Reviewed: 08/12/17 / Issue No. 1
Page 1 of 65
MEDICATION POLICY USING PROACTIVE CARE SYSTEM (PCS)
Contents
1.Introduction
1.1.Purpose
1.2.Scope
1.3.Elements of the care home medicines policy...... 5
1.4.Medicines Management Systems within Woodchurch House
1.5.Responsibilities of the Care Home Manager
2.The Pro-active Care System and arrangements for pharmaceutical services
2.1.The Pro-active Care System
2.1.1.Fundamental requirements for using the PCS device
2.2.Support for the PCS device
2.3.Arrangements for the pharmaceutical service
2.3.1.Dispensing of medicines
2.4.Service Level Agreement (SLA)
2.5.Customer support and escalation procedures for resolving issues...... 11
3.Supply and Storage of Medicines
3.1.Introduction
3.2.Supply of medicines
3.2.1.Dispensing of medicines and label requirements
3.2.2.Prescribed medicines - the property of the resident ...... 1
3.3.Records of medicines, dressings and appliances received
3.3.1.Booking out medicines in periods of absence from the care home
3.4.Records of disposal of medicines
3.4.1.Storage and collection of medicines for disposal
3.4.2.Disposal of controlled drugs
3.5.Storage of medicines
3.5.1.Expiry dates
3.5.2.Expiry dates for “in use” medicines
3.5.3.Items requiring refrigeration
3.6.Controlled Drugs (CDs)
3.6.1.Storage of Controlled Drugs
3.6.2.Controlled Drugs Register
3.6.3.Controlled Drug Register entries
3.6.4.Dealing with discrepancies
3.7.Use of oxygen in care homes
3.7.1.Storage of oxygen
4.Medicines Administration
4.1.Introduction
4.2.General requirements relating to administration of medicines
4.3.Medicines administration procedure
4.3.1.Resident refusal and covert medication requirements8
4.3.2.Administration of controlled drugs
4.3.3 Injections 30
4.3.4 Dressings 31
4.3.5 Enemas 31
4.3.6 Suppositories, Pessaries, Vaginal/Rectal creams and Ointments 31
4.3.7 Eye drops, ear drops, Nasal Sprays and Inhalers 32
4.3.8 Creams, Ointments and Gels 32
4.3.9 Percuataneous Endoscopic Gastrostomy (PEG) 33
4.3.10 External Diagnostic Procedures 36
4.3.11 Subcutaneous Infusion 36
4.3.12 Syringe Drivers 36
4.3.13 Nutritional Supplements 37
4.3.14 Use of Thick and Easy / Fluid thickeners 37
4.3.15 Oral anticoagulants 37
4.4 When Required Medication (PRN) 39
4.4.1 Structured PRNs 40
4.4.2 Non- structured PRNs 41
4.5.Regular prescribed medicines2
4.5.1.Specific times for administration...... 42
4.5.2 Hand written MAR sheets 42
4.5.3 Discontinued Treatment 42
4.5.4 Change of dosage 42
4.5.5 Telephone/verbal instruction 43
4.5.6 Prescriptions obtained out of hours 43
4.6.Records of medicines administered using PCS...... 43
4.6.1 Audit of medication administration records 45
4.6.2 Clinical readings and monitoring 46
4.6.3 Access to medicines information 46
4.7.Self-administration of medicines
4.8.Homely Remedies...... 48
5.Ordering and receiving medicines in to the care home...... 51
5.1.Introduction...... 51
5.2.Determining which medicines are needed...... 51
5.3.The prescription ordering process...... 51
5.4.The prescription collection, dispensing and delivery process...... 53
5.5.Interim prescriptions...... 53
5.5.1.Urgent supplies...... 54
5.5.2.Receiving an interim supply of medicines...... 55
5.6.Monthly medication cycle...... 55
5.6.1.General Requirements...... 55
5.6.2.Monthly process using the PCS device
Step 1 Placing orders on PCS...... 56
Step 2 Ordering the monthly prescriptions...... 56
Step 3 Collecting your monthly prescriptions and reconciliation against PCS order
Step 4 Checking of missing prescriptions and discrepancies...... 57
Step 5 Dispensing, packaging and delivery...... 57
Step 6 Booking in your monthly medication supply with the PCS device...... 57
Step 7 New medication cycle...... 58
5.7.Checking of authorized prescriptions on the Invalife web portal...... 58
5.7.1.The Invalife Invalife web portal...... 59
