Community Pharmacy Enhanced Service

Appendix 1

COMMUNITY PHARMACY ENHANCED SERVICE

FOR SHEFFIELD CARE HOMES

Agreement Between:______(home)

______(home address & postcode)

And______(pharmacy name)

______(pharmacy address)

For Year1 April 2016 to 31 March 2017

Care Home SUPPORT TOOL

The pharmacy contractor providing the service to the care home (in consultation with the care home manager) should complete this form at the initial visit and record the numbers of YES, NO and N/A responses as well as the Action Plan, boththrough PharmOutcomes, by 31st August 2016 to ensure 1stpayment is made. COPIES TO BE RETAINED BY PHARMACY AND CARE HOME

Six months after the initial Care Home visit, a follow up visit MUST be undertaken to monitor progress against the Action Plan.

Following the second visit, progress should be recorded against the Action Plan through PharmOutcomes by 28th February2017 to ensure the 2nd payment is made.

Initial visit
Care Home manager signature______Date: ______
Care Home manager name (PRINT)
Pharmacist signature______Date: ______
Pharmacist name (PRINT)
6 month re-visit
Care home manager signature______Date: ______
Care home manager name (PRINT)

From 01 April 2015 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) replaced CQC’s Guidance about Compliance: Essential Standards of Quality and Safety and its 28 outcomes. This checklist reflects these changes and Pharmacists/Pharmacy Technicians should acquaint themselves with the new regulations.

CQC have revised the way they inspect the organisations they regulate. They base their inspection on 5 questions. Each of the questions are broken down into a further set of questions. CQC call these their line of enquiry.

1. Are they safe?

Safe: Users of the service are protected from abuse and avoidable harm.

1. Are they effective?

Effective: All care, treatment and support achieve good outcomes, helps users of the service to maintain quality of life and is based on the best available evidence.

1. Are they caring?

Caring: Staff involve and treat users of the service with compassion, kindness, dignity and respect.

1. Are they responsive to people’s needs?

Responsive: Services are organised so that they meet the needs of users of the service.

1. Are they well led?

Well-led: The leadership, management and governance of the organisation makes sure that it provides high-quality care that is based around the individual needs of service users, encouraging learning and innovation, and promoting an open and fair culture.

The inspection is based on the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part3). Medication is mentioned specifically in regulation 9 – Person Centred Care: Regulation 12: Safe care and treatment and regulation 14: Meeting nutritional and hydration needs.

Furthermore, homes are aspiring to achieve the six NICE Quality Statements[1]:-

QS1.People who transfer into a care home have their medicines listed by the care home on the day that they transfer.

QS2.Providers of health or social care services send a discharge summary, including details of the person’s current medicines, with a person who transfers to or from a care home

QS3.People who live in care homes are supported to self-administer their medicines if they wish to and it does not put them or others at risk.

QS4.Prescribers responsible for people who live in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines.

QS5.People who live in care homes have medication reviews undertaken by a multidisciplinary team.

QS6.Adults who live in care homes and have been assessed as lacking capacity are only administered medicines covertly if a management plan is agreed after a best interest meeting.

As part of the visit the pharmacist or pharmacy technician should raise awareness that research[2] has shown that the following common issues are associated with medication administration errors. Care managers and their staff who administer medication should be alert to these risks.

• administering and managing inhalers and liquid medicines is much more likely to give rise to medication errors than tablets or capsules;
• antibiotic administration may be particularly prone to error with a number of doses being missed over the course of treatment; and
• allergy and drug sensitivities should be checked prior to administration of medicines;

Research has also identified that medication administration errors are more common in the morning. For this reason the pharmacy should work with the home and suggest to the GP that the administration of medicines is moved to later times in the day if the morning tablet burden has been identified as an issue.

Interruptions during the preparation and administration of medicines are associated with medication errors and a discussion should be had with the care home manager to reduce the level of distraction to administering staff. This could be byminimising drug rounds at meal times, ensuring protected time for staff or providing support staff who are tasked with diverting or managing any potential distractions, etc.

