CARE WITH MEDICATION

1. CARE WITH MEDICATION

2. Prescribed medicine is the most frequent treatment provided for patients in the NHS. GPs in England issue more than 660 million prescriptions every year = (1.8 million a day) There are estimated 200 millionprescriptions in hospitals. Standards of prescribing in this country are high and the majority of drug treatment is provided safely.

3. Care Homes Regulations 2001 Regulation 13(2) requires the registered person ‘to make arrangements for the…safe administration..of medicines’ prescribed for the people they care for.

4. Domiciliary Care Agencies Regulations 2002 The registered person shall : ‘… specify circumstances in which domiciliary care workers may administer or assist in the administration of medication… and the procedures to be adopted…’Regulation 14(6)(a) • ‘…make arrangements for recording, handling, safe keeping, administration & disposal of medicines…’ Regulation 14(7)

5. Care Homes Reports 2004 NCSC report :- Medication Management • incorrect medication give • poor recording of administration • medicines inappropriately handled, sometimes by untrained staff • inappropriate storage conditions follow-up study commissioned by CSCI ‘Handled with Care?’(February 2006)

6. ‘Handled with Care?’ • Slight overall improvement in performance with exception of nursing homes for older people • Nearly half the care homes for older people and younger adults, providing 210,000 places, are still not meeting the minimum standard • Similar proportion of children’s homes failed – nearly 6000 places • Wide variation of performance from area to area

7. ‘One third of homes do not meet the standards relating to managing medication safely and operating safe working practices’ ‘Homes themselves need to put their house in order and place medication management at the top of their agendas’

8. Actions required by Care Homes • Review policies and practices in managing medication • Make use of existing good practice guidance and demonstrate progress • Support and closely monitor the practices of care workers in relation to this standard • Develop policies and practices which are culturally sensitive

9. Domiciliary Care‘TIME TO CARE’ • Report published Oct 2006 • 58% of agencies achieved the medication standard in 2005-06 • Similar findings & concerns to those in care homes

10. Why does it go wrong? • Weak/bad management • Poor procedures • Poor records • Staff not following procedures • Inadequate training • Staff not assessed as competent • Complacency

11. Three Essential Safeguards • Written procedures, reviewed and monitored to make sure safe practice is followed • Correct level of training before giving medicines, followed by competency assessments, supervision and updates • Only give medicines from containers filled, labelled and provided from a pharmacy (or from a dispensing doctor)

12. Durham and Tees Valley Social Care Medication Strategy Group

13. Middlesbrough Primary Care Trust Middlesbrough Borough Council Redcar and Cleveland Council Redcar and Cleveland Primary Care Trust Durham County Council Commission for Social Care Inspection Darlington Borough Council Independent Providers Durham Darlington Teesside Hartlepool Borough Council Durham Employer Care and Health Alliance Stockton Borough Council Centre of Vocational Excellence for Social Care CELS City &Guilds Skills for care And…….

14. There have also been high profile cases of corporate manslaughter associated with medication brought against care home managers and carers. A common finding of enquiries is poor quality training as a fundamental cause. A substantial number of home care services are failing standards relating to medication’

15. READ ALL ABOUT IT NORTH EAST LEADS THE WAY ON MEDICATION

16. Have the care workers had sufficient and appropriate training to meet the needs of the people they care for? • Is there a formal means to assess & record staff competence in medication handling & administration? • Do the policies and procedures support staff to manage all aspects of medication handling?

17. The indications are that there is a serious deficit in the competence of carers to administer medication safely. The training to date has been knowledge based and often distance learning. Estimates indicate that there are 89,000 – 123,000 carers who require assessment of this competence in the Northern East Region. 

18. The aim of the group was to develop a regional strategy and policy for the safe administration of medication. Produced in consultation with the Commission for Social Care Inspection. (CSCI). SAFE HANDLING OF MEDICINES A training plan was devised that closely follows the NVQ Code of Practice especially around the competence of the assessors and expert witnesses.

19. Outcome Two significant documents have been produced: A Strategy for the Safe Handling, Management and Administration of Medication by Carers across the North East of England Model of Good Practice for the Development of those involved in Handling, Management and Administration of Medication across the North East of England…………….

20. The documents are freely available to all employers to adopt or amend to suit their needs.

21. WORKBOOKS INTERMEDIATE CERTIFICATE IN SAFE HANDLING OF MEDICINES OPEN COLLEGE NETWORK LEVEL 1 - MEDICATION

22. NATIONAL VOCATIONAL QUALIFICATIONS • The level 2 units • HSC221 – Assist in the administration of medication • HSC236 – Receive and Store medication and products • Are suitable for health and social care staff who are assisting health care professionals

23. NATIONAL VOCATIONAL QUALIFICATIONS • The most appropriate accredited knowledge and competency assessment is the NVQ level 3 Optional Unit • HSC375 – Administer Medication to Individuals

24. Assessment Process • Initial Assessment carried out by appropriate assessor who will ensure that the candidate meets: • Requirements of the award • Skills for Life development if appropriate

25. Assessor • Hold assessor award A1 or achieve it within 12 months of commencing the role • Be occupationally competent • Clinically updated • Currently competent • Be familiar with the award body requirements for documentation

26. More Tailored & unique No knowledge or skills Already have NVQ 3 Fragmented assessment Peripatetic assessor Tutor assesses Less Several learners together Prior knowledge and skills Does not have NVQ level 3 Holistic assessment Work based assessor Assessor assesses LSC estimate that it costs £145

27. CLEMENT O’DONOVAN WORKFORCE DEVELOPMENT MANAGER MIDDLESBROUGH DEPARTMENT OF SOCIAL CARE