NICE - supporting quality in care homes

1. NICE - supporting quality in care homes Deborah O’Callaghan - Implementation Consultant 5th November 2015

2. Overview • NICE: who we are and what we do • How NICE fits with the regulatory and quality frameworks for social care • Using NICE guidelines in care homes • Using NICE Quality Standards in care homes • Practical help • Finding what you need • Staying up to date and opportunities for getting involved

3. NICE: Who we are and what we do

4. The role of NICE • To identify good practice using the best available evidence • To help resolve uncertainty for the public, patients and professionals • To reduce variation in the availability and quality of practice and care April 2013 – social care guidance and standards

5. What are NICE guidance and quality standards? A set of systematically developed recommendations to guide decisions for a particular area of care or health issue A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

6. NICE and the regulatory and quality frameworks for social care

7. Our position in the social care sector Evidence, Guidance, Standards.

8. Regulation - CQC Andrea Sutcliffe, Chief Inspector for Adult Social Care at the CQC “At the CQC we are asking the questions that matter to people. We’re asking whether services are safe, caring, effective, responsive to people’s needs, and well led. “And the way that we can do this is by identifying key lines of enquiry – so the questions that we will ask when we go out on inspections. We will also identify what the characteristics are of the services that we see, so whether they are good, outstanding, require improvement or are inadequate. “This quality standard will inform the questions that we ask, and help us to provide the understanding of what ‘good’ and ‘outstanding’ practice looks like in this area.” https://www.youtube.com/watch?v=RxwHM0JsdyI

9. And the importance of NICE guidance to the public, service users, carers and patients • “Having confidence in the staff looking after me ” • “Understanding what treatment I can expect” • “Being confident in the system” • Better user experience and outcomes • Empowering people to make choices about their own care

10. Using NICE guidance in care homesFinding what you need and practical help

15. Guidance and quality standards supporting quality in care homes

16. Example guideline: Managing medicines in care homes

17. Managing medicines in care homes key points • People living in care homes have the same rights in relation to NHS care as the rest of us, as set out in the NHS Constitution. • Care homes residents should have the opportunity to make informed decisionsabout their care and treatment. • Person-centredcare is important. • Helping residents to look after and take their own medicines helps them retain their independence. • When a person moves into a care home, staff should assume they can manage their own medicines, unless indicated otherwise. • Each resident should have an individual risk assessmentto determine the support they need to manage their own medicines. • Care home providers should have a medicines policywhich includes written processes for the safe and effective use of medicines

18. Care Home Policy • Assessing mental capacity (legislation) • Storing and sharing information (including transfers) • Keeping accurate records • Problem identification and reporting • Safeguarding residents • Medicines reconciliation and review • Ordering and disposing of medicines • Stock control of medicines • Administration of medicines (by resident, staff and covertly) • Staff training and competency • Non-prescription medicines NICE have published a ‘checklist’ to help you put a local policy in place

22. Outlines how you can use NICE quality standards to improve your care home to: • Demonstrate commitment to quality improvement • Prepare for inspection • Guide workforce recruitment and development • Support requests for help to other services • Inform people looking for a care home

23. NICE has commissioned 60 online educational tools. Modules are free but you need to register. Certificates are available upon completion. Some offer CPD credit. Clinical case studies, slide sets and academic detailing aids also available. Online learning modules Topics: Acute Kidney Injury – aimed at nurses and healthcare support workers in all settings Nutrition Lower urinary tract symptoms in men Urinary incontinence in women Dementia Epilepsy Smoking cessation Hip Fracture Depression in adults Depression in adults with a chronic health problem VTE – prevention, and reducing the risk NICE Evidence into practice topics: How to bring about change How to make evidence based decisions How to put guidance into practice How to use audit to improve patient care www.nice.org.uk/About/What-we-do/Into-practice/Education-learning-and-professional-development

