Administration of Medicines by Powys Community Nurses and Allied Health Care Professionals to Residents in Glan Irfon

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Administration of Medicines by Powys Community Nurses and Allied Health Care Professionals to Residents Document Code PTHB / CDP 013 Date Version Number Review Date May 2014 1 May 2017 Document Owner

1 Administration of Medicines by Powys Community Nurses and Allied Health Care Professionals to Residents Document Code PTHB / CDP 013 Date Version Number Review Date May May 2017 Document Owner Approved by Date Head of Pharmacy Clinical Effectiveness Committee 13/05/2014 Document Type Policy Scope Registered Nurses and other Health Care Professionals employed by Powys Teaching Health Board requested to administer medication to residents. GP s, ShropDoc or other independent prescribers providing a service to Glan Irfon. Glan Irfon provider staff Local Community Pharmacies Medicines Management Team Mid Locality Management Team Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys Powys Teaching Health Board is the operational name of Powys Teaching Local Health Board

2 Contents Page Validation Form 3 Consultation 4 Equality Assessment 5 Relevant to 6 Purpose 6 Definitions 7 Process 8 Responsibilities 13 For Reviewed &/or Updated Policies Only: Relevant Changes The following amendments were made in agreement with the previous designated document owner the Director of Nursing: Date 24/08/2015 Coding. Changed from GBP 055 to M&NP 012 to reflect the cross/multi discipline scope of the document Ownership. Changed from DoN to Head of Pharmacy/Research & Development to reflect the subject of the document and reflecting line management of the document author. Publication. To be relocated from Nursing to Cross &/or Multi Discipline folder for online access. Coding. Changed from M&NP 012 to CDP 013 by Corporate Governance Department 25/01/2018 Page 2 of 13 Review Date: May 2017

3 VALIDATION FORM To be completed by the Author no policy, procedure or guidance will be accepted without completion of this section which must remain part of the policy Title: Policy for the Administration of Medicines by Powys Community Nurses and Allied Health Care Professionals to Residents Author: Jayne Price. Medicines Management Pharmacist Directorate: Primary & Community Care EVIDENCE BASE Are there national guidelines, policies, legislation or standards relating to this subject area? Human Medicines Regulations 2012 PTHB/MMP 001 Medicines Policy DOING WELL, DOING BETTER - STANDARDS FOR HEALTH SERVICES IN WALES Please state which Health Services Standards this policy will support / link to: Standards 9 Patient Information & Consent Standard 10 Dignity & Respect Standard 13 Infection Prevention & Control & Decontamination Standard 15 Medicines Management CONSULTATION Please list the groups, specialists or individuals involved in the development & consultation process: Name Date Lead Nurse Mid Locality Aug 2013 Senior Nurse Mid Locality Aug 2013 Senior Nurse Mid Locality Aug 2013 Head of Pharmacy Aug 2013 IMPLICATIONS Please state any training implications as a result of implementing the policy / procedure. Please state any resource implications associated with the implementation. Please state any other implications which may arise from the implementation of this policy/procedure. Page 3 of 13 Review Date: May 2017

4 Equality Assessment Statement Please complete the following table to state whether the following groups will be adversely, positively, differentially affected by the policy or that the policy will have no affect at all Equality statement No impact Adverse Differential Positive Comments Age Disability Gender Race Religion/ Belief Sexual Orientation Welsh Language Human Rights RISK ASSESSMENT Are there any new or additional risks arising from the implementation of this policy? No Do you believe that they are adequately controlled? N/A Page 4 of 13 Review Date: May 2017

5 Introduction Glan Irfon is a Health and Social care facility in Builth Wells. It is a joint project between Powys Teaching Health Board and Powys County Council. The facility will have:- downstairs area leased to Powys Teaching Health Board which will offer outpatient services in the same way as currently provided at Builth Cottage Hospital. upstairs area which will have a total of 12 beds and will be registered with the Care and Social Services Inspectorate Wales (CSSIW) as a residential home. For the purposes of this document it is the administration of medicines to the upstairs residential home area that will be considered only. The supply and administration of medicines to the downstairs outpatient facility will continue in accordance with the Powys Teaching Health Board Medicines Policy and will therefore be unchanged from the current systems for outpatients at Builth Cottage Hospital. The upstairs 12 bed area will be operated by BUPA with unregistered care staff. PTHB community staff will attend as necessary to support more complex medication or other clinical needs, for example administration of insulin, IV antibiotics, parenteral fluids or syringe drivers. Purpose of Policy To support PTHB employed community staff in the administration of medications to residents of Glan Irfon. To describe the process of the administration of medications by PTHB community nurses to residents of Glan Irfon To clarify the responsibilities of:- Prescribers PTHB Community Staff BUPA home care provider Medicines Management Team Definitions Administer: To introduce a medicine into a patient by means of enteral (oral) or parenteral (injection) route or by external application. All Wales Long Stay In-patient Medication Administration Record This administration record is a chart that allows up to 35 days of medication administration and is the chart used in all Powys community hospitals. It is also already in use and familiar to PTHB Community teams e.g. this chart is included in the Powys Palliative Care Just in Case boxes. This administration record is ordered through Oracle using the order code AWMR05. Page 5 of 13 Review Date: May 2017

