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How to achieve the NICE guidelines on Managing Medicines in Care Homes
- 1. www.icarehealth.co.uk How to achieve the NICE guidelines on Managing Medicines in Care Homes Connect with iCareHealth:
- 2. www.icarehealth.co.uk Objectives Understand roles and accountabilities for improving quality of care Understand the importance of the NICE Quality Standards for managing medicines How you can make use of NICE Quality Standards to improve standards of care Understand resources available to support your care homes
- 3. www.icarehealth.co.uk Improving the quality of care – who does what? Quality Care Managers Commissioners NICE CQC
- 4. www.icarehealth.co.uk What are NICE Guidelines and Quality Standards NICE guidelines – evidence based recommendations on ‘what works’ Quality standards – a concise set of statements designed to drive and measure improvement in quality 90 Recommendations 7 Statements NICE GUIDANCE NICE QUALITY STANDARDS
- 5. www.icarehealth.co.uk How you can use NICE quality standards to improve your care home Demonstrate commitment to quality improvement Prepare for CQC inspection and evidence that your service is well led Guide workforce recruitment and development
- 6. www.icarehealth.co.uk Managing Medicines in Care Homes Quality Standards – commencing March 2015 1) Care homes have a medicines policy that is regularly reviewed. 2) People who live in care homes are supported to self-administer their medicines unless a risk assessment has indicated that they are unable to do so. 3) People who live in care homes have an accurate listing of their medicines made on the day that they transfer into a care home. 4) People who live in care homes have details of their medicines shared with their new care provider when they move from one care setting to another. 5) GP practices have a clear written process for prescribing medicines for their patients who live in care homes. 6) People who live in care homes have at least 1 multidisciplinary medication review per year. 7) Care homes have a documented process for the covert administration of medicines for adult residents.
- 7. www.icarehealth.co.uk Statement 1. Care homes have a medicines policy that is regularly reviewed How is this measured? Written evidence of a care home medicine policy that is relevant to the individual care home Evidence that the policy has been reviewed and is up to date with local arrangements and current legislation How is it achieved? Undertake a base line assessment against NICE policy check list and local guidelines Appoint a person to be accountable for maintaining, updating and reviewing policies. What trigger points initiate a review? Cascade briefing to all staff – including night and agency staff – role of eLearning systems How is compliance to policies and procedures measured and monitored?
- 8. www.icarehealth.co.uk Statement 2. People who live in care homes are supported to self- administer their medicines unless a risk assessment has indicated that they are unable to do so How is it measured? Number of residents where risk assessment has been undertaken Number of residents who self-administer (based on risk assessment) Resident feedback on how they feel supported to self-administer How is it achieved? Include a self-administration assessment as part of initial resident assessment (include existing residents) Seek involvement of wider stakeholders e.g. resident, family, GP and Pharmacist Define ongoing review process and success criteria Review use of Monitored Dosage Systems Review medication formulations with Pharmacist and GP
- 9. www.icarehealth.co.uk Statement 3. People who live in care homes have an accurate listing of their medicines made on the day that they transfer into a care home How is it measured? Protocol exists to ensure accurate listing of residents medication Time between a person entering a care home and completion of their medicines reconciliation How is it achieved? Medicines reconciliation forms part of initial assessment and is a prioritised activity Agree protocols with main agencies e.g. social services, hospital, GP Where should this information be recorded and who should be informed? Support and escalation process where discrepancies exist
- 10. www.icarehealth.co.uk Statement 4. People who live in care homes have details of their medicines shared with their new care provider when they move from one care setting to another How is it measured? Proportion of transfers to and from a care home where the resident is accompanied with an accurate record of their medicines How is it achieved? Production of a master MAR - containing regular medication and other sourced drugs – use of eMAR solutions Agreement with hospital and local care providers on standardised templates Process to share data between health professionals – GP, Pharmacist Escalation and support process where discrepancies exist
- 11. www.icarehealth.co.uk Statement 5. GP practices have a clear written process for prescribing medicines for their patients who live in care homes How is it measured? Number of prescriptions that include clear instructions of when and how (including dosage instructions) the prescribed medicine is to be used Medication errors attributable to incomplete information provided with a prescription How is it achieved? Agree a policy with the GP practices/ hospital for the prescribing to residents in the care home Agree verbal change to instructions protocol with key prescribers Utilise pharmacy to conduct an initial review of all prescriptions, to check for missing, inaccurate or incomplete instructions e.g. as directed, PRNs without protocol Define process to ensure that changes made at point of care are reflected in both GP and pharmacy software systems.
- 12. www.icarehealth.co.uk Statement 6. People who live in care homes have at least 1 multidisciplinary medication review per year How is it measured? Proportion of people who live in care homes and are receiving medication whose last multidisciplinary medication review occurred no more than 1 year ago Feedback from care home residents that they feel involved in their medication reviews. How is it achieved? Define process for prompting a medication review Agreement from GPs as to when and where medication reviews will be conducted – GP clinic in the home? Liaise with CCG regarding single GP Model for care home Prioritisation of residents for review e.g. multiple meds, chronic conditions, risk of fall Multidisciplinary approach using other health professionals, families and residents Utilise administration and clinical data to understand holistic view of resident
- 13. www.icarehealth.co.uk Statement 7. Care homes have a documented process for the covert administration of medicines for adult residents How it measured? Evidence of a written process for the covert administration of medicines to adult residents in care homes How is it achieved? Agree criteria that trigger an assessment Adopt a multidisciplinary approach including family/ advocate How is success measured and what is the review period? Liaison from pharmacy and local drug Information service to assess medication formulation suitability
- 14. www.icarehealth.co.uk Summary Recommendations Have an accountable person for maintaining, updating and reviewing policies and procedures that cover each Quality Standard Have a process for checking staff competency – new starters and ongoing Have a process for evidencing actions and assessing outcomes of Quality Standards Review role of software solutions for medication data capture, management information, training and competency assessments, auditing and task management
- 17. www.icarehealth.co.uk What next? 59 209 502 18 0 20 40 60 80 100 120 Inadequate Requires Improvement Good Outstanding 0 100 200 300 400 500 600 % Inspected Care Home Ratings and % Achieving NICE Standards CQC % Achieving NICE Standards