Home Care Services for Medicines - wsh.nhs.uk17)296... · Source: Pharmacy Dept Status: Approved Page 1 Issue date: ... delivery, dispensing, nurse administration and aseptic preparation.

Source: Pharmacy Dept Status: Approved Page 1

Issue date: January 2017 Review date: May 2019 Document reference: PP(17)296

Trust Policy and Procedure Document ref no: PP(17)296

Home Care Services for Medicines Policy

For use in: All Areas

For use by: All Trust Staff

For use for: To ensure all medication provided under formal homecare arrangements is done so safely and

effectively

Document owner: Pharmacy Department

Status: Approved

CONTENTS Page No Section 1 – Introduction 1.1 Policy Statement and Rationale 2 1.2 Key Principles 2 1.3 Background Information - if necessary 2 1.4 Definitions 2 Section 2 – Duties and Responsibilities 2 Section 3 – Home Care Services for Medicines Policy 3 Flow chart representing outline of home delivery scheme process 6 Section 4 – Training and Education 6 Section 5 – Development and Implementation including Dissemination 6 Section 6 – Monitoring Compliance and Effectiveness 7 Section 7 – Control of document including archiving arrangements 7 Section 8 – Supporting Compliance and References 7 Appendix 1 – Stake holder responsibilities 8



SECTION 1 - INTRODUCTION 1.1 Policy Statement and Rationale

This document sets out the hospital’s approach to the use of Homecare services to be followed in relation to the supply of medicines directly to patients at home.

The overall objective is to ensure that there is a hospital-wide approach to the development, management and implementation of a homecare service which is communicated to and available to all staff, patients and their families and/or carers.

1.2 Key Principles .

This policy defines the procedure and process for the use of medicines delivered by homecare companies external to the trust.

Clinical governance issues are also defined to ensure there is clarity on prescribing, dispensing, and clinical responsibilities and ensure patient safety is maintained.

Financial accountability is defined to ensure that the pharmacy, procurement, finance and the relevant commissioner are involved in all medicines homecare delivery services.

1.3 Background Information

1.3.1 Hospital services normally administer medicines to their patients within the confines of their own clinical environment. However, on some occasions the supply and administration of medicines is preferably provided to the patient whilst in their own home. Homecare is increasingly being used as a way of providing medical supplies and/or clinical services prescribed in secondary care to patients in the community. It is a complex and evolving area which involves several organisations within its processes e.g. commissioners, acute trusts and homecare providers.

1.3.2 There are currently different aspects of home care service which include simple

delivery, dispensing, nurse administration and aseptic preparation. The purpose of a homecare service is to improve patient care and choice in their treatment. The homecare service can be provided by using external suppliers under contract with the Trust, although other methods of delivery may be considered.

1.3.3 Shared care has prescribing responsibility passing to the GP by agreement

between the consultants, GP and CCG and is beyond the scope of this policy. 1.4 Definitions

HCP – Health Care Professional D&TC – Drugs and Therapeutics Committee POD – Proof of Delivery SLA – Service Level Agreement CCG – Clinical Commissioning Group SFI – Standard Financial Instruction



SECTION 2 – DUTIES AND RESPONSIBILITIES 2.1 It is the responsibility of the Drugs & Therapeutics Committee to approve this policy in

accordance with West Suffolk Hospital NHS Trust Policy. 2.2 It is the responsibility of the Directorate Clinical Governance Groups to ratify this policy

in accordance with West Suffolk Hospital NHS Trust policy. 2.3 The designated Responsible Officer for this Policy is the Chief Pharmacist. 2.4 The following outlines the responsibilities of individuals/departments within the terms of

this policy:

2.4.1 Prescriber - Specification for service - Decision to use homecare in an individual patient - Patient consent - Prescription to supplier - GP liaison if appropriate

2.2.2 Pharmacy Department - Liaising with finance and supplier - Specification for service - Processing of orders and invoices - Audit - Clinical screening of prescriptions

2.2.3 Finance/Contracts Team - Approval of service initiative - Payment of invoices - CCG liaison (SLA Manager) - Assessment of impact on revenue in lieu of national tariff

2.2.4 Procurement - Setting up contractual arrangements. - European tender of the contract when required.

2.2.5 Supplier - Delivery of service to agreed specification See Appendix 1



SECTION 3 – HOMECARE SERVICES POLICY

3.1 All homecare services will be provided under contract to an agreed specification

following consultation and input from the prescribing clinician, pharmacy, procurement, finance contracts team and management.

3.2 The Trust and clinician who will normally retain clinical responsibility for the relevant

aspect of a patient’s treatment will continue to take the appropriate level of responsibility for the patient whether the patient receives treatment in hospital or their home.

3.3 Agreement to the use of a specific homecare service should be the responsibility of

clinical, pharmacy and finance staff, after full consultation. The Chief Pharmacist must be involved in the management of any such homecare service. Choice of homecare service provider should take into consideration any framework agreement in place within national/regional pharmacy consortia.

