Issuing take home medication (TTAs) in pre-packs directly to patients from maternity wards

Issuing take home medication (TTAs) in pre-packs directly to patients from maternity wards Controlled document This document is uncontrolled when downloaded or printed. Reference number Version 1 Author WHHT: MM088 Rekha Shah Margaret Turner Date ratified March 2015 Committee/individual responsible MUSP Issue date March 2015 Review date March 2017 Target audience Key Words Previous Policy Name Maternity Staff TTAs New policy Author: Rekha Shah Review Date: March2017 Page 1 of 19

CONTRIBUTION LIST Key individuals involved in developing this version of the document Name Rekha Shah Margaret Turner Designation Approved by Committee (date) Change History Version Date Author Reason Author: Rekha Shah Review Date: March2017 Page 2 of 19

CONTENTS 1 Introduction... 4 2 Purpose... 4 3 Duties and Responsibilities... 4 4 Process for monitoring compliance... 4 4.1 Procedure for issuing pre-pack drugs directly to the patients from the wards... 5 5 References:... 7 6 Appendix 1 Checklist for assessing competency of midwife issuing... 8 7 Appendix 2: List of midwives authorised to issue pre-packs.... 10 8 Appendix 3 List of Pre-pack medication available for use on the Maternity wards... 12 9 Appendix 4: Checklist for prescription requirements and issuing pre-packs 13 10 Appendix 5 Pre-pack Issues Log Sheet... 14 11 Appendix 6: Checklist for giving out pre-packs... 15 12 Equality Impact Assessment... 16 13 Policy and Procedure Sign-off Sheet... 17 14 Policy Ratification Form... 18 Author: Rekha Shah Review Date: March2017 Page 3 of 19

1 Introduction Timely and safe patient discharge is a priority for West Herts Hospitals NHS Trust. Delays in supplying patients TTAs can contribute to delays in discharges. Often patients go home, intending to collect their medication later. A number of patients do not return. Maternity patients are requested to bring in any regular medication they are taking on admission to the unit. The Trust operates a one stop dispensing policy whereby patients own drugs (PODs) are used during their in patient stay if continued on this medication. These should be prescribed on the TTA and it is the responsibilty of the midwife discharging the patient to ensure that the patient s own medication is returned to the patient on discharge from hospital providing that the patient is to continue on this medication. Most maternity patients go home on some combination of analgesia, antibiotics, laxatives, iron tablets and low molecular weight heparin (LMWH) medication. Prepacks of these drugs are available for use in the Trust. 2 Purpose To ensure a safe, efficient and uniform system of issuing pre-packs to maternity patients on their discharge. 3 Duties and Responsibilities It is the responsibility of the Women s Services pharmacist, the midwifery staff and the obstetric medical staff to implement this policy. The Pharmacy Department must ensure that stocks of the pre-pack medication are available on the wards. The Women s Services pharmacist or deputy must ensure that the midwives have received training in issuing these pre-packs. It is the responsibility of all the midwives who are involved in issuing pre-pack medication to have undergone the relevant training and signed the competency checklist before issuing pre-pack medication. 4 Process for monitoring compliance There will be an ongoing programme of audit to ensure the system is operating as described in this policy. Author: Rekha Shah Review Date: March2017 Page 4 of 19

