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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: sara.hobden@nbt.nhs.uk
Julie Hamer: Senior Pharmacy Technician, Medicines Management
Direct line: 0117 323 2309
Email: julie.hamer@nbt.nhs.uk
Jane Smith: Principal Pharmacist - Service Development & Governance
Direct line: 0117 323 2391
Mobile: 0788 443 7780
Email: jane.smith@nbt.nhs.uk
Lunch, exhibition and
poster viewing
Please by back by 13.20
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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
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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!