3.4 Homecare services which involve medicines should be regarded as an integral part of

the Trust Medicines Management framework. All homecare products should comply with the Trust prescribing formulary and medicines evaluation processes.

3.5 Homecare packages of care may not be suitable for all patients or therapies and the

decision to opt for this course of treatment must be part of a multidisciplinary approach involving the patient, the clinician, the pharmacy service and in some cases primary care. Any patient deemed suitable for homecare must be reviewed by an appropriate clinician or HCP to assess suitability for the provision of a homecare service as part of a risk assessment process.

3.6 Home services should be provided in the best interest of the patient. Provision of a

homecare service should not be driven through VAT savings schemes only. 3.7 A patient must fully understand the benefits and risks of a homecare service before

initiating the service. Patients preferring to receive care and supplies direct from the hospital despite the existence of homecare services should not be prevented from doing so. A patient must provide formal written consent to use a homecare medicine by completing and signing a patient registration form.

3.8 Funding should be obtained and confirmed prior to proceeding with any homecare

service. Funding should take account of costs associated with both the external home care service provider and the additional internal operational systems. NHS England or CCG approval should be sought prior to the use of any new non-tariff drug.

3.9 Homecare services should take into account the impact of a range of financial

parameters e.g. national tariffs, VAT, medicines contracts. 3.10 The procurement process and decision to use a homecare service provider must be

robust and comply with the Trust’s Standing Financial Instructions and Financial Order’s and be performance managed as follows:

3.10.1 All contracts should contain a detailed Service Level Agreement which covers

all aspects of the service from initiating treatment, supply and payment. The service level agreement should include reporting a set of key performance indicators to facilitate the above and a formal complaints and error procedure

3.10.2 The value of the contract will require a formal tendering process applied by the

procurement department, if there is no regional/national framework agreement in place.



3.11 Each individual prescription should be accompanied by an official order. Invoices should be sent directly to the hospital pharmacy. Hospital pharmacy should raise an order for each prescription. Evidence should be obtained that the patient has received the service i.e. POD. Payment to homecare providers should be made a priority to ensure adherence to contracts and NHS finance regulations. Finance data should be available to reflect costs to individual patients and clinicians.

3.12 Homecare services contracts should clarify the individual stages of the homecare

service and the responsibilities of each party. Homecare contracts should only be between the homecare provider and the organisation and clinicians that directly receive and monitor the service.

3.13 Consideration needs to be made to a range of quality issues e.g. concordance, quality

assurance of product, temperature controlled storage. 3.14 Homecare services must be carefully managed to maintain the Trust’s duty of care to

patients (clinical governance) and ensure that financial governance requirements are fulfilled.

3.15 Unlicensed medicinal products are not appropriate for homecare unless:

(a) The benefits are substantially higher than the risks (b) Maximum risk reduction processes have been implemented and (c) The D&TC has approved the service.

3.16 It is the responsibility of the homecare supplier to request the Trust to supply further

prescriptions before the patient’s supply is exhausted. A copy of the prescription is retained within pharmacy to assist in ensuring the service is delivered and invoices are appropriately paid.

3.17 The homecare supplier then arranges for a delivery time for the first supply of the drug,

together with any educational or training resource available as prior to agreement and stated in the SLA and contract. Patients are given a telephone contact number for the homecare supplier.

3.18 On subsequent visits, waste is removed in accordance with the agreement with the

homecare supplier or other approved waste disposal service and a new supply of drug initiated. The homecare supplier is responsible for ensuring that homecare medicine stocks are rotated thus reducing the risk of expired stock being taken by the patient or wasted.



3.19 Flow chart representing outline of home delivery scheme process SECTION 4 – TRAINING AND EDUCATION The Homecare Medicines Pharmacy Technician within Pharmacy will deliver training and education on induction to the administration/technical staff involved in the procurement of medicines via homecare services. Further training/education needs with regard to homecare services will be identified through annual PDR. SECTION 5 – DEVELOPMENT AND IMPLEMENTATION INCLUDING DISSEMINATION 5.1 This policy has been written to reflect national guidance on the mechanisms by which

medicines are supplied via a homecare service. 5.2 This policy will be made available on the hospital intranet. The chief pharmacist will lead

on its implementation within the trust.

Home delivery of medicine identified as clinically appropriate for patient by multi-disciplinary team

Involve commissioners as appropriate

Selection of Homecare Provider

Service Level Agreement developed by service provider, pharmacy, and clinical staff involved and signed off by chief pharmacist

Patient registration and consent obtained by clinical staff with first prescription

Registration form and prescription sent to pharmacy procurement team

Prescription validated by pharmacist and pharmacy procurement team raises order, e-mails prescription and order to homecare service provider via NHS.NET

Original copy posted to provider

Homecare service provider contacts patient to agree delivery time and delivers to patients home within the terms of the SLA

Homecare service provider contracts clinicians when further prescriptions are required