6 An example of this record is available on the All Wales Medicines and Strategy Group (AWMSG) website: n-patient%20medication%20record.pdf This document will abbreviate this record as the All Wales chart. Anaphylaxis Pack Community anaphylaxis packs can be obtained on requisition from Nevill Hall Pharmacy. The pack contains 2 ampoules of adrenaline 1 in 1000 (1mg in 1ml) but does not contain needles or syringes which must be obtained separately. Community Pharmacy A retail Pharmacy ie not attached to a hospital, A Community Pharmacy can dispense prescriptions, produce MAR charts and other compliance aids and will supply and sell certain medications. Community Pharmacies also provide advice on safe and effective use of medicines. Homely Remedies Medicines for minor ailments that could be bought over the counter such as paracetamol for headaches or indigestion remedies. Residential homes may purchase these GSL or P classified medicines and store for use by their residents. Any home using homely remedies is encouraged to have a policy to ensure safe use. MAR Chart A MAR chart is a Medicine Administration Record, it is not a prescription. It is usually compiled and supplied by a Community Pharmacy when dispensing medications for nursing or residential homes from a prescription (WP10) supplied by a GP. Legally there is nothing precluding anyone from adding a medication to a MAR chart and some homes may write homely remedies or antibiotic courses on the chart themselves. Parenteral Route of Administration The parenteral route of administration is by any injectable route and includes intramuscular, subcutaneous or intravenous routes. PTHB Medicines Policy This policy outlines the legislative and best practice requirements for medicines management in the organisation. PTHB Drug Formulary The Powys Drug Formulary is decided by the Primary Care Drug and Therapeutics committee which includes GP s, Consultants and Pharmacists from across the county. It identifies the drugs that are considered suitable for prescribing in Powys. Page 6 of 13 Review Date: May 2017

7 The formulary is available on the internet - PROCESS Prescribing of Medication Any medication intended to be administered by a PTHB community nurse must be prescribed on an All Wales Long Stay In-patient Medication Administration Record. PTHB community nursing staff will not administer medication documented on a MAR chart. Medication may be prescribed on the All Wales chart by:- Powys GP s contracted to provide services to Glan Irfon ShropDoc Doctor when providing emergency out of hours cover PTHB employed Independent Prescriber registered as such with the NMC, GPhC or HPC. Prescribing is expected to be in accordance with the PTHB Medicines Policy and PTHB Drug Formulary. Any diluents or flushes needed to administer a particular drug should also be prescribed. Please note the prescribing of medications on the All Wales chart alone does not allow a supply to be made see supply of medication section. Other medications not intended to be administered by the PTHB community team will be documented on a MAR chart in accordance with BUPA policies and procedures. The prescriber must consider medications on the most recently available MAR chart for the patient before making prescribing choices for the All Wales chart, this is to ensure that there are no duplications of medication or unintended drug interactions. The prescriber must make reference on the All Wales chart that a MAR chart is in use for the patient by entering in the DETAILS OF SUPPLEMENTARY CHARTS box under OTHER (PLEASE SPECIFY) MAR Chart. Referral to PTHB Community Team for the Administration of Medication The prescriber must make a referral to the PTHB community team in the normal way when a drug has been prescribed that they will be required to administer. The referral must include:- Requestor details GP name, practice & contact details Full patient details name and date of birth Page 7 of 13 Review Date: May 2017

