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Medicines in Social Care - Coggle Diagram
Medicines in Social Care
Support implementation of the NICE endorsed national domiciliary principles and the underpinning NG67/accompanying quality standards
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Challanges
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NICE has made recommendations on the contracting of home care and the amount of time needed for each visit. Please see the NICE guideline on home care.
Principles agreed levels for support with medication (Level 0, 1 ,2 and delegated tasks as 3 )
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MCA
NG67
The Committee concluded that monitored dosage systems should be used for the benefit of the person receiving care, rather than for the ease of carers or care workers. The recommendations make provision for the use of MDS, when an assessment has been carried out, in line with legislation and when a specific need has been identified to support medicines adherence. It does not state that all medication should be supplied in original packaging in all circumstances.
The person receiving care and/or their family members or carers and the care provider should be involved in decision-making and the person’s needs and preferences should be taken into account. There are resource implications for using monitored dosage systems, for example, training of pharmacy staff, additional time to fill and check individual compartments and pharmacies are not reimbursed for the costs of monitored dosage system packaging.
dispensing label on original packaging is the authority to administer each medicine. However, the labels or directions for each medicine supplied in monitored dosage systems is not always clear. In some cases, the Committee were aware that non-pharmacy supplied compliance aids do not appropriately labelled.
Training
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Care workers who are supporting people with their medicines must be appropriately trained in the handling and use of medicines, and have their competence assessed.
The NICE guideline on home care [NG21] contains recommendations on the recruitment and training of home care workers.
Care providers should: a) provide support, training (including induction training), professional development, supervision and appraisal in order for them to carry out care b)ensure that new care workers who have never worked in social care before do not give medicines until trained to do so and demonstrate the required or acceptable level of competence to work unsupervised c)provide access to further qualifications for care workers, in line with their work if this is appropriate.
Any training delivered in Wales on this subject should ideally be accredited with an Awarding Body e.g. City and Guilds/Agored. Therefore any mapping of other training would need to be done against this rather than details on the lifelong pillar on the CQFW. If the training currently delivered by yourselves does meet the Awarding Body standards then I would argue that learners should receive the credit for their learning. This has the added bonus of it being recognisable across all of health and social care in Wales and therefore does not have to be repeated if an individual were to change employer, which means less waste of public money. Our guidance also states that an individual should have achieved a full level 3 qualification before undertaking any training in the administration of medication. Unfortunately our Sector Skills Council for Care in Wales is Social Care Wales and not Skills for Care so any training also needs to fit with their qualifications and training requirements. I have provided the links to the 2 most popular qualifications at Level 3 that contain the medicines units
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NICE and the CQC don't identify any particular standards in relation to medicines administration training for care home staff
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MAR charts
The legal requirement under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 17 (2)(c) is for the Registered person (the care provider) to maintain the record. The responsibility for this cannot be transferred, although the action of producing printed medicine administration records can be agreed between the social care provider and either a pharmacy or dispensing doctor.
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Should the information that should be recorded for medicines that are given, and medicines that the clients are physically assisted to take be the same?
the absence of a medicines administration record for a person should not delay medicines being given as it is the label on the medicine packaging that is the legal authority to administer a medicine, not what is recorded on the medicines administration record which is a record of the care given. The medicines administration record should be used to confirm that the care worker is not, for example, giving a duplicate dose.
Evidence Review
Documenting medicines assessments
Regulation 9(3)(d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 state that homecare providers must keep a record of ‘all assessments, care and treatment plans, and decisions made by people who use the service and/or those acting on their behalf.’
This could be made easier by standardising a form that a home care provider could complete and send to the GP. In addition community pharmacists could be involved in this area with some benefits
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Medicines incidents
The NICE guideline on medicines optimisation [NG5] contains recommendations for health and social care organisations and practitioners on systems for identifying, reporting and learning from medicines-related patient related safety incidents.
Governance
the need for governance of a medicines policy and agreed that care providers should review their medicines management policies and processes to ensure that they are up to date and that it is clear who is accountable and responsible for using medicines safely
The Committee was aware that the NICE guideline on Home care [NG21] recommends that home care providers should have a medicines management policy. The Committee was also aware that the CQC (2015) guidance for compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 12, recommends that care providers have policies and processes in place for administering medicines in line with current legislation and guidance.
The Committee agreed this should include what support care workers are allowed to give when helping people to take their medicines, including ‘when required’, time sensitive and over-the-counter medicines
The Committee concluded that in line with legislation (The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 18) care workers must be trained and assessed as competent by the service provider before giving any medicines. Additionally, care workers should only give a medicine when there is a clearly documented agreement to do so in the care plan and there is authorisation and clear instructions about how the medicine should be used (for example, on the label of a prescribed medicine), and the 6 R’s of administration have been met
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