4.1 Procedure for issuing pre-pack drugs directly to the patients from the wards 1) Medical staff should be aware that these prescriptions have not been clinically screened by a pharmacist and that they take full responsibility for the required checks normally completed by a pharmacist. 2) Each midwife authorised to issue pre-pack medication on the maternity wards should complete the training on issuing pre-pack TTAs and sign the competency checklist (Appendix 1). The pharmacist on the wards will provide the training. 3) The ward manager should keep a list (Appendix 2) of the authorised midwives on the ward where they issue these pre-packs and a copy of this should be kept in the pre-pack recording file. 4) All drugs issued directly to patients must be in labelled prepacks supplied by the pharmacy department. Drugs must not be issued from the ward stock. 5) A pre-pack list will be available on each maternity ward (Appendix 3). This will be attached to the front of the pre-pack cupboard on each maternity ward at WGH. 6) Medication must not be transferred from one container to another. 7) All the medicines on the pre-pack list are available as a pre-labelled patient pack with the instructions printed on the label. 8) The prescription should be written as normal and signed by a Doctor or Non medical presciber. 9) Prescriber must ensure that the wording of the prescription corresponds exactly with the label on the pre-pack. 10) It is the responsibility of the prescriber to ensure that there are no allergies, contraindications or drug interactions prior to prescribing. 11) Requests for discharge drugs which are not available as pre-packs must be sent to the pharmacy on a TTA form. If a TTA form has some medication available as pre packs and some medication to be dispensed from the pharmacy then this TTA should be sent down to pharmacy for dispensing. 12) Labelled medication that has been sent up for patients as one stop medication must be prescribed on a TTA and checked off by a pharmacist before handing it to the patient. 13) There should be 2 midwives involved in the supply of the pre-pack: a midwife issuer and a midwife checker. Author: Rekha Shah Review Date: March2017 Page 5 of 19

14) The midwife issuing the pre-pack against a prescription should ensure that : The prescription is written as per the following legal requirements. Written in ink or otherwise indelible Name and address of patient (usually via addressograph) Date of birth or age Drug and strength written appropriately Directions written appropriately Quantity mentioned clearly Signature of Doctor or Non medical presciber Dated The patient is not allergic to the prepacked medication. See the checklist. This will be attached to the front of the pre-pack cupboard (Appendix 4) 15) The midwife checking the pre-pack against a prescription should ensure that: The pre-pack drug is: The same drug as prescribed The correct strength The correct quantity In date (check expiry) Labelled with the correct patient name Issued with the correct date of dispensing Handed to the patient with correct verbal and written instructions The patient is not allergic to the prepacked medication See the checklist. This will be attached to the front of the pre-pack cupboard (Appendix 4) 16) Labels should not be amended or altered. 17) A record of all supplies should be made in the issuing log sheet (Appendix 5). This sheet should be stored in the pre-pack folder with the pre-packs. This is good practice. 18) The prescription form and the issuing log sheet should be endorsed with the following: Date issued. Patient Addressograph Medication Supplied Quantity supplied, Batch number and Expiry date Signature of the issuer and checker Author: Rekha Shah Review Date: March2017 Page 6 of 19

19) Random documentation audits will be carried out by pharmacy staff. 20) Pre-packs should not be supplied to other wards unless authorisation has been obtained from pharmacy.this authorisation should be recorded in the issuing log sheet with the authoriser's name, contact number, bleep and/or extension. 5 References: 1. Medicines Management Policy, WHHT, 2012 2. Bailey G, Procedure for Take Home Medication on Adult Short stay Surgical Areas; Cardiff & NHS Trust Vale, 2006 3. Bennett G, Skipper P, Competency Checklist for nurse dispensing on F1 South; University Hospital of South Manchester, NHS Foundation Trust: March 2008 4. Lapsley R, Trust Policy for supply of Medicinal Products in Pre-packs to patients directly from wards and Departments by Non Pharmacy Staff, East & North Herts NHS Trust, 2008 Author: Rekha Shah Review Date: March2017 Page 7 of 19

