Medicines in Care Homes Hammersmith 17907 Jane Shaw CSCI

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Medicines in Care HomesHammersmith
17/9/07Jane Shaw CSCI
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Pharmacists in CSCI

• Pharmacists are a resource
• Advice-Training of RI - Keeping up to date
• Liaison with colleagues and Head Pharmacist
• Liaison with other healthcare professionals
• Referrals
• Triggers

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Referrals and Triggers

• Poor medicines management identified by lead
  inspector
• Medicines errors- Reg 37
• AQUA
• Complaints
• Change in manager
• Intelligence e.g PCT,falls,deaths,POVA issues
• Child and adult protection
• Enforcement

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After the inspection

• Random letter if standalone visit
• Immediate requirements and recommendations
• Follow up
• Enforcement
• Publication

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Sources of information

• National Minimum Standards
• Royal Pharmaceutical Society
• Skills for Care
• UKHCC
• ARC
• BNF and Patient Information Leaflets
• Pharmacists
• CSCI

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CSCI guidance

• Published on the internet
• Medicines in Domiciliary Care
• Medicines in care homes
• Controlled Drugs
• Training
• Medication Administration Records
• Immunization
• csci.org.uk

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Good Practice

• Medication Policy
• Recording of receipts,administration and disposal
• Administration.Resident choice.
• Audit
• Storage

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Recurring Problems

• Re-dispensing medicines by care staff or family
• Self-administration- risk assessments- locked
  drawers
• - Mar charts and monitoring.
• Covert administration and crushing
• Wrong medicine give to service user
• Medicines not given
• Timing e.g before food
• Variable dosages

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Recording Issues

• No recording of receipts or disposals of
  medicines.No audit trail
• Incomplete recording of medicines given or not
  given.Recording not done at time of
  administration
• Recording of variable doses
• Recording of allergies and DOB on MAR
• Changes of doses and medication reviews
• Spare labels. Pharm Soc guidance.Transcribing is
  witnessed
• MAR charts have identical instructions to labels.
• Homely remedies are recorded.

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Administration

• Care staff should verify medication when a
  service user is admitted.
• Prescriptions should be checked before dispensing
• Labels should not be altered.
• Keys are held securely
• Medication prescribed for one resident is never
  administered to another.
• Medication is out of stock
• Identification of residents
• Warfarin books with MAR or readily accessible
• Oxygen
• BNF and Patient Information Leaflets.

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Storage problems

• Cleanliness and tidiness
• Temperature
• Separate storage for internal and external
  medicines
• Stockpiling
• Expiry dates
• Dates of Opening on eye drops,liquids and creams
• Lockable fridge - clean defrosted
• Evidence of recording min/max temperature
• Separate lockable box in domestic fridge
• No pathology specimens in fridge

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Controlled Drugs

• In care homes and Nursing homes
• Storage
• Recording in a register
• Crossings out
• Witness signatures
• One page/CD/Service user
• Nil or zero balance
• Small Homes Existing storage
• Patient
  packs or MDS
• Staff access
  
• Alternative
  hypnotic

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CD Changes

• Reg 37
• Self-assessment
• 28 day maximum prescription
• Proof of identity if collecting S2,3 CD
• Recording
• Storage from 1/9/07
• Midazolam

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Training

• No accredited training
• Induction Training
• Basic Training
• Training for specialised procedure and delegation
• Competency

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Audit

• Self Audit
• Document
• Follow up
• THE END