27. Using NICE Quality standards in care homes

28. What are NICE guidance and quality standards? A set of systematically developed recommendations to guide decisions for a particular area of care or health issue A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

31. Evidence sources • Managing medicines in care homes (2014) NICE guideline SC1 • Care Quality Commission (2015) Guidance for providers on meeting the regulations • Royal Pharmaceutical Society (2014) Pharmacists improving care in care homes • Department of Health (2013) Best practice for ensuring efficient supply and distribution of medicines to patients • General Medical Council (2013) Good practice in prescribing and managing medicines and devices • National Care Forum (2013) Safety of medicines in the care home • National Care Forum (2013) Safety of medicines in care homes: Framework: Making the best use of medicines across all care settings • Royal Pharmaceutical Society (2013) Medicines optimisation: helping patients to make the most of medicines

32. Evidence sources cont. • The King's Fund (2013) Polypharmacy and medicines optimisation: making it safe and sound • Care Quality Commission (2012) Meeting the health care needs of people in care homes • Department of Health (2012) Action plan for improving the use of medicines and reducing waste • Royal Pharmaceutical Society (2012) Improving pharmaceutical care in care homes • Royal Pharmaceutical Society (2012) Keeping patients safe when they transfer between care providers – getting the medicines right • Social Care Institute for Excellence's (SCIE) (2012) Commissioning care homes: common safeguarding challenges • Centre for Policy on Ageing (2011) A report for the project: Working together to develop practical solutions – an integrated approach to medication in care homes • Report to the Patient Safety Research Portfolio, Department of Health (2009) Care home use of medicines study (CHUMS): prevalence, causes and potential harm of medication errors in care homes for older people • National Prescribing Centre (2009) A guide to good practice in the management of controlled drugs in primary care (England)

33. Evidence sources cont. • Department of Health (2008) Medicines management: everybody's business • National Prescribing Centre (2008) Medicines reconciliation: a guide to implementation • Nursing and Midwifery Council (2007) Standards for medicines management • Royal Pharmaceutical Society (2007) The handling of medicines in social care • Department of Health (2003) National service framework for children, young people and maternity services: medicines for children and young people

35. Typically 6 – 8 statements Include measures to help inform local quality improvement work Define priority areas for quality improvement Based on best available evidence such as NICE guidance and other evidence sources accredited by NICE

36. 2 Suggested service review questions: How do we ensure that a list is made of a person’s medicines on the day that they transfer into our care? Who is responsible for listing a person’s medicines on the day that they transfer into our care? At what stage is the list made? Do we use a template? Does the person completing the list of medicines routinely provide their details (name, job title) and the date the list was recorded? Once written up, where is the list kept?

37. The initial assessment • A positive assessment can: • provide assurance • could be included in the organisation’s quality profile • An assessment indicating areas requiring quality improvement can: • inform local quality improvement • support discussions with commissioners • Inform local risk management

42. How can quality standards be used? "As a user of care services, they support me in my choices about who provides care for me, and in knowing what to expect from a good quality care service." “As aprovider of care services, I can use NICE guidance and quality standards to ensure, and therefore demonstrate, that I provide high quality care, based on the best available evidence.” "Commissioning services using NICE quality standards allows me to meet my duties as a local authority commissioner to promote integration of health and social care, and support me in ensuring the services I commission are high quality, and value for money”

43. Resources for care homes • The Mental wellbeing of older people in care homes film is about how the NICE quality standard can help to improve the lives of older people in care homes.  • The Tailored resource for managers of care homes for older peopleexplains how older people can be supported to maintain their mental wellbeing. • Tailored resource for care providers on supporting people to live well with dementia • Managing medicines in care homes: checklist for care home medicine policy

44. Keeping up to date and getting involved

45. Keeping up to date • Sign up for the NICE News • Log on to the website and register your details at www.nice.org.uk • Register as a Stakeholder for Social Care Guidance and Quality Standards: socialcaresh@nice.org.uk • Email: deborah.ocallaghan@nice.org.uk