5.8.Communicating with the Pharmacy...... 60
5.8.1.New Resident Registration Form (PP14)...... 60
6.Special considerations...... 61
6.1.Introduction...... 61
6.2.Promoting Independence...... 61
6.3.Informed consent and freedom of choice...... 61
6.4.Confidentiality and data protection...... 61
6.5.Care home inspections and medicines...... 62
6.6.Residents Medication Reviews...... 62
7.Procedure for dealing with medication errors and drug alerts...... 63
7.1.Medication errors...... 63
7.2.Drug and Safety alerts...... 63
8.Staff Training for medicines administration and assessment of competence...... 64
9. Damaged medicines 65
10. Responding to adverse drug reactions and medicine alerts 65
11. Day care and respite service users 66
12. Unplanned outings for residents 66
13. Holidays and planned outings for residents 66
14 Residents leaving the care home 67
15. Specials Medication 67 16. Emergency evacuation of the care home 68
17. Failure to comply with Medication Policy 69
Introduction
It is Woodchurch House policy to ensure that medication management promotes residents’ safety and wellbeing and provides a framework of safe practicesbyall Care Staff and Nurses. Compliance with this medicines policy and procedures within will promote safe administration of medication to residents, efficient medicines management and compliance with legal and regulatory requirements.
In writing this policy the following regulations and guidance have been taken in to account:
- The Medicines Act 1968
- The Misuse of Drugs Act 1971
- Mental Health Act 2005
- In England: Health and Social Care Act 2008 – Regulation 12
- In Wales: CSSIW: National Minimum Standards for care homes for older people: Standard 17- Medication
- NICE – Developing and updating a Care Home Medication Policy – May 2014
- NICE Quality Standard 85 – Medicines Management
- CQC – ‘How we inspect and regulate’ – May 2015
- Royal Pharmaceutical Society – The Handling Medicines in Social Care - 2007
1.1.Purpose
This policy ensures a safe framework for the correct ordering of prescriptions, receipt, storage and administration and disposal of medicines in Woodchurch House.
The promotion of safety and the enhancement of the wellbeing of residents must be considered and upheld at all times.
1.2.Scope
All registered managers and all qualified nursing staff involved in medication management in care homes with residents with nursing needs and all senior carers in residential settings who deal with medication including all agency staff.
1.3.Elements of the care home medicines policy
It is recommended that all care homes should possess a Medication Policy document which will assist care home owners, care home managers and care home staff to:
- inform the development of care home/organisational structures, systems and processes
- clarify existing lines of accountability between the care home and wider members of the care team to include for example GPs, Pharmacists and community nurses
- identify training and competency needs of care home staff
- improve the transfer of care between service providers to include hospitals and other care homes
The National Institute for Health and Care Excellence (NICE) has produced a Guideline for care homes to support them in developing and updating a care home medicines policy and this Guideline (dated March 2014) can be accessed in full via the NICE website at:
The NICE Guideline can fully viewed and printed by clicking on the Download tab at the top right hand corner of the page.
NICE has also published a Quality Standard 85 issued in March 2015 relating to medicines management in care homes and reference should also be made to this document when developing a care home policy. The document can be located at the NICE website ( ) and use the search facility for NICE QS 85 Medicines Management.
