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A Medication Administration Training Tool in Care

Homes

Sally Hall, Senior Pharmacy Technician, Gilbert Bain Hospital, Lerwick

Medicines management- audits and current practice

in Care Homes

Wendy Bagnall, Medicines Management Technician, Walsall

CCG

Walsall Medicines

Medicines Management in Care

Homes

Wendy BagnallMedicines Management Technician

Walsall CCG

Walsall CCG employs one Medicines Management Technician to undertake audits and provide help and support to care homes.

Community Pharmacists are contracted via a local enhanced service agreement to undertake quarterly audits and also to provide help and support to care homes.

Medicines Management support is provided to 70 care homes

Current service provision

To improve safety by ensuring that care homes have policies in place for all aspects of medicines management.

To reduce potential patient harm as procedures for handling medication improve

To improve patient experience because medication will be handled safely and staff will have increased knowledge of medication

Service Aims

Care Homes Use Of Medicines Study 2009 (N

Barber et al.)Main findings of study were: Residents (mean age 85 years) were

taking 8 medicines each On any one day 7 out of 10 patients

experienced at least one medication error

Mean score for potential harm was low but results indicate opportunity for more serious harm

Audits A programme of audits for care homes

began in April 2009

All 70 care homes in Walsall, both nursing & residential are included

One audit is undertaken each quarter and of these: 25% are undertaken by the MMT

75% are undertaken by Community Pharmacists

Before undertaking the audits the Community Pharmacists are required to

1. Complete the CPPE Open Learning programme ‘Supporting People in Care Homes’

2. Attend two training sessions provided by the Medicines Management Team.

Training

Now been running for Four years

16 audits have been undertaken so far

Improvements have been seen

Now able to re-visit some audits and compare results

Service is appreciated by care home staff

The service so far

Audit AgreeThe audit scheme has increased staff awareness of the need for accuracy when recording administration of medication for residents in the care home 95%

The audit scheme has increased staff awareness of the need to undertake self audits on a regular basis 95%The audit scheme has increased staff awareness of the different schedules for controlled drugs and the legal requirements for each schedule 84%

The audit scheme has made staff aware that ALL care homes should have a controlled drugs cabinet and controlled drugs register that complies with the misuse of drugs safe custody regulations.

94%

The audit scheme has increased staff knowledge of what a High Risk drug is 89%The audit scheme has increased staff awareness of the risks associated with the use/ misuse of certain classes of drugs 89%The audit scheme has increased staff awareness of why antipsychotics should not be given to people with dementia 74%The audit scheme has increased staff awareness of the other types of therapies that can be used for challenging behaviour e.g. Music therapy 84%

Evaluation Survey 2012-13

Medicines Policies Nutritional Supplements Administration Antibiotics & C-Difficile High Risk Drugs Specials Asthma & Inhalers Antipsychotics & Dementia

Previous Audits

Controlled Drugs Audit 2012

First audited in 2009

Good increase in compliance

Results show an increased awareness of the need for good policies and procedures for the management of Controlled Drugs

 Results of Controlled Drugs Audit

2012

2009

Does the home have a Controlled Drugs Policy? 100% 89%Do care workers know which prescribed medicines are controlled drugs? 93% 89%

Is there an approved CD Cupboard used to store CDs only? 97% 77%

Are keys held by designated members of staff only? 99% 84%

Does the home have a controlled drugs register? 94% n/aIs administration witnessed by trained and designated care workers? 93% 75%

Does the witness confirm that the correct drug is selected 91% 72%Does the witness confirm that the name on the label attached to the drug is the same as the person the carer intends to give it to 90% 72%Does the witness confirm that the Care worker has prepared the right dose, as stated on the label and MAR chart 90% 71%Does the witness confirm that the care worker gives it to the right person? 91% 72%Does the witness confirm that the administration is recorded in the CD register and signed on the MAR? 91% 72%

Unused prescription medicines cost the NHS at least £300 million a year and of that £50 million worth of NHS supplied medicines are disposed of annually by care homes

3025 items were included in the audit at a total cost of £12,570.52

The annual figure for waste meds could be around £75,000.

Waste Medicines

Type of waste 2011 2009

Inhalers (full or part used) 0.36% 1.59%

PRN medication not used up in 28 day cycle

7.70% 10.84%

Topical preparation 0.49% 3.4%

Results

Local Authority - if they have a contract with a local care home that is failing in some way and may need more support on medicines management issues.

Community Pharmacy- by undertaking audits they gain a better understanding of the problems faced by care homes and are better able to advise staff.

Working with others

Questions?

