WELCOME BACK Please switch off your mobile phones A Medication Administration Training Tool in Care Homes Sally Hall, Senior Pharmacy Technician, Gilbert Bain Hospital, Lerwick Medicines managementaudits and current practice in Care Homes Wendy Bagnall, Medicines Management Technician, Walsall CCG Wendy Bagnall Medicines 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 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 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 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. 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 Audit Agree The 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% Medicines Policies Nutritional Supplements Administration Antibiotics & C-Difficile High Risk Drugs Specials Asthma & Inhalers Antipsychotics & Dementia 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 Does the home have a Controlled Drugs Policy? Do care workers know which prescribed medicines are controlled drugs? 2012 2009 100% 89% 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? Is administration witnessed by trained and designated care workers? 94% n/a 93% 75% Does the witness confirm that the correct drug is selected 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 Does the witness confirm that the Care worker has prepared the right dose, as stated on the label and MAR chart Does the witness confirm that the care worker gives it to the right person? Does the witness confirm that the administration is recorded in the CD register and signed on the MAR? 91% 72% 90% 72% 90% 71% 91% 72% 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. 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% 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. Questions? Reducing the incidence of “Missed Doses” at North Bristol NHS Trust Sara Hobden, Pharmacy Technician, Medicines Management, Bristol Reducing the incidence of “Missed Doses” at North Bristol NHS Trust Sara Hobden, Pharmacy Technician, Medicines Management Pharmacy Department 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 Governance Group Executive Lead: Director of Pharmacy Medical Director Clinical Audit Pharmacists Chris Burton Frank Hamill Matrons Simon Anderson Heads of Nursing Rebecca Lewis Consultants Training Dept Patient Panel Members Nurses Denver McCrum Jennie Gillard Medicines Management Work stream Jane Smith Alison Mundell Consultants / Doctors Julie Hamer Sue Wensley Natasha Mogford James Calvert Robert Brown Arla Gamper Ruth Gillam Lorraine Motuel Pharmacy Medicines Management Technicians Clinical pharmacists Dispensary team 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. Code ‘6’ – drug unavailable Aims and objectives To 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 eaudit tool. Plan Do Act Study 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 WELCOME BACK Please switch off your mobile phones 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 viewing Please go to your Parallel Workshop Sessions at 15.45 WELCOME Sunday 9 June 2013 Yellow Card Reporting & What it means for Pharmacy Technicians Anthony 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 WELCOME BACK Please switch off your mobile phones My role as a Pharmacy Technician Specialist in Homecare Diane Meech, Pharmacy Technician Specialist- Homecare & High Cost Drugs, Ealing Hospital NHS Trust Closing remarks Steve Acres, President, APTUK Thank you See you in 2014!