Areas that should be covered by a Care Home Medicines Policy
The NICE Guideline has recommended that the following areas should be covered within a care home medicines policy:
- Sharing information about a residents medicines, including when they transfer between different care settings to include discharge summaries and availability of medicines on the day that they transfer to a new setting
- Ensuring that records relating to residents medicines are accurate and up to date
- Identifying, reporting and reviewing medicines–related problems
- Keeping residents safe (Safeguarding)
- Accurately listing a residents medicines and reconciling them with the prescribers current intentions
- Reviewing residents medicines with multidisciplinary teams
- Ordering medicines
- Receiving, storing and disposing of medicines
- Helping residents to look after and take their medicines themselves if appropriate (self-administration)
- Care home staff administering medicines to residents , including staff training and competency requirements
- Care home staff giving medicines to residents without their knowledge (covert administration)
- Care home staff giving non-prescription and over the counter products (homely remedies) to residents if appropriate
The Medicines Policy Checklist (dated May 2014) provides more information about these areas and processes that should be covered within a care home medicines policy. The checklist can be located from the same page that the NICE Guideline is accessed at:
Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print the Medicines Policy Checklist.
Using the Medication Policy Checklist
Care Home providers may wish to consider:
- how they can use the checklist as a tool for the development and improvement of practices and processes within the care home
- how each section and topic area applies to the scope of practice within the care setting
- how care home providers will ensure that the care home staff are aware of the content of the care home medicines policy and understand how to put it into practice
- whether any changes to their care home medicines policy are needed to reflect the care setting in which it is being used
- how often they will review and update the care homes medicines policy, taking into accounts new evidence on best practice
Baseline Assessment Tool
NICE have also produced a baseline assessment tool which can be used by care homes to evaluate their current practices against the recommendations in the NICE Guideline on Managing Medicines in Care homes. This tool can also be used to help care homes plan any activity to meet these recommendations.
The baseline assessment tool (dated March 2014) can be located from the same page that the NICE Guideline is accessed at:
Access the Tools and Resources tab at the top of the page and then scroll down to obtain and print the baseline assessment tool.
In England - A care home policy should also contain reference to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 and to the new CQC inspection guidance (updated in May 2015) to include the standard set of key lines of enquiry (KLOE) that relate to the five key measures of service provision – are services safe, effective, caring, responsive and well led – with a key focus for medicines management being included in the ‘safe’ category.
This guidance now replaces the previous reference to Outcome 9 – Management of medicines
In Wales – There have been no changes and CSSIW will continue to make reference in their inspection visits and reporting to the National Minimum Standards – Standard 17 (Medication). CSSIW are currently reviewing the Policy guidance which has been issued by NICE (March 2014)
For Information
Beacon Digital takes no responsibility for the medication policies of individual care homes and it is recommended that a reference to the use of the Proactive Care System (PCS) is included within the care home medicines policy with cross referencing to PCS processes and procedures available via Invatech e-learning and on line help guides. Care homes are responsible for ensuring that any NICE or other guidance used in the development of medicines policy is obtained from the latest available versions.
Beacon Digital are able to offer limited assistance in signposting care homes to the appropriate documentation referenced in this guidance.
1.4.Medicines Management Systems within Woodchurch House
It is a key aim of Woodchurch House to provide safe, efficient and accountable systems of medicines management.
Woodchurch House has entered into anagreement with Beacon Digital and Well Pharmacy and introduced an electronic medication management system called the Proactive Care System (PCS). This consists of a hand held device that is used by nurses and carers to support the administration and documentation of medicines and a range of supporting services that ensure the company’s aims under section 1.3 are met.
All medicines related activities within the care home will therefore be processed using the PCS system and the adoption of the use of original pack dispensing in place of previous Monitored Dosage Systems.
1.5.Responsibilities of the Care Home Manager
This medicines policy requires the care home manager to be responsible for the delivery of the organisations aims under section 1.3 and for the following tasks which protect residents from harm due to medicines administration:
- To ensure that a safe environment exists at all times in the home in relation to the ordering, storage, administration and the disposal of medicines
- In discharging this responsibility, the manager must promote a safety conscious approach in which all members of staff involved understand what is expected of them and the procedures that need to be followed and complied with.
- To ensure members of staff are adequately trained and competent in the use of the PCS device for the administration of medicines to residents and in the associated systems and processes in the care home for medicines management
- Assessing at induction and the subsequent monitoring of the competency of all appropriate staff to administer medicines safely
- Checking of on-line medication administration records every week and assessment of performance of staff in relation to medicines managementas well acting on the various management information reports available.
- Ensuring that all staff members know how to access the electronic drug information that is available on the PCS device and on the on-line Invalife service.
