El1a: METHADONE SUPERVISED ADMINISTRATION SERVICE

LOCAL ENHANCED SERVICE

EL1a: METHADONE SUPERVISED ADMINISTRATION SERVICE

SERVICE LEVEL AGREEMENT 2010 - 11

PLEASE INSERT PHARMACY STAMP HERE (if available)

CONTENTS

·  Summary of Scheme

·  Financial Details

·  Service Aims

·  Service Criteria

·  Ongoing Measurement & Evaluation

Appendices

·  Appendix 1 - Audit

·  Appendix 2 - Revised Supervised Methadone Guidelines

·  Appendix 3 - Claim form

·  Appendix 4 - Example of a terms of Agreement for Supervised Administration

·  Signature Sheet

SUMMARY OF SCHEME

·  This service is commissioned by NHS East Riding of Yorkshire (“the PCT”) on behalf of the East Riding of Yorkshire Drug Action Team (“the DAT”)

·  This service will require the pharmacist or trained member of staff under the supervision of a pharmacist to supervise the consumption of methadone at the point of dispensing in the pharmacy, ensuring that the dose has been administered to the patient.

·  The service will be provided by the pharmacy according to a written Standard Operating Procedure.

·  Pharmacies will offer a user-friendly, non-judgmental, client-centred and confidential service.

·  The pharmacy will provide support and advice to the patient, and liaise with primary care or specialist centres where appropriate.

·  The service will be monitored by the PCT with the support of the DAT.

·  The DAT will manage the budget for the scheme and the PCT will make the payments to the Contractor against the invoices.

Provision of Enhanced Services

This enhanced service will only be commissioned from pharmacies providing the full range of Essential Services as defined by the Pharmacy Contract and operate a minimum 6-day opening policy. Exceptions to the minimum 6-day opening policy will only be considered when there is no pharmacy available locally that the client can access. Approval must be gained from the DAT and prescribing team for new pharmacy contractors to provide this service.

Financial Details

Set Up Cost (per pharmacy) [New Providers Only] £75

Fee per Supervised Dose £1.58

The set up cost is a one off payment to enable newly participating pharmacies to audit their existing service provision and make any necessary changes to meet the requirements of the service specification.

VAT is not included in the price as HM Revenue & Customs (HMRC) have agreed that the advice that community pharmacies offer in relation to the supervised consumption will be exempt under the support for self-care rules.

No cost is included for Hepatitis B vaccination as the consensus is that the risk can be managed without it.

Payment Terms

Claims for this service should be sent on a monthly basis by the 5th of each month to:

Sue Kitching, Finance Dept, Health House, Grange Park Lane, Willerby,

Hull HU10 6DT

Agreement Period

The agreement will commence on 1st April 2010 until 31st March 2011. It will be subject to renewal if agreed by all parties.

The agreement may be terminated without penalty if the PCT or the Pharmacy gives the other party at least one month’s notice in writing.

N.B. The PCT reserves the right to withdraw this enhanced service immediately if the pharmacy is found not to be meeting its requirements for the provision of essential services after the SLA has commenced.

SERVICE AIMS

To ensure compliance with the agreed treatment plan (prescription) by:

·  dispensing in specified instalments (doses may be dispensed for the patient to take away to cover days when the pharmacy is closed),

·  ensuring each supervised dose is consumed by the patient for whom it was intended.

To reduce the risk to local communities of:

·  diversion of methadone onto the illicit drugs market; and

·  accidental exposure to methadone.

To provide service users with regular contact with health care professionals and to help them access further advice or assistance. The service user will be referred to specialist treatment centres or other health and social care professionals where appropriate.

Guidance on pharmaceutical services for drug misusers in England has been published by the National Treatment Agency for Substance Misuse (NTA), the Royal Pharmaceutical Society and the Pharmaceutical Services Negotiating Committee. The guidance entitled "Best practice guidance for commissioners and providers of pharmaceutical services to drug users" is available to download from the Society’s website at http://www.rpsgb.org/pdfs/pharmservdrugusersguid.pdf.

SERVICE CRITERIA

The specification details the following service criteria. The following pages contain some further guidance from the PCT on expected processes, outcomes and deliverables based on this process.