Name of Pharmacist/Pharmacy Technician:-______
This checklist must be completed at initial visit
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
1)Person-Centred Care (Regulation 9)
The care and treatment of service users must be appropriate, meet their needs and reflect their preferences
Is there an assessment protocol for self-medication where this is appropriate?
9(1c); NICE QS3 / Copies of completed assessment protocols seen?
Evidence seen Yes / No
If applicable, is there suitable storage in the resident’s room for medication?
9(1c) , 12(1) / E.g. lockable storage areas in patient’s rooms where the temperature is suitable for such purpose (<25°C).
Evidence seen Yes / No
Is the self-medication appropriately managed/recorded? I.e. is the ability of the patient to self-medicate periodically assessed?
9(1), 12(1); NICE QS3 / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No
Are residents who self-medicate supported to enable them to managesome or all of their medicines (e.g. inhaler techniques, packaging, formulation)?
9(1); NICE QS3 / Evidence of suitably trained personnel to provide counselling. Counselling recorded in care plans. Devices such as Auto-droppers, Haleraids etc.?
Evidence seen Yes / No
Is there a method for monitoring patient outcomes for pain relief with the administration of analgesia (e.g. the use of regular pain score charts with analgesia) / Evidence of use of pain assessment tools, observation monitoring records
Evidence seen Yes / No / Signpost to a pain assessment tool in Minor Illness Pack[3]
Is there a periodic review of pain management by care home staff? / View example of patient care plan. Observe for pattern in administration - is this justified?
Evidence seen Yes / No
Does the Care Home consider the preferences, cultural and ethical needs of patients when administering medication (e.g. formulation and supply of vegetarian or vegan medicines) / Observe reference in patient care plans.
Evidence seen Yes / No
2) Regulation 12:- Safe Care and Treatment
This regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
GENERAL
Does the current MAR chart match the current prescription?
12(1) & 12(2) / Check the MAR chart for 3 residents
Evidence seen Yes / No
Does the evidence of administration reflect the directions on the MAR
12(1) & 12(2) / Check the MAR chart for 3 residents
Evidence seen Yes / No
Are outcomes of relevant GP visits suitably recorded?
12(1) & 12(2) / Is there a clear indication on MAR chart or care plan of GP interventions?
Evidence seen Yes / No
Are service users medicines reviewed? / Check for evidence that at least 5 patients >75 yrs have had their medicines reviewed in last 6 months or more frequently if appropriate.
Evidence seen Yes / No / If ‘No’ direct concern to GP
Do staff monitor the effects of medicines? / Check there is a documented record for monitoring e.g. blood pressure, bowel movements, and falls?
Evidence seen Yes / No
Are there up to date medicines information resources available to staff, service users and relatives if appropriate / Check there are recent BNFs and PILs available to staff, service users and there relatives.
Evidence seen Yes / No
Do care staff utilise the BNF appropriately / Are staff aware of the full potential of the BNF (e.g. Side effects, interactions, etc.)
Evidence seen Yes / No
Are you satisfied that medicines are not removed from the original containers/ MDS packs other than for administration directly to the service user?
12(1g) / Observe inside of drug trolley. This is seeking evidence of ‘pre-potting’ tablets, etc.
Evidence seen Yes / No
Is there a procedure/check list/ training available to ensure appropriate staff are competently trained on the use of equipment required to administer medication (e.g. inhaler spacer devices or the use of measuring cylinders for liquids) and how to clean such equipment?
12(1c), 12(1e) / Evidence of a system in place to ensure staff competency eg Manager’s periodic observation
Evidence seen Yes/No
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
If a multi-dose MDS is in use, can all tablets be clearly and easily identified?
12(1g) / Check packaging and MAR charts – has the supplying pharmacy clearly identified tablet or capsule markings, shape or colour?
Evidence seen Yes / No / If ‘No’ direct concern to supplying pharmacy
Is every medicine taken/applied recorded at the time of administration? E.g. is the MAR chart signed off at the time of administration
12(1g) / Select 5 MAR charts and check there are no blank spaces where medicines have been administered.
Evidence seen Yes / No
Is there a procedure to manage medicated patches (e.g. fentanyl) which includes documenting:-

• site of application
• frequency of change
• a check to ensure patch is still in-situ between changes
• prompts to rotate the application area
• removal of patch?

/ Evidence of SOP
Use of body maps or other appropriate method
MAR chart clearly demonstrates application intervals of patches
Use of ‘Sign Off & Sign On’
N.B. writing date applied in biro on patch is not advocated
Evidence seen Yes / No / The home can be signposted to a suitable body chart[4] or provided with some paper copies
Is there a process to highlight to the prescriber when medication has not been taken as prescribed? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No
Are reasons for non-administration recorded e.g. the reverse of the MAR/other area of the chart? / Check that non-administration is clearly coded on at least 5 MARs and appropriate action taken to manage it.
Evidence seen Yes / No
Are all instructions clear and comprehensive for newly prescribed medicines?
NICE QS4 / Select 5 MAR charts and check instructions
Evidence seen Yes / No
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
Are PRN medicine directions clear and comprehensive? (“as directed” is not an acceptable instruction. PRN directions should state dose, frequency, reason and maximum in 24 hours)
NICE QS4 / Check no ‘as directed’ instructions on PRN medicines for at least 5 MAR charts
Evidence seen Yes / No / If ‘No’ direct concern to prescriber
Is the administration of ‘PRN’ medicines clearly recorded either on the MAR or other location inc details of dose, reason and outcome. / Check for evidence of clear record of administration (including dose, reason & outcome) of ‘PRN’ medicines on at least 5 MARs and patient care plan.
Evidence seen Yes / No / Refer to Care Home Best Practice PRN guidance
Is the remaining total of the PRN, that is deemed fit for purpose and to be continued, appropriately recorded on the new MAR? / Check at least one MAR chart with PRN items to check if running balances are being recorded. Check the balance matches the stock.
Evidence seen Yes / No
Are PRNs dispensed in original packs? / Observe storage of PRNs
Evidence seen Yes / No / Encourage move from MDS to original packs to reduce waste
Is there a process to record “date opened” as well as the maker’s expiry date for life limited medicines such as GTN, Insulin, eye drops etc? / Check fridge / medicines trolley/cupboard for limited life medicines and record of “date opened”.
Evidence seen Yes / No
Is there a procedure to manage excess medicines such as when a patient is admitted to secondary care? / Procedures to