- Arrangements for the preparation of orders for medication from the surgery and forwarding of the requests to the GP surgery in line with the Service Level Agreement (SLA) which is in place between the pharmacy provider and care home.
- Arrangements for the collection of the prescriptions, dispensing and delivery as agreed within the SLA provided by the pharmacy provider. This will include out of hours and weekend arrangements
- Arrangements for the accurate and timely booking in of the medicines to the care home
- Safe Storage and Security of Medicines, including Controlled Drugs
- Liaising with GPs and other allied healthcare clinicians and staff and communicating changes to residents’ medication to the pharmacy provider as appropriate and via the PCS handset as per agreed processes and protocols
- Recording and accounting for the medicines administered to residents
- Ensuring access and review of all records relating to medicines management
- Maintaining a list of all homely remedies used in the home and clearly indicating and recording the administration to each appropriate resident
2.The Pro-active Care System and arrangements for pharmaceutical services
This section outlines the procedure for using the electronic medication system called the Pro-active Care System (PCS) and the agreement in place with Well Pharmacy as the provider of pharmaceutical services and a partner in the management of medicines at the care home.
The Care Home Manager must ensure that the agreed Service Level Agreement with the Pharmacy Provider is upheld at all times to support the integrity of the Pharmacy service and to ensure residents receive their medication when they require it.
2.1.The Pro-active Care System
Woodchurch House will employ the PCS system to manage medicines related activities. This will ensure the safe, efficient, consistent and accountable management of residents’ medicines at all times. The medicines related activities to be carried out using the PCS system includes:
- Administration of medicines
- Communication of changes to medicines or therapy
- Ordering of prescriptions
- Receipt of medicines
- Disposal and return of medicines
- Viewing prescriptions (via Invalife)
- Accessing medicines or clinical information(not yet available)
- Stock management and control
2.1.1.Fundamental requirements for using the PCS device
There are a number of fundamental requirements for the use and application of the PCS system which will ensure high standards of medicines management in the care home. All members of staff are required to meet these fundamental requirements at ll times:
- Scan the barcodes on the medication labels of the medicines selected prior to administration.
This policy requires that 100% of medicines which have barcodes on their instruction labels are scanned prior to administration. - “Dock” or “Synchronise” the PCS device before and after every medication round and when prompted.
This policy requires that the PCS device is “docked” before and after each medicines round. - Book in all supplies of medicines received on the PCS device.
This policy requires that 100% of all medicines received in to the care home are booked in using the PCS device. - Carry out a stock take for the prompted medicines.
This policy requires that 100% of all required stock takes are carried out. - Take action on the “low stock” medicines prompted.
This policy requires that 100% of “low stock” items are acted up on promptly. - Order the Monthly medicines on time.
This policy requires that the Monthly Medicines are ordered on the day that they are prompted and this is typically day 8 of the monthly cycle and where possible to use the PCS summary order reports in agreement with your local GP surgeries to ensure accuracy and efficiency of ordering - Account for all “Missing Entries”.
This policy requires that all 100% of “missing entries” are accounted for at every hand over or by using the Invalife web portal. - Complete the administration plans for “PRNs”, “Emollients”, and “Dressings”.
This policy requires that 100% of administration plans are completed. - Ensure the PCS device is charged.
This policy requires that the PCS device is charged 100% of time when not in use and that its battery charge does not drop below 40%. All members of staff are required to be vigilant and never allow the PCS device to run out of charge. - Ensure that paper MAR charts are only used in exceptional circumstances once all options to address issues and problems have been explored.
This policy requires that the use of paper MAR charts in the care home is only initiated in conjunction with your pharmacy provider once Invatech customer services department has been consulted and all attempts to resolve the situation have been fully explored.
2.2.Support for the PCS device
Each care home will have available as a minimum one member of staff trained on the PCS device 24 hours a day. This will ensure capability of each care home to train agency staff or newly inducted staff in the use of the PCS device to administer medicines. The names of members of staff trained and competent in the use of PCS should be recorded by the care home manager and included as an appendix in the care home medication policy folder.