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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

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

Children’s medicines – how listening to parents led to safer care

August 22, 2015 By Steve Turner

iStock_000009289937_Medium (2)

Case Study:

Background:
From 2008 to 2014 my company ran education sessions on managing medicines in a mental health trust. In common with some other mental health trusts the provider also looked after paediatric community services. This is not a mental health service. It covers children with complex health needs including enteral feeding tubes, ventilation; epilepsy and rapidly changing medicines. Children under the care of this service may be taking in excess of 15 different medicines per day, have complex titration regimes, emergency drugs with associated care plans, plus numerous ‘as required’ (prn) medicines.
It is not unusual for children with complex conditions to be under the care of up to five different providers, and to move between three different providers in one day. For example, from a Home Care Service to the Special School, to a Short Break House, maybe also being seen in an Outpatient Clinic on the same day too. As a result parents frequently have to repeat the information on their child’s medicines every time they move to another service, or a new person is involved.

Where to start?
The idea for change came about because of concerns that the staff in Children’s Short Break Houses were not learning what they needed about children’s medicines, as the learning was geared to the majority of staff who worked in mental health. So a new learning package for children’s staff was commissioned.
Part of the work to design the learning package included a baseline assessment which was conducted with parents and staff. This soon revealed that training alone was not the answer. It showed delays in medicines information reaching GPs, workarounds for obtaining information in order to administer medicines in the houses and a general lack of confidence in the whole process.
As a result we looked at the whole system starting with the area where most concerns had been raised, which was having an up to date complete list of a child’s medicines available at all times (medicines reconciliation). The system in place for Short Break Houses involved paying a local GP (not usually from the child’s GP Practice) to write up a medicines chart for each child. The process was fraught with difficulties and delays and widely disliked by everyone directly involved.
So we set about looking for a new way to manage the lists of medicines with more training and more input for the staff in the services involved. We came up with a new (and much more robust) process for medicines reconciliation in the Short Break Houses. This was fully documented in a new policy, and involved cross checking by both the staff and the parents.
Just before this went live, we asked the parents to review and comment on it and they said
‘If you’re producing an accurate and up-to-date list of my child’s medicines, why keep it the Short Break House, can’t it go with my child?’
So the My Medicines chart, which travels with the child, was born.

What was involved?
The My Medicines process led to the design and production of a new chart which has to be signed and checked by the parents.
It resulted in 40 children with complex conditions being offered a hand held paper record of their medicines (produced and validated by clinicians), which they take around with them wherever they go.

Benefits:
The new process, which continues to evolve, means that the child’s GP is now directly involved in day to day medicines reconciliation (they weren’t before); the parents are always asked to check and sign the charts (they weren’t before); verbal messages about medicines are never taken, and incomplete (or missing) directions are rapidly rectified (never worked around).
Some specific benefits of the new process include:
• It has reduced the risks of error, by providing full and accurate information on children’s medicine across their entire pathway.
• It cuts out the need for parents to keep having to repeat what medicines their child is taking to different professionals and care agencies.
• It frees up medical and clinical time which was previously spent chasing missing information.
• It has reduced the number of third part handovers and transcribing of prescription information.
Looking back it’s hard to believe that the old ways of working, which caused so many difficulties (especially for front line staff), were carried out for so long. These risky practices, or similar, are believed to still be commonplace in England.

Revealing hidden incidents and near misses:

In the first month of the project we raised 17 medicines incidents or near misses. Of these 11 related to problems with communication of information across the child’s pathway.
Resolving these has resulted in improved communication and engagement between different clinical groups and providers, and a desire from all quarters to take the project further. Previously many of these incidents were not logged or tracked across organisations. In some cases it was only due to the vigilance of the staff and parents that they were spotted and errors avoided.

Accepting the changes:

The project was well received by parents and staff, and resulted in improved communication and engagement between different clinical groups and providers. This included the Consultant Paediatricians (working for the secondary care provider), who were initially sceptical.
The project was less well received by the relevant medicines and prescribing committees, who were understandably concerned about who owned the My Medicines chart and had agreed its content. Explaining this was made more difficult because it is hard to get across the complexity of the arrangements, due to the critical nature of the children’s illnesses, in a committee setting.
I make no apologies for ensuring from the outset that it was the parents who owned the charts, which were designed by the project team (not a committee) to meet all best practice standards. It always worries me that when it comes to cross- organisational working the formal committees and systems in place can inadvertently act as a barrier to safety rather than promoting it. There is no doubt we had designed a safer process and my company was happy to take accountability for any associated risks.
As a legacy of the project, a Community Paediatric Pharmacist was appointed specifically to work with this group of children. So whatever evolves will now be based on inter-disciplinary thinking and working and will have clear safety parameters. I am grateful to the enlightened thinking of the leaders who commissioned this work and supported this novel approach.

Steve Turner

Managing Director Care Right Now (CIC)

This example is incuded in the NICE Shared Learning resource and was  highly commended in 2015.

Click here for the poster.

Last updated: 06.12.2021

CRNAnimationTestFor more information contact: info@carerightnow.co.uk

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Filed Under: Care Right Now, Children Health, Leadership in Health, Medicines, Medicines Optimisation, NHS, Organisational Culture, Prescribing, Transparency, Uncategorized, Workshops

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