8 Medication name, dose, route, frequency, anticipated length of treatment and any additional instructions for administration. Clinical indication for drug. Other clinical and medication history of patient. Mechanism for supply of drug. Supply of Medication For this section, only the supply of medication for administration against the All Wales chart is considered and medicines on the MAR chart should be obtained in accordance with BUPA s normal policies and procedures. The supply of medicines documented on the MAR chart is not the responsibility of PTHB staff. The upstairs bedded area of Glan Irfon is registered as a residential home and therefore there is no legal mechanism of obtaining stock medication of prescription only medicines. All medication supplied to the upstairs area must be on a named patient basis only by:- WP10 prescription dispensed at a Community Pharmacy or GP dispensing practice. Discharge medication sent from a DGH Patients Own Medication brought in from home i.e. previously prescribed and dispensed for them. Emergency supply made by ShropDoc Direct labeled supply from an Accident and Emergency Department or Minor Injuries Unit. Medication classed as a homely remedy. Medication purchased by a patient. It is the responsibility of the prescriber to ensure that the medication chosen is available and the mechanism of obtaining. Consideration should also be given to the availability of any diluents or flushes required for the administration of the drug, these will not be available as stock and therefore will also need to be obtained on prescription. Local Community Pharmacy contacts (please note, opening times are subject to change):- Boots Pharmacy Builth Wells 11 High Street, Builth Wells, Powys, LD2 3DN Tel: Open: Mon-Fri: 9am to 6:30pm, Sat: 9am to 5pm, Sun: Closed. Closed for lunch 1pm 2pm. Lakeside Pharmacy Llandrindod Wells Princess Avenue, Llandrindod Wells, Powys, LD1 5HU Tel: Open: Mon-Fri: 8.30am 5.30pm, Sat: 9am to 1pm, Sun Closed Page 8 of 13 Review Date: May 2017

9 Rota session Mon-Fri 5.30pm to 6pm 1 week in two Closed for lunch Mon-Fri 12.30pm 1pm. Boots Pharmacy Llandrindod Wells Victoria House, Llandrindod Wells, Powys, LD1 5BB Tel: Open: Mon-Fri: 8.30am 5.30pm, Sat: 8.30am to 5.30pm, Sun: Closed Closed for lunch 1pm 2pm Rota session Mon Fri 5.30pm 6.30pm 1 week in two. P&C Davies (Llanwrtyd Wells) Ltd The Healthcentre, Ffos Rd, Llanwrtyd Wells, Powys LD5 4RG Tel: Open: Mon, Tue, Thur, Fri: 8.30am to 4.30pm, Wed 8.30am to 5.30pm. Closed Sat and Sun. No lunchtime closing. Note community pharmacies have a limited product range and may have difficulty obtaining injectable medicines in a timely manner if at all. For any support in obtaining medicines for the Glan Irfon upstairs area please contact the Medicines Management Team on (in hours, Monday to Friday 9 5pm) and Nevill Hall out of Hours. PTHB community nurses will be expected to have an in date anaphylaxis pack with them when attending Glan Irfon to administer medication. These do not need to be supplied on an individual patient basis. Nevill Hall Pharmacy will continue to supply the PTHB maintained downstairs outpatient area with stock drugs but there is no mechanism for them to supply medications for the upstairs area. Medications must not be obtained for patients in the upstairs area from:- Downstairs area of Glan Irfon Any other Powys Community Hospital medication stocks. Medication used in the Glan Irfon upstairs area must be prescribed, dispensed and labeled for that particular patient. The only exceptions are medication purchased over the counter for that patient, a Glan Irfon obtained homely remedy or anaphylaxis pack. Any significant issues in obtaining supplies for the Glan Irfon upstairs area should be reported through the senior nurse and on Datix. PTHB community team should only be expected to collect and transport medicines in exceptional circumstances and provider staff would normally be expected to collect medications. Equipment for the Administration of Medication Page 9 of 13 Review Date: May 2017