• liaise with GP and pharmacy to prevent re-supplying
• Retain stock (rather than dispose of it) pending patient’s discharge

Evidence seen Yes / No
If appropriate, are there clear procedures to manage, monitor, review and administer homely remedies? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No
Has the list of homely remedies been agreed with the GP? / Check for documented evidence of agreement.
Evidence seen Yes / No / Refer to Care Home Best Practice Homely Remedy Guidance
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
3) MEDICINES RECEIPT, STORAGE & DISPOSAL - RECEIPT
Are all prescriptions received seen and checked by the home staff prior to going to the dispensing pharmacy? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No / Promote best practice of checking before going to pharmacy
Are EPS tokens provided by the pharmacy or surgery to enable checks before dispensing? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No
Is there appropriate documentation of all medicines received? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No
Is there a procedure to manage medicines brought into the home via the service user
Prescribed prior admission
Purchased by service user
See also meds reconciliation section / Check this is covered in SOP or other relevant procedure.
Review a patient’s records where this has happened and check that the procedure has been followed.
Evidence seen Yes / No
Is there a procedure to manage illicit substances entering the Care Home via the service user? / Check this is covered in SOP or other relevant procedure.
Evidence seen Yes / No / Refer to guidance for management of illicit substances in care homes[5]
Is there a procedure for transcribing on a MAR chart? E.g. a hospital discharge prescription, respite / Evidence of SOP and observe a transcription on a MAR chart checking e.g. legibility, formulation, dose, dose spacing, advice labels, instruction transcribed marries with label on original pack, witness signature and obtained source
Evidence seen Yes/No
Are mid-cycle changes recorded correctly on the MAR? E.g. meds stopped, started, dose changes, endorsed by GP, if necessary, or other process followed? / Check there is a procedure/ process present for the management of mid-cycle changes. Confirm by reviewing MAR charts.
Evidence seen Yes / No
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
3) MEDICINES RECEIPT, STORAGE & DISPOSAL - SAFE STORAGE
Is there a suitable storage facility for medicines to be stored? (apart from locked area in resident’s room) / Are medicines stored in an organised and systematic fashion? Is there adequate space?
Evidence seen Yes / No
If a trolley is used, is the trolley secured to a wall in the room, or stored in a locked room when not in use? / Check how trolleys are stored.
Evidence seen Yes / No
Is the medicine storage room/cupboard/trolley/fridge locked? / Check doors of cupboards, trolleys/ fridge and room.
Evidence seen Yes / No
Are the keys secure and held by a designated/named person at all times? / Check who the named personnel is/are.
Evidence seen Yes / No
Is there a procedure for the hand-over of keys? / Check for evidence of procedure.
Evidence seen Yes / No
Is the temperature of the room monitored and suitable for a storage area (max 25C)? / Check for evidence of room thermometer (min/max) or other method of measuring and maintaining room temperature. What action is taken if outside range?
Evidence seen Yes / No
Are external/internal medicines stored separately, to prevent picking error? / Check trolley and cupboards
Evidence seen Yes / No
Is the process of transporting medicines around the home suitable? (E.g. Using a tray for carrying multiples medicines to residents) / Check process of transporting is satisfactory
Evidence seen Yes / No
Are all medicines expiry dates checked regularly? / Check this is covered in SOP or other relevant procedure.
Randomly check 5 items.
Evidence seen Yes / No / Refer to Care Home Best Practice Expiry Guidance
Where appropriate, is there a separate lockable fridge for medicines? / Check treatment rooms. Check only medication stored in fridge.
Evidence seen Yes / No
If there is only a domestic fridge are medicines stored in a separate lockable container within that fridge? / Check fridge contents.
Evidence seen Yes / No
Observe fridge temperature monitoring records: is the temperature of the fridge monitored daily? / Check for evidence of documented daily record of fridge temperature.
Evidence seen Yes / No
Section / In order to score ‘Yes’ please indicate that the evidence below has been viewed / Is outcome
achieved
Yes / No / NA / If ‘No‘ consider actions below or refer to Action Sheet, page 10
Are the minimum and maximum temperatures recorded daily (min 2 C max 8 C)? / Check fridge temperature log.
Evidence seen Yes / No / Define importance of min/max temperature recording
Are staff aware how to re-set device? / Ask members of available staff to demonstrate
Evidence seen Yes / No
If out of range, is there a process in place to manage this? / Check this is covered in SOP or other relevant procedure. Check for documentation of actions taken.