The Patients Association has recently published a ‘Care Home Charter’ for medicines (link: http://bit.ly/2p1H76b). A key theme of the charter is medicines safety, which is the focus of this opinion piece.
Ensuring your Medicines Policy is accessible and can be used for training.
It’s worth considering how your policy links to staff training, and how accessible user-friendly it is. Are procedures outlined clearly in the policy? Do they link to Standard Operating Procedures [SOPs] and to competency assessments? Are they updated as the result of incidents and near-misses, and do you use checklists to make them easy to read, follow and audit?
Using this simple checklist can help ensure your policies are up-to-date, accessible and relevant, and don’t just sit on a shelf.
Ensuring residents have at least 1 multidisciplinary medication review per year.
There is increasing help available from Clinical Commissioning Group Medicines Management Teams and Specialist Clinicians in this area.
These baseline actions can also help the review process:
Ensuring you have safe systems for administering and recording medicines.
It is vital that you have an accurate, accessible, legible and auditable system for medicines administration.
There has been a recent move by some of Pharmacies to change residential homes from Monitored Dose Systems [MDS] (also called blister packs) back to Original Pack Dispensing [OPD]. The reason for this, often given, is to improve safety. It is sometimes incorrectly implied that ‘guidelines’ are driving this move back to original pack dispensing, even bizarrely that OPD can help prevent polypharmacy & reduce medicines waste.
I have not been able to find any evidence that OPD is safer than MDS. The related NICE guidelines, quality standards and the CQC report ‘Medicines in Health and Social Care’ do not state this.
What’s important is that the home uses the safest system of delivering the medicines to the residents, considering the resident’s wishes, the home’s skill mix, the layout of the home, staff competencies, workload and capacity. This is particularly important as staff tell me original pack dispensing takes ‘twice as long’.
Bearing in mind that OPD takes longer, what are the advantages of moving to this? Can you be sure, for example, that unsafe practices such as ‘potting up’ will not creep into use?
My advice about MDS vs OPD is that if you are being lobbied to change to original pack dispensing, is to consider the questions set out below:
I am a nurse by trade and used to be a proponent of OPD in all circumstances. Since working in social care and with residential homes I’ve re-visited this view. I now believe that care home residents need well-designed systems and that, unless the resident can manage their medicines themselves (always the first consideration), a good MDS system is often a much safer way to administer medicines.
A shorter version of this article first appeared in the Autumn Edition of The Carer.