6 Appendix 1 Checklist for assessing competency of midwife issuing Checklist for assessing competency of midwife issuing ALL criteria must be met for midwife issuing to occur Criteria met? Staff Criteria Midwife qualified for 6 months or more Midwife signed to say they have completed the relevant training Midwife issuer (For each TTO a midwife can either fulfil the issuing OR the checker role NOT both) The midwife has checked with the patient if he/she takes any prescribed medication The midwife has checked that the patient has supplies of this prescribed medication The allergy status of the patient should be stated on the discharge prescription - NKDA or the allergy/intolerance written in the allergy/intolerance box Midwife has checked the allergy status is not compromised by the prescribed medication Midwife has checked the prescription for legality (Appendix 4) Midwife has checked that the prescription contains medication available on the pre-pack list (Appendix 3) Midwife has checked the patient does not have any contraindications to the prescribed medications. Midwife has checked that the doses prescribed on the TTA match the doses on the list of pre-pack medication (Appendix 3). Midwife has selected the correct medication(s) for discharge from the ward prepack & the label is completed to include name of the patient and the date of issuing A patient information leaflet has been provided in the pre-pack The midwife has endorsed the TTA with the amount supplied and signed the TTA. The midwife has completed the issuing log sheet (Appendix 5) Midwife Checker This must be a different midwife than the one who issues the prescription Midwife has checked the name and strength of the medication matches the prescription Midwife has checked quantity dispensed matches the prescription Midwife has checked the patient s name is present and correct Midwife has checked the directions for use are present and correct Midwife has checked correct patient information leaflet has been supplied Midwife has checked the date of supply is on the medication Midwife has checked the medication is in date Author: Rekha Shah Review Date: March2017 Page 8 of 19

Midwife has signed the discharge prescription in the checking box Midwife has completed the issuing log sheet Midwife has filed the white copy of the prescription in the pre-pack file Counselling Either the midwife issuer or checker may counsel the patient regarding their medications Midwife has told the patient the name of medication Midwife has explained to the patient what the medication is for Midwife has explained how to use the medication Midwife has told the patient about any precautions/warnings they need to take note of Author: Rekha Shah Review Date: March2017 Page 9 of 19

7 Appendix 2: List of midwives authorised to issue pre-packs. List of midwives authorised to issue pre-packs Date Name of midwives Signature Author: Rekha Shah Review Date: March2017 Page 10 of 19

Author: Rekha Shah Review Date: March2017 Page 11 of 19

8 Appendix 3 List of Pre-pack medication available for use on the Maternity wards Name of Drug and Strength Directions Pack Size Stock 1 Amoxicillin 500mg capsules ONE to be taken THREE times a 21 3 day 2 Cefalexin 500mg capsules ONE to be taken THREE times a 21 10 day 3 Co- Amoxiclav tablet 500/125mg ONE to be taken THREE times a 21 10 day 4 Co-Dydramol Tablet 10/500 ONE or TWO to be taken every 30 40 FOUR to SIX hours,maximum 8 tablets in 24 hours 5 Diclofenac Sodium E/C 50mg tablet 6 Enoxaparin 40mg/0.4ml syringe ONE to be taken THREE times a 28 30 day 40mg to be injected 6 40 subcutaneously.. times daily as directed 7 Erythromycin 250mg tablets (Victoria ward only) Take tablet times daily 28 2 for.. days 8 Ferrous Sulphate Tablet 200mg ONE to be taken.. times a 28 5 day 9 Flucloxacillin Capsules 500mg ONE to be taken FOUR times a 28 2 day 10 Ibuprofen Tablet 400mg ONE to be taken THREE times a 24 5 day 11 Lactulose Solution 3.35g in 5ml.. 5ml spoonfuls to be taken 200ml 10. a day 12 Metronidazole Tablet 400mg ONE to be taken. times a 21 10 day 13 Ranitidine 150mg tablets (ANC only)) Take one tablet 12 hours before 2 30 and one 2 hours before caesarian section. List of Pre-pack medication available for use on the Maternity wards Author: Rekha Shah Review Date: March2017 Page 12 of 19

9 Appendix 4: Checklist for prescription requirements and issuing pre-packs Checklist for prescription requirements and issuing pre-packs All pre-packs to be given out only if the prescription meets all the criteria mentioned below 1 Age / Date of birth of Patient 2 Name of the Patient 3 Drug name written in full 4 Drug Strength written clearly 5 Directions written appropriately 6 Total quantity or duration 7 Signature of doctor and contact or Bleep number 8 Date All the pre-packs should be checked for the following details on the label before being handed out to the patients. 1 Dose and direction to match prescription and prepack 2 Name of the patient entered in space provided 3 Date of dispensing entered in space provided 4 Use by date/ Expiry date checked 5 6 Quantity to match Prescription and pack size (do NOT split or mix boxes ) Ensure number of days for duration of antibiotic is completed 7 Ensure appropriate verbal instructions patient information leaflet are given Author: Rekha Shah Review Date: March2017 Page 13 of 19

