Delivering a joined up approach to dementia care, medicines and medicines administration Anne Child MBE MRPharmS, PHwSI, I.P, Director Of Pharmacy and Dementia Care Avante Care and Support.
First Steps Medicines Optimisation The golden thread of medicines From all the clinical safety aspects to the person Medication review polypharmacy appropriate de prescribing For dementia residents review of psychotropic agents Support of shared decision making To support those that give medicines to improve well being Support self administration wherever possible enabling individual
Moving away from medicines rounds in care homes -why Task focused doesn t put the person at centre of care delivery Interrupts meal times Do not promote good sleep hygiene May not mean residents have their medicines when they need them i.e. pain killers for joint pain before dressing May cause unrest if sleep is disturbed which can impact on behaviours and falls esp in dementia care Doesn t put person at centre of care dignity in small things the conversations care staff can have and social interaction
How Investment in staff training in Carers to include : 12 weeks NCFE Level 2 medication course A bespoke session with our supporting community pharmacist with a work book for completion Seven day shadowing and support Staff resistant at first now embrace this Relatives were keen to see their relative supported this way A new policy and procedure to split management of medicines and administration into defined tiers.
The person at the centre of it all our resident A personalised Meds support plan to include : Examples of what information might be on the support plan: (Name).. prefers to take her/his medication with (for example: water or cup of tea) (name) would like staff to sit (example: on her/his right as this is hand she/he likes to use.) (name) would like to be told when it is time to take her/his medication
would like staff to explain to her/him why her/his medicine is important (name) would like staff to patiently explain to her/him why she/he is taking this medication (name) is able/not able to put her/his tablets in her/his own mouth (name) would like staff to tip the tablets out of the pot into her/his hand (name) requires medicines to be given after food so please ensure available at time of medication (name) likes to talk about (example: family/friends) as these are my favourite topics which give her/him a feeling of wellbeing
Medication Personalisation Pilot Findings London Avante Home working with community pharmacy one year on Anecdotal evidence from KPIs and pharmacy audit : Reduction in Falls Increase in weights Better sleep hygiene Medicines are calmer Care staff are more empowered
Reduction in resident to resident behaviours especially at night people aren t woken meds is part of care delivery Reduction in refusals Meds weren t the only change but overall holistic improvements One more home about to start a phased transfer to this pathway Three more in planning stage
Medication Incidents
Slips trips and falls
Challenging Behaviour
Assaults
Weights Riverdale Weights Trending Lost Weight Gained Weight Linear (Lost Weight) Linear (Gained Weight) 35 30 25 20 15 No data for the months of December meaning there is no camparison for January. 10 5 0 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Our residents stories Resident 1 Resident A is a lady with capacity. She was always unhappy and distressed when her medication was not given early enough in the morning or after she had gone to bed and the night staff have to wake her. Now she has personalised medication as soon as she is up and awake she asks who is giving her her medication that day.
Knowing the name of the carer who is giving her medication helps alleviate her stress. She also can now have this before her breakfast which is how she always wanted to take her medication. At night time, she does now not have to be disturbed. The medication that was given at night has now been given earlier, so that she can go to bed after tea, which is her choice, and not be disturbed from her slumbers. she is happier in the day. She likes to leave staff a sweet each day for the staff member who administers her medication,
Resident 2 Is a lady who like to go to bed early. She has capacity and would be very cross with staff, often complaining that she had been disturbed from her sleep in order to give her eye drops and night tablets. Since being on the medication project she is sleeping better as she is not being disturbed. Her relationship with staff is better as she is not cross with the staff for disturbing her. When she had disturbed sleep, she would often then become restless and try and get up sometimes falling. The falls at night time have decreased and she now sleeps soundly all night.
Resident 3 A gentleman who always will continually ask for his medication, interrupting the meds round and causing other Service Users distress due to his constant calling out for his medication. Since being in the project, he is able to have his medication as soon as he is awake. Therefore breakfast time in the dining room is calmer and other Service Users are not disturbed. There is a calmer atmosphere in the unit. The same applied to the night medication as this is now given at 7pm so that he can go to bed early as this is his preferred pattern. He is also on PRN pain relief, which is more accessible to him when he is requiring it as the carers are not then looking for a senior staff member to be able to administer this, he can have this within mins of his request.
Resident 4 Is a lady who through choice remains in her room. By being on the personalised medication project, it enables staff to spend a bit more time with her, giving some one to one support
Areas that were challenging Management of the rota and clear deployment of staff Commitment by management to quality audits needs more checking Managing complex medication regimes Staff resistance to change initially Learning to do the same thing a different way
The Future of Dementia Care and supportive medication administration There are opportunities to build new services that recognise the individual needs of people living with dementia and which are responsive to those needs. Medicines to treat LTC need to be supported vascular risk reduction The use of psychotropic medications especially low dose antipsychotics must be an area of review to ensure appropriate usage social interactions and care planning vital Consideration of psychotropic in general THE GOLDEN THREAD OF MEDICINES FROM PRESCRIPTION TO RESIDENT
Any Questions THANKYOU
Refrences Administration of medicines in care homes (with nursing) for older people by care assistants Evidence-based guidance for care home providers D of H guidance Spilsbury K, Baker J, Alldred DP (2016) Administration of medicines in care homes (with nursing) for older people by care assistants: Developing evidence-based guidance for care home providers. Summary of evidence. University of Leeds. http://medhealth.leeds.ac.uk/info/1128/medicine_a dministration_by_care_assistants_in_care_homes//
National Care Forum (2013) Safety of medicines in the care home: Final project report. http://patientsafety.health.org.uk/sites/default/file s/resources/safety_of_medicines_in_the_care_ho me_0.pdf and free online resources http://www.nationalcareforum.org.uk/medsafetyre sources.asp NICE quality standard [QS85] https://www.nice.org.uk/guidance/qs85.