. What have other Trusts done as an alternative to paper solutions (which is time consuming and can cause delays?) I d be interested of electronic solutions used by other Trusts and if there has been any costs involved. We mark in signature box as signature held on file ; we do this when we have an stating that they agree to sign. jo.jenkins@hchs.nhs.uk ee also Further advice from Angela Bussey, National PGD Website pecialist Pharmacist: It is becoming increasingly difficult for organisations to manage signing of PGDs using paper solutions. I favour "electronic" authorisations as the most practical way of dealing with this situation. There is nothing in legislation that states that PGDs must be on paper and the CQC have said that they would be happy with PGDs which have been authorised electronically as long as there is an auditable trail for signatures. What is important is to identify what is the most robust process for the organisation, taking into account version and document control and the ability to keep all relevant s and audit trail of "signatures". We have a FAQ on the website but I think it would be helpful if we could share some examples at some point. The FAQ (and thus the opinion of the PGD Website Board) does say that the use of a JPEG or similar picture of a signature inserted into a file would be unacceptable. However, I know that some organisations do add jpegs of signatures into documents so I must add a Health warning for those who go down this route. The important thing is that these cannot be changed, added, moved or otherwise used at a later date by an unauthorised user. In addition, it is my opinion that if there is evidence of an approval for a document by , there is no need to add in a picture of a signature and in fact, increases the burden of the process. An is associated with an electronic signature but this should of course then be stored and kept on file. CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 6

7 Medicines Use and afety Here at GTFT, we use a document management system where guidelines and PGDs are submitted online. It is not ideal but as people have to log in to the system to approve, again there is an auditable electronic signature. On the very the odd occasion where a signatory has not had access to the system, we have taken an approval. I checked with the MHRA and they were happy with this approach. For Trust authorisation, we say: Authorisation of this PGD was conferred by Guy s and t. Thomas Hospital NH Foundation Trust, Drug and Therapeutics Committee (DTC), using electronic approval systems. For clinical and directorate authorisations, we say: The following have approved this PGD using electronic authorisation systems: Finally, one Trust that I know of is testing e sign and I have asked to be kept closely involved because if it can work for one Trust, it may be very useful for others if it is financially viable. As all IT projects have teething problems, I think it best to leave this with them to pilot for the time being but will keep colleagues up to date as I learn more. Wing Koo, Community services pharmacist, Berkshire Healthcare Foundation Trust Wing.koo@berkshire.nhs.uk CH Market Place 1 Oct (TR) pecialist Pharmacy ervice 7