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Medicines safety in Care Homes

November 14, 2019 By Steve Turner

The Patients Association has 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.

Click here for more information on the Care Right Now Speak Up For Learning approach to change.

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 move by some 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. Click here to know about Dumposaurus Dumpsters & Rolloff Rental about illegal dumping

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.

About the author: Steve is a nurse prescriber, Head of Medicines and Prescribing for www.medicinegov.org, Information Governance Lead for CareMeds Ltd and Associate Lecturer at Plymouth University.

Contact steve@carerightnow.co.uk 07931 919 330. Related blogs & shared learning resources can be found here.

Date: 14.11.2019

Updated: 23.09.2021

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Filed Under: Care Homes, Care Right Now, Elderly care, Medicines, Medicines Optimisation, MEDSINFO, Prescribing

Using technology in care homes – eMAR

October 22, 2019 By Steve Turner

Introduction

Medicines errors in care homes are unacceptably high. A key study found that residents taking 7 or more medicines had a 79% chance of being a victim of a medicines error (Alldred et all 2009).

Slide1

Best practice in medicines record keeping

The management of medicines in nursing and residential homes is part of a highly complex pathway.  It involves multiple staff groups and organisations.

These include the G.P.; all who prescribe medicines and treatments; Care Staff of all grades; Support Workers; Consultants: Specialist Practitioners; and the Pharmacies who supply the medicines.

Benefits of electronic MAR charts

The benefits of implementing electronic MAR charts fall into three categories.

  1. Improved legibility.
  2. Improved access (e.g. if the charts are accessed and updated on a computer or portable device there is less risk of losing, damaging or mislaying them).
  3. eMAR chart systems that obtain the data taken directly from the Community Pharmacy system eliminate the need for transcribing, which is a high-risk area.

In addition to the three benefits mentioned, carefully planned and implemented eMAR systems contribute to a decrease in medicines errors, reduced administrative costs and improved quality of care.

Challenges of implementing electronic MAR charts

There are three ‘bottom line’ challenges to manage when transitioning to electronic MAR charts.

1. Assessing the way the system works is critical, as poorly designed will not deliver benefits, and eventually fail.

The system must be easy to use and jargon-free; using only approved acronyms or mnemonics.

Electronic systems also offer the opportunity to introduce features that enhance safety, some of which, such as time-ordered charts, are difficult to include in a paper-based system.

Here’s a checklist:

Slide2
Slide3

2. It is vital that the system handles patient consent; patient confidentiality, system access; ownership of patient identifiable data; storage and transfer of data in a way which is compliant with the laws and regulations of your part of the U.K. This is an important question for you to pose to the supplier, particularly with the advent of General Data Protection Regulation (GDPR),  and the new Data Protection Act 2018.

Slide4

3. It is important to look at current processes and how the new system will work. There been problems where acute prescriptions were needed and supplied by a different pharmacy from the one providing the MAR charts, so the home ended up at times with an electronic MAR and a paper MAR. This causes confusion and increases the risk of errors and/or omissions. Colleagues have told me of instances where this has led to eMAR systems being abandoned.

Training and support requirements

Quality training and support, both during the implementation and on an ongoing basis, underpin all successful healthcare I.T systems and need to be planned from the outset. There are four areas that are sometimes overlooked, that deserve special mention.

1.  Many of the users of eMAR systems will be Healthcare Assistants or other non-registered skilled staff. As a result, it will be important that the training they receive reinforces their duty to keep accurate records, and their accountability and role is made clear.

2. A significant number of staff may speak English as a second language. Therefore it is important that eMAR systems do not use any unnecessary jargon, and that any help text is in plain language.

3. Appropriate knowledge of Data Protection (GDPR) and Information Governance Rules and regulations are essential and should be built in to any training programmes.

Overall, consideration needs to be given to the nature and content of the training needed to implement the system, including how this is linked to the policies and procedures and overall governance of the home.

Good suppliers will be able to give advice and support on this.

Conclusion

Record keeping in medicines management is a critical safety area for care homes. The Senior Care Authority: Employee Assistance Solutions for Eldercare says that it is a crucial task for the staff. The current high level of medicines errors is in care homes affects half a million people in England.

The prospect of implementing electronic systems for recording medicines administration holds great potential but is not itself without risk. It needs to be approached carefully in the light of the complex arrangements and multiple organisations involved in prescribing, supplying, administering and monitoring medicines in care homes.

In time, electronic systems will become the norm for medicines management in care homes.

Given the considerations over choice and implementation of systems, eMAR can overcome problems of legibility, transcribing, and access to records and information in a way that is not possible with paper systems.

In years to come it is likely that, just as most G.P.’s would not want to return to paper systems, care homes will come to see electronic systems in the same way. The main beneficiary from this will be the residents in terms of improved safety.

This, in turn, will benefit care home staff who will no longer be involved in the risky business of sorting out, transcribing and chasing paper records. Care home providers will also benefit through decreased indirect costs associated with more efficient and safer processes.

