Joint Medication Policy for Social Care Settings

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Joint Medication Policy for Social Care Settings

• Domiciliary Care Association Wales Conference
• Wednesday 16th July 2008
• Ruth Owen
• Practice Pharmacist

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Introduction

• Working together to improve the health and
  wellbeing of the people of Wrexham
• To ensure safe, evidence based and cost-effective
  prescribing through direct advice and support to
  GP practices.

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Need for New Policyin Wrexham

• WCBC 5 current policies dated 2002.
• Query whether they now meet current standards and
  law.
• Requirement for medication to be dispensed into a
  Monitored Dosage System (MDS).

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Whats the problem withMonitored Dosage Systems?

• Pharmacists under no obligation to provide MDS to
  persons who are not disabled.
• Pharmacies have supplied MDS at no cost to
  service users as material costs have been
  recouped by asking GPs to sign 7 day
  prescriptions.
• Welsh LMCs have advised GPs to cease 7 day
  prescriptions solely for the purpose of
  supporting MDS dispensing.

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Medication not suitablefor MDS.

• Patient discharged from hospital with medication
  dispensed in MDS except for Epilim (epilepsy
  medication) as not suitable for dispensing into
  an MDS.
• Carers refused to give Epilim as not in MDS.
  Patient found collapsed by son and taken to AE,
  where the missing doses of Epilim were held to be
  responsible for his collapse.

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Medication not in MDS

• Care staff came to give evening dose of
  medication, but not in MDS pack.
• Had not been put in pack by chemist.
• Only identified because regular carer knew
  medication given in evening.
• Need comprehensive records and audit trail that
  each and every medication is given.

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Other issues with MDS

• Inappropriate timing of medication administration
  e.g. some drugs should be taken after food, some
  before which may result in side-effects or
  reduced efficacy.
• Not all medication is included in the MDS such as
  inhalers and as required medications.
• Manufacturers do not endorse the practice of MDS
  dispensing and is therefore outside the product
  licence.
• Disempowerment of patients who may be capable of
  managing their drugs by some other way e.g. large
  print labels.

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Potential Solution?
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Examples of medicinesunsuitable for MDS

• Aspirin dispersible.
• Amlodipine.
• Sinemet.
• Arthrotec.
• Enalapril.

• Asacol.
• Methotrexate.
• Ranitidine.
• Senna.
• Venlafaxine.

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Potential Solution?
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What to do?

• Formation of a steering group in September 2007.
• Agreed a standard policy across Health and Social
  Care was needed.
• Same assessment process to identify medication
  issues used across Health and Social Care.
• Training.
• Link with independent providers.

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Working Groups
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Policy Review Group

• Adopted principles from Royal Pharmaceutical
  Society document
• The Handling of Medicines in Social Care
• www.rpsgb.org.uk/pdfs/handlingmedsocialcare.pdf
• Also WAG national minimum standards for Social
  Care incorporated.

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Principles of safe and appropriate handling of
medicines (1).

• People who use social care services have freedom
  of choice in relation to their provider of
  pharmaceutical care and services including
  dispensed medicines.
• Care staff know which medicines each person has
  and the social care service keeps a complete
  account of medicines.
• Care staff who help people with their medicines
  are competent.

Ref Royal Pharmaceutical Society of Great
Britain Oct 2007 The Handling of Medicines in
Social Care
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Principles of safe and appropriate handling of
medicines (2).

• Medicines are given safely and correctly, and
  care staff preserve the dignity and privacy of
  the individual when they give medicines to them.
• Medicines are available when the individual needs
  them and the care provider makes sure that
  unwanted medicines are disposed of safely.

Ref Royal Pharmaceutical Society of Great
Britain Oct 2007 The Handling of Medicines in
Social Care
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Principles of safe and appropriate handling of
medicines (3).

• Medicines are stored safely.
• The social care service has access to advice from
  a pharmacist.
• Medicines are used to cure or prevent disease, or
  to relieve symptoms, and not to punish or control
  behaviour.

Ref Royal Pharmaceutical Society of Great
Britain Oct 2007 The Handling of Medicines in
Social Care
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Assessment Process

• Need to have a more robust process for assessing
  a persons needs for assistance with medication.
• Varying process and degree of assessment between
  different professions and organisations.
• A range of solutions needed for differing needs
  with medication assistance.

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Some Solutions

• Labels large print / yellow background.
• Matchsticks.
• Elastic bands.
• Larger bottles.

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Medicine Reminder Chart
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Multicompartment Aids
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Bottle Tops
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Pill Extractors
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Eye Drop Dispensers
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Creams and Lotions
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Talking Labels
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Liquid Medicine
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Inhaler Aids
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Telecare

• Alarm / phone call to remind service user that it
  is time to take medication.
• Electronic MDS systems with built in alarms.

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Training

• Policy Awareness.
• Handling of Medicines in Social Care Settings.
• Covers the learning outcomes of the Skills for
  Care Medication Knowledge and Skills Set.

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Key Changes (1)

• A single policy that could apply to all social
  care settings, providing a consistent approach
  for staff and service users, as well as the
  requirement for service specific protocols to be
  development as appropriate.
• A common medication assessment tool to enable
  other solutions to be offered to service users
  who may require adjustments to the supply of
  their medication rather than assistance with
  medication.

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Key Changes (2)

• The need to supply Medicine Administration Record
  (MAR) charts by the dispensing pharmacy (or
  doctor if dispensing practice).
• Relaxation of the need for service users, who are
  assisted by professionals, to have their
  medication dispensed in a monitored dosing system.

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Consultation

• Running until September 26th 2008.
• Draft policy available from
• Ruth.Owen_at_WrexhamLHB.wales.nhs.uk
• or 01978 346517.
• Any Questions?