Reducing the incidence of “Missed Doses” at North

Bristol NHS Trust

Sara Hobden, Pharmacy Technician, Medicines

Management, Bristol

Sara Hobden, Pharmacy Technician, Medicines ManagementPharmacy Department

Reducing the incidence of “Missed Doses”

atNorth Bristol NHS Trust

North Bristol NHS Trust (NBT)

Acute Teaching Trust: 2 sites 1087 beds 53 wards 9100 staff Safer Patients Initiative (SPI2): 2007 – 2009 Southwest Quality and Patient Safety Improvement

programme: 2009 – 2013 New Hospital: May 2014

Patient safety background

Patient Safety – Medicines Management work stream

SPI2 project team SWQPSI project team Medicines Governance Group – Patients NBT staff – Consultants; Other Doctors; 

Pharmacists; Nurses; Ward receptionists; Clinical Audit; etc.

NBT Team

Medicines Management Work stream

Jane SmithAlison Mundell

Julie HamerNatasha Mogford

Robert Brown

Executive Lead:Medical Director

Chris BurtonClinical Audit

Frank HamillSimon AndersonRebecca Lewis

Consultants / Doctors

Sue WensleyJames CalvertArla GamperRuth Gillam 

PharmacyMedicines Management Technicians

Clinical pharmacistsDispensary team

NursesDenver McCrum

Jennie GillardLorraine Motuel

Medicines Governance Group

Director of PharmacyPharmacists

MatronsHeads of Nursing

ConsultantsTraining Dept 

Patient Panel Members

Why is this important ?Nationally/Regionally

NPSA – guidance (2010) SWQPSI target NBT CQUIN target

Patient Safety Reduced harm Reduce length of stay

Definition:Missed doses occur when a medicine is not given to a patient when prescribed and may result in harm. There are variety of causes and our initial focus is drug unavailability code ‘6’

Code ‘6’ – drug unavailable

Aims and objectivesTo reduce the incidence of missed doses at NBT due to drug unavailability code ‘6’

Objectives Reduce the number of missed doses Raise awareness of effects on patients Monitoring on a daily basis Understand the reasons for missed doses Introduce an e-tool for wards to audit themselves

What have we done ?Phase 1: February 2010 – July 2010: Determine criteria for a missed dose. Using Plan Do Study Act (PDSA) cycles developed an e-

audit tool.

Do

StudyAct

Plan

What have we done ?Phase 2: August 2010 – April 2011: e-audit tool Daily data collection Emergency cupboards Location of stock medication Pharmacy staff awareness

What have we done ?Phase 3: May 2011 – September 2011: Training package Posters displayed on wards Ward handover sheet

What have we done ?Phase 4: October 2011 – present day: Monthly data shared Missed dose order slip Missed dose orange leaflet

Pharmacy blue bag

Orange leaflet

Missed dose 

Please give to nurse looking after patient

Role of Medicines Management Technician

MM service Medication lockers One-stop dispensing PODs

Patient’s Own Drugs

Patient’s Own Drugs

Promoting Patients Own Drugs Poster exhibited in the following areas:

GP surgeries Community chemists Hospital outpatients Hospital wards

Results

Other / Future work Maintain / improve results Investigate ‘blanks’ Alert for new medication Parkinson's’ disease

Summary 1.95%target: Achieved and maintained

NPSA Alert: Compliant

2010/11 CQUIN target: Achieved

2011/12 CQUIN target: Achieved

Posters: National Pharmacy Management Forum (London: Nov 2012)     

        European Hospital Pharmacy Congress (Paris: March 2013)

Any Questions ?

Contact us

Sara Hobden: Pharmacy Technician, Medicines Management Direct line: 0117 323 2309 Email: [email protected]

Julie Hamer: Senior Pharmacy Technician, Medicines Management Direct line: 0117 323 2309 Email: [email protected]

Jane Smith: Principal Pharmacist - Service Development & Governance Direct line: 0117 323 2391 Mobile: 0788 443 7780

Email: [email protected]

Lunch, exhibition and poster viewing

Please by back by 13.20

WELCOMEBACK

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Annual General Meeting

Fiona Price, Honorary Secretary, APTUK

AHH Prize Winners

12 years of a wandering soul, the good and bad parts of life as a Locum

Carole Tilbrook, Locum Pharmacy

Refreshments, exhibition and poster

viewingPlease go to your Parallel

Workshop Sessions at 15.45

WELCOME

Sunday 9 June 2013

Yellow Card Reporting & What it means for Pharmacy

TechniciansAnthony R Cox, Lecturer in Clinical Pharmacy,

University of Birmingham and Pharmacovigilance Pharmacist, Yellow Card

Centre, West Midlands

Poster prize awards

Supported by

Parallel Workshops Session E

Please go to the designated rooms

WELCOMEBACK

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My role as a Pharmacy Technician Specialist in

HomecareDiane Meech, Pharmacy Technician

Specialist- Homecare & High Cost Drugs, Ealing Hospital NHS Trust

Closing remarks

Steve Acres, President, APTUK

Thank you

See you in 2014!