1.  Service Outline

2.  Staffing

3.  Records/Audits

4.  Quality Indicators

Criterion One: Service Outline

Details

·  This enhanced service must be provided throughout the pharmacy’s contracted hours although it is recognised that some restriction at the beginning or end of the day may be necessary.
·  The part of the pharmacy used for provision of the service will provide a sufficient level of privacy and safety.
·  The pharmacy will present the medicine to the service user in a labelled dispensing container which could be used as a suitable single use receptacle and will provide the service user with water to facilitate administration and/or reduce the risk of doses being held in the mouth.
Criterion Two: Staffing

Details

·  The pharmacy contractor will ensure that pharmacists, locums and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.
·  All pharmacists providing this service will complete the CPPE Open Learning Programme entitled “Substance Use and Misuse” A copy of their certificate of completion will be held in the pharmacy.
·  The pharmacy contractor will ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols.
·  The DAT in conjunction with the PCT will provide details of relevant referral points which pharmacy staff can use to signpost service users who require further assistance.
·  The DAT in conjunction with the PCT will obtain or produce health promotion material relevant to the service users and make this available to pharmacies
Criterion Three: Records/Audits

Details

·  The pharmacy will maintain appropriate records to ensure effective ongoing service delivery and audit. A record of each client will be maintained on a patient medication record (PMR) at the pharmacy.
·  Pharmacists will share relevant information with other health care professionals and agencies, in line with confidentiality arrangements. They will input into the prescriber/client reviews of supervised consumption as requested.
·  Pharmacists will record relevant service information for the purposes of audit using the framework provided the PCT in conjunction with the DAT (appendix 1).
·  The pharmacy participates in an annual audit of the service requested by the PCT in conjunction with the DAT in liaison with the LPC. The results of this audit are reviewed by the DAT annually.

Criterion Four: Quality Indicators

Details

·  The pharmacy will deliver this service in line with the agreed guideline – see Appendix 2 – as amended.
·  The pharmacy has appropriate health promotion material (available for the user group and promotes its uptake). This information will be agreed by the DAT in conjunction with the PCT. The material will be provided by the DAT.
·  The pharmacy reviews its standard operating procedures and the referral pathways for the service where necessary or at least on an annual basis.
·  The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service. CPPE Open learning packs “Substance use and misuse” for pharmacists and “Substance use and misuse: fundamentals and practicalities for the pharmacy technician” are particularly relevant.
·  The pharmacy participates with any audit of service provision agreed by the Joint Commissioning Group in conjunction with the DAT and the PCT and completes the audit in Appendix 1 at least annually.
·  The pharmacy co-operates with any locally agreed PCT in conjunction with the DAT-led assessment of service user experience.

ONGOING MEASUREMENT AND EVALUATION

1.  The pharmacy is required to agree with the PCT this service specification/plan at the start of the year.

2.  The specific data measurement, evaluation and audit requirements of the scheme are outlined in the individual sections of this document