Reference: Alldred P, Barber N, Buckle P et al (2009) Care home use of medicines study (CHUMS): Medication errors in nursing and residential care homes – prevalence, consequences, causes, and solutions. Report to the Patient Safety Research Portfolio. Department of Health, London.
 Steve Turner is Information Governance Lead and Data Protection Officer
for CareMeds Ltd

Author: Steve Turner

Date: 22.10.2019

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Filed Under: Care Homes, Care Right Now, Elderly care, Medicines, Medicines Optimisation, MEDSINFO, NHS, Uncategorized

Is this the profile of a healthcare radical or a troublemaker?

October 12, 2017 By Steve Turner

Steve Turner career and experience:

I began my professional career as a nurse in 1984, eventually specialising in mental health.

I spent a decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the U.S. arm of the company.

In 1999 I returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger. A spell in consultancy for a large Cancer Network followed, by leading two highly successful multi-organisational projects.

More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.

In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. (www.tutv.org.uk).

We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.


Steve is a nurse prescriber, Head of Medicines and Prescribing for @MedicineGov , Associate Lecturer at Plymouth University  and former NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @MedicineGovSte  


 

  • Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator

Steve Turner  RGN; RMN; Ba (Hons); P.G. Dip. Ed.

 

steve@carerightnow.co.uk

Date: 18.11.2019

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Filed Under: Care Right Now, Children Health, Elderly care, Leadership in Health, Medicines Optimisation, NHS, NICE, Organisational Culture, Prescribing, Substance Misuse, Transparency, Uncategorized, whistleblowing, Workshops

Boundary spanning in health and care -a short profile of Steve Turner

July 20, 2017 By Steve Turner

People ask me ‘what exactly do you do for a living?’. Because I’ve been around a bit I sometimes struggle to answer this concisely, so here’s a short summary:

My career and experience:

After ten years of traveling around the world, I began my career as a nurse eventually specialising in mental health. My appetite for learning took me through a degree in Social Policy and then into the world of healthcare I.T.

I spent the next decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the US arm of the company, working with leaders of clinical teams in the NHS.

I then returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger.

A spell in consultancy for a large Cancer Network followed, by leading two multi-organisational projects to identify the most effective information and prescribing systems. These brought clinical teams together to manage a complicated buying system in a much more efficient and cost effective way.

More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.

All of these projects have received national recognition.

I have been a NICE Medicines and Prescribing Centre Associate, sharing related information /guidance & learning with a diverse group of NICE Affiliates, and documenting outcomes. I also continue to practice as a mental health clinician, focusing on several areas including mental capacity assessments and medicines management.

In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.


Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator.

Here’s Steve talking about one of our wellbeing projects:

Steve Turner

@MedicineGovSte

Click here for LinkedIn profile

info@carerightnow.co.uk

07931 919 330

Revised blog published: 10.09.2020

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Filed Under: Care Right Now, Jargon Buster, Leadership in Health, Medicines Optimisation, NICE, Organisational Culture, Prescribing, Transparency, whistleblowing, Workshops

Multi-morbidity & polypharmacy (taking 4 or more meds.)

May 15, 2017 By Steve Turner

Multi-morbidity and polypharmacy (that’s taking four or more medicines)

Taken from NICE Key Therapeutic Topics  pages 5-10.

Key points:

  • People with multiple illnesses are often prescribed multiple medicines, with new medicines being added to counter side-effects of others. The actual benefits of doing this are hard to ascertain.

Taking multiple medicines involves increased risks.

  • Everyone with multiple illnesses should receive a holistic person-centred review of their medicines and share in the decision making of what they take. (My view takes this further. I’d say ‘be given the option to lead on the decision making of what they take’).
  • Polypharmacy (taking four or more medicines) can be divided into two categories. Appropriate polypharmacy, where the benefits and disadvantages have been fully evaluated together. Problematic polypharmacy, where this hasn’t been done and the benefits of the medicines are not realised, sometimes to the extent that they are making the person worse.
  • There are some useful tools which can be used to help evaluate appropriateness of medicines in individuals (described in the document). Additionally I’d add that motivational interviewing techniques and time to build trust of the patients are also vital.
  • Intentional non-adherence can be overcome in a trusting clinician patient relationship, which usually happens over time.

#jargonbuster ‘intentional non-adherence’ = not telling clinical staff what you are actually taking and/or not taking.


More on the NICE Key Therapeutics Document here:


Personal views of Steve Turner RGN; RMN; Ba (Hons); P.G. Dip Ed; MIHM

Steve is a nurse prescriber and NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @SteveMedGov

Steve is an Ambassador for @MedicineGov

Posting on #mentalhealth #MedsOpt #MedLearn #NICEGuidance #PatientEducation #substancemisuse #selfcare #prescribing 

Search under #MedLearn

LinkedIn profile here: https://www.linkedin.com/in/sjturner/

For more on Care Right Now’s Patient Led Clinical Education work-streams click here: https://www.carerightnow.co.uk/projects/

‘Phone 01872 248327

Or email steve@carerightnow.co.uk

 

For part one of this blog ‘Medicines are overused’ click on the image below:


 

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Filed Under: Academic Detailing, Elderly care, Jargon Buster, Medicines, Medicines Optimisation, NHS, NICE, Prescribing

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