SECTION 6 – MONITORING COMPLIANCE AND EFFECTIVENESS The Chief Pharmacist will monitor the compliance and effectiveness of this policy. Performance management is an essential part of providing a homecare medicines management service. It ensures patients are getting the service the Trust requires, including how incidents, errors and complaints are handled. Resource will be required to deliver performance management of homecare services. Key performance indicator (KPI) reports agreed by West Suffolk Hospital will be provided by the homecare providers at initiation of the contract. A report will be available for each therapy area. Homecare providers shall make the reports available at the end of each month. KPIs will be analysed by the homecare pharmacy team and discussed with the appropriate clinical staff by therapy area. Failure to perform and provide the service level specified will be discussed when required and at regular performance review meetings by both parties. SECTION 7 – CONTROL OF DOCUMENTS INCLUDING ARCHIVING ARRANGEMENTS 7.1 Once ratified by the Patient Safety Committee the Responsible Officer will forward this

document to the Information Governance Department for a document index registration number to be assigned and for the document to be recorded onto the central hospital master index and central library of current documentation.

7.2 In order that this document adheres to the hospital’s Records Management Policy, the

Information Governance Department will:

Ensure that the most up-to-date version of this document is stored on the documentation library.

Archive previous versions of this document.

Retain previous versions of this document for a period of time in accordance with the NHS Records Retention and Disposal Schedule.

SECTION 8 - SUPPORTING COMPLIANCE AND REFERENCES Care Quality Commission (2009), Essential Standards of Quality and Safety. Commercial Medicines Unit (May 2011), Procurement Guidance for the Provision of Homecare Delivery Service of Medicines to Patients at Home, DH CMU. Karr, A (2013), Home Care Services Policy for use by NHS Trusts, National Home Care Medicines Supply Committee. Homecare Medicines — Towards a Vision for the Future Mark Hackett, CEO, University Hospital Southampton NHS Foundation Trust Professional Standards for Homecare Services in England-The Royal Pharmaceutical

Author(s): Kaylie Gunn, Pharmacy Homecare Technician

Other contributors: Anita Marshall, Pharmacy Homecare Technician Simon Whitworth, Chief Pharmacist

Approvals and endorsements: Drugs & Therapeutics Committee

Consultation:

Issue no: 3

File name:

Supersedes: PP(12)296

Equality Assessed Yes

Implementation

Monitoring: (give brief details how this will be done)

Other relevant policies/documents & references:



Additional Information:



Stakeholders Appendix 1

Fun

ctio

ns

Trust Homecare Provider

Commissioner/CCG Patient Manufacturer

Chief Pharmacist

Clinical Team

Finance Corporate DTC/MMC

Governance arrangements

Development of a Trust Policy for Medicines Homecare services

Ratification of Trust Policy by relevant committee

Development of SOP's

Ratification of SOP's

Monitoring of risk, incidents and timely, appropriate follow up

Reporting serious incidents locally and national if warranted

Monitoring patient complaints

Agreeing documentation including prescriptions and registration forms

Performing audits/self-assessments of homecare services arrangements





Pharmacy Clinical Team


Introduction of new services

Completion of clinical, risk and economic assessment if appropriate

Production of documentation to support safe and effective introduction of new medicines homecare services

Financial approval of introduction of new medicines homecare services

Development of service specification

Incorporating homecare within existing clinical guidelines and pathways

Horizon scanning for potential new Medicines homecare opportunities

Confirming the quality and integrity of medicines supplied by Homecare







Procurement

Sourcing medicines homecare provision

Agreeing SLA

Checking SLA for Pharma schemes

Tendering for medicines homecare services

Monitoring medicines homecare services contract

Managing change between medicines homecare providers

Ensuring SLA or contracts are in place

Providing CMU contract prices to medicines homecare providers

To inform homecare providers of any changes to contract prices







Financial management

Providing data on medicines homecare activity

Process transactions Invoices/order reconciliation

Monitoring expenditure and savings to CCG/NHS E

Ensuring secure nhs.net accounts are used for the transfer of patient identifiable data

Monitoring uptake of medicines homecare services

Provision of invoices to the Trust in a timely manor

Accurate processing of transactions on JAC







Operational management of medicines homecare services

Patient consent and registration

Decision to use homecare for a patient

Writing an accurate, legible prescription

Dealing with drug recalls and alerts

Ensuring links with GP's

Provision of appropriate training to staff and patients

Reporting incident, errors and complaints

Providing patient support

Carrying out service reviews

Monitoring KPI's

Overseeing prescription management

Clinical screening

Professional and accuracy checking of prescription








conducting patient satisfaction surveys

Provision of consumables/ancillary’s to patients

Providing information to staff and patients on medicines homecare services

To provide clinical support to patients

To provide on-going clinical monitoring of the patient

Timely provision of medicines homecare stationary

Accurate, legal and timely dispensing of prescriptions

Ensuring the patients receive the correct medication at the correct time and place

Patient to be at home at the agreed delivery time

Notification of changes to address/delivery location








Proactive reporting of patient safety incident to the pharmacy and clinical team

Home Care Services for Medicines - wsh.nhs.uk17)296... · Source: Pharmacy Dept Status: Approved Page 1 Issue date: ... delivery, dispensing, nurse administration and aseptic preparation.

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