10 Any equipment needed for the administration of medications, such as syringes, needles, swabs, alcohol gel, gloves, aprons, administration sets, syringe drivers or infusion pumps should be obtained in accordance with normal PTHB policies and procedures. Storage of Medication Medications will be supplied on a named patient basis and will be stored in accordance with the Glan Irfon provider policies and procedures. Which may include in the patient s/resident s own room. PTHB community staff may be required to give advice (or refer to the Medicines Management team) on the safe and appropriate storage of medication to Glan Irfon staff e.g. ensuring cold chain of medications. Any concerns regarding the storage of medication should be reported to BUPA Home care manager, senior nurse and on Datix as appropriate. Administration of Medication Administration of medication must be carried out in accordance with the PTHB Medicines Policy which encompasses the Guidelines for the Standards for Medicines Management (NMC 2008) and within the PTHB community nurse s competency. PTHB community nurses will only be responsible for administering medication on the All Wales Chart following referral from a prescriber. Cross Reference to the most recent MAR Chart The prescriber should have indicated on the All Wales Chart if a MAR chart is in use under the SUPPLEMENTARY CHARTS section on the All Wales Chart. Even if it is not stated the PTHB community team member should establish with Glan Irfon staff if a MAR chart is in use. PTHB community team will not be responsible for administering medications on the MAR chart. But as a healthcare professional there is an expectation that there would be a holistic approach to patient care and therefore the patient s MAR chart should be reviewed. A PTHB community team member should consider duplications, and unintended drug interactions and any concerns with regard to the use of the MAR chart by Glan Irfon staff e.g. omitted medication, should be reported to the Glan Irfon Provider Manager, prescriber/gp, senior nurse and on Datix as appropriate. Note there may be variations in how MAR chart medications are taken. Some residents may be fully independent and able to self administer, some may require support to take their medication e.g. help with opening packaging or reminding to take and others may need complete administration. Glan Irfon staff may be trained to administer medications in the form of tablets or capsules for example, but would not be able to Page 10 of 13 Review Date: May 2017

11 undertake more complex medication administration, such as parenteral administration. Recording Administration of Medication The recording of administration of medication should be made on the All Wales Chart and in accordance with the PTHB Medicines Policy. Adverse Reactions to Administered Medication The response to adverse reactions to medication should be in accordance with PTHB medicines policy. Remember when considering adverse reactions to review medications on the MAR chart as well as the All Wales chart. PTHB community staff will carry anaphylaxis packs with them when attending Glan Irfon for the administration of medication. Report any adverse reactions to prescriber/gp and advise colleagues/glan Ifron staff suspected medication must not be administered until advised by prescriber/gp. Disposal of Medication Medications no longer required or part used and disposable equipment should be disposed of in the normal manner in accordance with the PTHB Waste Management Policy. Under no circumstances should excess medication be stored for future use or for another patient/resident. Waste created by PTHB staff i.e. any medicines for administration by PTHB staff should be destroyed in a Powys waste stream in the dedicated appropriate waste receptacles kept in the downstairs area. Glan Irfon staff should discard unneeded medications in accordance with their own policies and procedures and should not use PTHB waste streams. Training on Medication Administration In some cases PTHB may be required to train Glan Ifron staff and/or patients/residents in the administration of medications by some routes. For example use of inhalers or eye-drops. Training must only be given if in agreement with PTHB senior nurse and Glan Irfon provider manager. Responsibilities Prescriber Responsibilities Prescribing in accordance with the PTHB Medicines Policy and PTHB drug formulary. Prescribing on the All Wales Chart for medication to be administered by PTHB Community Nursing Team Page 11 of 13 Review Date: May 2017

12 Cross referencing any MAR chart in use for the patient on the All Wales chart and checking to ensure no duplications or unintended drug interactions between charts. Ensuring the availability of the prescribed medicine and mechanism of obtaining. Referral to the community nursing team for administration. PTHB Community Nursing Team Responding to the referral for medication administration at Glan Ifron in a timely manner, prioritising as appropriate. Advising Glan Ifron staff on appropriate storage of medication when appropriate Double checking any MAR chart for duplications or drug interactions with medication on All Wales Chart, referring to the prescribing doctor/gp as appropriate. Highlighting any concerns with the MAR chart for example appropriate choice of medication for the patient, omissions in administration and referring to the Glan Ifron manager, prescribing doctor/gp as appropriate. Reporting errors, omissions, concerns or incidents via Datix. Administering medication in accordance with the PTHB Medicines Policy and NMC guidelines. BUPA Care Staff Medicines to be administered by PTHB community team must be stored in a designated area with. Any medicines stored in this way must be in accordance with the PTHB medicines policy. Collecting medication supplies Medicines Management Team Responsibilities Supporting prescribers and PTHB community nurses in obtaining medication for administration by PTHB community nurses. The Powys MM team based are responsible for supporting the implementation of this policy. Providing advice on safe and correct storage of medications. Responsible for reviewing this policy and mechanisms for medication supply in conjunction with the Mid Locality management team. Responding to incidents reported through Datix as appropriate and as requested by the Mid Locality Management team. Page 12 of 13 Review Date: May 2017

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