10 Appendix 5 Pre-pack Issues Log Sheet Date time & Patient addressograph Medication Quantity Batch No / Expiry date Midwife signature Midwife checker Comments Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 14 of 19

11 Appendix 6: Checklist for giving out pre-packs Check list for Giving out Pre-packs West Hertfordshire Hospitals NHS Trust Mr. xyz 30.01.09 7 All pre-packs to be given out only if the Prescription meets all the criteria Mentioned below. 1. Age / Date of birth of Patient. 2. Name of the Patient. 3. Drug name written in full. 4. Drug Strength written clearly 5. Directions written appropriately. 6. Total quantity or Duration. 7. Signature of doctor and contact or Bleep number. 8. Date. All the Pre-packs should be checked for all the following details on the Pre-pack before being handed out to Patients. 1. Dose and direction to match prescription and pre-pack. 2. Name of the patient entered in space provided. 3. Date of dispensing entered in space provided. 4. Use by date/ Expiry checked. 5. Quantity to match Prescription and pack size. (DO NOT split or mix Boxes ) 6. Ensure NO of days for duration of antibiotic is completed. 7. Ensure appropriate verbal instructions patient information leaflet are given. Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 15 of 19

12 Equality Impact Assessment 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems Marriage & Civil partnership Pregnancy & maternity 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? Yes/No Comments If you have identified a potential discriminatory impact of this procedural document, please refer it to (Insert name and position) together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact (Insert name and position). Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 16 of 19

13 Policy and Procedure Sign-off Sheet Policy Name and Number: Version Number and Date: No: Service Location: PLEASE INSERT SERVICE LOCATION All staff members must sign to confirm they have read and understood this policy. Name Signature Name Signature Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 17 of 19

14 Policy Ratification Form Name of Document: Date: Ratification Name of Persons Job Title Date Divisional Support (Direct Line Manager / Matron / Consultant / Divisional Manager) Consultation Process (list of stakeholders consulted / staff groups presented to) Endorsement By Panel/Group Name of Committee Chair of Committee Date Document Checklist 1. Style & Format Is the title clear and unambiguous? Is the font in Arial? Is the format for the front sheet as per Appendix 1 of the policy framework Has the Trust Logo been added to the Front sheet of the policy? Is it clear whether the document is a guideline, policy, protocol or standard operating procedure? 2. Rationale Are reasons for development of the document stated? 3. Content Is there an introduction? Is the objective of the document clear? Does the policy describe how it will be implemented? Are the statements clear and unambiguous? Are definitions included? Are the responsibilities of individuals outlined? 4. Evidence Base Is the type of evidence to support the document identified explicitly? Are key references cited? Are supporting documents referenced? Yes / No Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 18 of 19

Document Checklist 5. Approval Does the document identify which committee/group will approve it? 6. Review Date Is the review date identified? Is the frequency of review identified? If so is it acceptable? 7. Process to Monitor Compliance and Effectiveness Are there measurable standards or Key Performance Indicators to support the monitoring of compliance with and effectiveness of the document? Is there a plan to review or audit compliance with the document? Yes / No Standard Equality Impact Assessment Tool Persons likely to be affected by policy change / implementation Staff Are there concerns that the proposed documentation / change could have an adverse impact on: Race. Ethnicity, National Origin, Culture, Heritage Religion, Faith, Philosophical Belief Gender, Marital Status, Pregnancy Physical or Learning Disabilities Mental Health Sexual Orientation / Gender Reassignment Age Homelessness, Gypsy / Travellers, Refugees / Asylum Seekers Please give details of any adverse impact identified: If adverse impacts are identified, are these considered justifiable? (Please give reasoning) There is unlikely to be an adverse impact on different minority groups Name of Person completing Ratification Form Job Title Date Ratification Group/Committee Chair Signature Date Ref: WHHT: G001 Date: July 2014 Version no: 1 Author: Kate Witt Review Date: July 2017 Page 19 of 19