3.  The pharmacy will be required to collate the necessary evidence of compliance with the requirements of the scheme.

4.  The scheme will then be evaluated at the annual contract review with the PCT.

APPENDIX 1

Audit of Service

Service Standard / Rating / How can my service be improved? /
Always / Mostly / Never / (Action plan for improvement) /
1 / Where a new service user presents without prior notification by the prescriber, contact is made with the prescriber to confirm the client’s identity and prescription details before issuing the first dose.
2 / An agreement on the “conduct of behaviour” should be explained and two copies signed by each new service user (one for them to keep and one to be kept in the pharmacy).
See Appendix 5 for example.
3 / A signed copy of any agreement is held securely in the pharmacy for 11 Years.
4 / Service users are given a practice leaflet and information about appropriate times to collect doses
5 / Information is given to service users relating to weekend and Bank Holiday doses
6 / Service users are introduced to staff so that they can be identified and dealt with promptly each day
7 / The pharmacy must have a method to confirm identification if the service user cannot be identified by staff e.g. PMR ID card or check signature against agreement
8 / The service user's PMR should be complete and include name and address, date of birth, GP/prescriber details, key worker name and contact details (if applicable) and “supervised consumption” or similar note
9 / The service user's PMR should also include all other prescription items dispensed by the pharmacy, and where appropriate, other over-the counter medication supplied.
10 / All patient identifiable information is kept in a secure place and is not passed on to anyone other than those authorised to see it.
11 / Prescriptions must be legally correct
12 / The methadone mixture used is a licensed product or is extemporaneously prepared according to an SOP in line with RPSGB guidance
13 / Any equipment used in the manufacture or dispensing of methadone mixture should be cleaned, calibrated and serviced regularly according to manufacturers instructions
14 / Sugar and/or colour free preparations should only be dispensed if they are specifically prescribed as they have a greater potential for abuse
15 / If doses are prepared in advance (recommended if space in the CD cabinet permits) they should be suitably labelled and stored in the CD cabinet
16 / Individual instalments are fully dispensed and labelled prior to supervision
17 / Doses are measured and checked before being dispensed into a suitable container
18 / The dispensing label should be attached to the container detailing name, directions, quantity and date of dispensing
19 / Take home doses are provided in an appropriate leak proof container and fitted with child resistant closures
20 / Advice is given on safe storage of take home doses as necessary
a.  “Keep out of reach of children”
b.  Pharmacists have a professional responsibility to ensure that patients are provided with sufficient information and advice to enable the safe and effective use of their medicine. Therefore, where a bottle of medicine contains more than one dose, the pharmacist should ensure that the patient is able to correctly measure out their required doses themselves. (See the Royal Pharmaceutical Society Guidance Fact Sheet 1 on controlled drugs, NPSA Patient Safety Alert 19 Promoting the safer measurement and administration of liquid medicines via oral and other enteral routes March 2007 and NPA updated Standard Operating Procedure (SOP) on Promoting Safer Measuring and Administration of Liquid Medicines).
21 / The right hand side of the prescription is marked with the date and quantity dispensed and initialled when the service user has consumed the dose or when any "take home" doses have been supplied
22 / If the service user does not collect a dose the prescription is marked "Not Collected" and the PMR record reflects this
23 / If the service user fails to collect three consecutive doses the prescription is suspended (NOT CANCELLED) until the prescriber has been contacted and an assessment has been made as their tolerance may have fallen
24 / If a service user is intoxicated the dose is not dispensed until the service user has “sobered up” and the clinic informed. Professional discretion should be used on Saturday for take home doses
25 / If a dose is to be collected by a third party this should be stated on the prescription or a verbal authorisation from the prescriber and written authorisation from the client (retained for 1 year) is required on each occasion.
26 / Supervision takes place in a quiet area with sufficient privacy to allow both service user and pharmacy staff member to feel comfortable (Supervision does not take place in the dispensary)
27 / Doses should be presented to the patient in a single use disposable receptacle (the cost of 2 disposable plastic cups is included in the costing of supervision)
28 / A drink of water is provided to the service user in a single use disposable receptacle
29 / The staff member supervising the dose should be satisfied that the dose has actually been swallowed by observing water being swallowed after the dose, or by conversing with the service user
30 / Any receptacles which the service user has been in contact with should not be reused and should be disposed of in the normal waste. Pharmacy staff should avoid handling the used containers.
31 / Harm minimisation information has been reviewed and steps taken to minimise
any risks to pharmacy staff.
See Appendix 1
32 / Confidentiality is protected by removing identifiable labels from containers prior to disposal or by obliterating names using permanent marker
33 / Entries are made in the CD register in chronological order on the day the dose was collected (recommended) or the day following
34 / The CD entry is marked clearly to indicate a supervised dose (‘S’ in the margin) or unsupervised dose (‘X’ in the margin) to provide an audit trail. (to be reviewed in-line with availability of electronic CD registers)
35 / Claim form is fully completed and submitted by the 5th of each month
(See appendix 4)
36 / The pharmacy makes use of health promotion materials relevant to the service users e.g. harm reduction information supplied by the PCT.
37 / The pharmacy makes use of signposting information provided by the PCT or DAT
38 / The pharmacy reviews its standard operating procedures and the referral pathways for the service where necessary or at least on an annual basis
39 / The pharmacy completes this audit at least annually and submits copies as requested for collation and review by the DAT
40 / The Pharmacy Contractor ensures the quality of the service is maintained by all pharmacists, locums and staff involved in its provision.
41 / The pharmacists and staff involved in the provision of the service have undertaken CPD relevant to the service and are able to demonstrate this if requested by the PCT/DAT

APPENDIX 2