Training
· The Middlesex group of local pharmaceutical
committees recently won a Pharmaceutical Services Negotiating
Committee development award
for the establishment of the Medicines Training Partnership, which
aims to help carers meet the minimum care standards. The partnership
organises the training of community pharmacists who then train
carers, including carers in residential homes, covering aspects
such as record
keeping and disposal of medicines.
Michael Levitan, secretary to the group and chief officer for the
Medicines Training Partnership told The Journal that although there
are other organisations and individuals who are prepared to carry
out such training, pharmacists should be the natural choice. The
partnership’s aim for the future is to ensure that all carers
are trained to meet the requirements of the national minimum standards,
and receive a transferable certificate as evidence of training.
· The National Pharmaceutical Association
has published a new training pack for pharmacists to train care
staff on medicines
administration.
· The College of Pharmacy Practice will
shortly launch an accreditation scheme for home staff. |
Nearly a quarter of care homes for older people do not meet minimum
standards on handling medicines, according to a new report. “The management
of medication in care services” is one of three reports published
by the National Care Standards Commission (NCSC) this month.
It reveals that around 1,500 care homes for older people in England (12
per cent) do not come up to scratch when it comes to medicines. Most
homes either meet or almost meet the standard (44 per cent and 43 per
cent, respectively); 1 per cent exceed it. The report recommends that
care providers and other agencies should consider the future
involvement of pharmacists in medicines
management.
The trouble is that although most care homes do have some input from
pharmacists, their knowledge and understanding of medicines management
is not always sought by care home managers, and this is essential if
homes are to reach these standards.
David Pruce, director of practice and quality improvement, Royal Pharmaceutical
Society, comments: “We are concerned about the wide variation in
compliance with the NCSC medication standards highlighted in this report
and urge care providers and other agencies to review their arrangements
for medicines management in care homes. Pharmacists involved in advising
care homes should urgently meet with the care home to discuss the implications
of the report. They should consider whether the level of advice and input
into the care home is appropriate.”
The NCSC recognises the important role pharmacists have within care homes
as inspectors and advisers and suggests that community pharmacists could
become more involved. The report states: “Community pharmacists
have an equally important part to play in assisting homes locally and
their more frequent and regular involvement would be welcomed by the
sector as a whole. We acknowledge that there is a wide variability in
the provision and extent of pharmacist involvement in care homes.”
An example of good practice comes from Devon, where four primary care
trusts (South Hams and West Devon, Torbay, Plymouth, and Teignbridge)
working in partnership with the NCSC, the local counter fraud team and
the local pharmaceutical committee, have revised their local pharmacy
scheme for care homes. It will start on 1 April.
Poor and better performance
Characteristics of poor performance include:
· Medicines stored insecurely or at the wrong temperature
· Wrong medication given to service users
· Poor recording of medicines received and administered
Characteristics of better performance include:
· Good staff training and supervision
· Regular audits of medication
· Good working relationships with local health professionals |
The new scheme consists of three parts. First is the provision of general
pharmaceutical advice to a care home, as in previous years. Secondly,
pharmacists will visit each care home at least once during the year to
complete a checklist for an annual pharmaceutical assessment. Sue Taylor,
chief officer of Devon LPCs told The Journal that this checklist has
been designed to remove overlap between the NCSC inspectors and the advising
pharmacist.
The third part, which is new and the most ambitious, is that pharmacists
may conduct a simple medication review for each resident. Although this
is optional, Mrs Taylor notes that this also ties in with the new GMS
contract to help GPs meet medication review targets. She says: “We
presented the scheme to pharmacists at two roadshows in February and
the feedback was good. It makes better use of pharmacists’ clinical
knowledge, offers a better service to the homes and provides better value
for money for the PCT.”
Mendip PCT has also recently relaunched and redesigned its community
pharmacist advice to care homes scheme. Karen Taylor, medicines management
facilitator at the PCT, told The Journal: “As part of our overall
medicines management strategy the PCT believes that individual clinical
issues around prescribing are just as much a risk to patients, as poor
control and administration procedures. Our new scheme places a much stronger
focus on medication review and systems for communication with the prescribing
doctors. In re-engineering the scheme, the expertise of the pharmacists
providing the advice service is being put to much better use than checking
cupboards.” She added: “The new scheme includes a reporting
link with the NCSC, so the NCSC is involved.”
In the East Midlands, Jitto Mehta, pharmacy proprietor of Heathbrook
pharmacy in Newbold Verdon, Leicestershire, provides the pharmacy services
for a local home that scored a level 4 (the highest level) in its latest
medication assessment by the NCSC. Mr Mehta, who has been visiting the
home once or twice a week for the past three years, says that he trains
staff at the home on topics such as safe medicines handling, storage
and date-checking.
He explains how he trains staff about dealing with symptoms such as headaches
and stomach upsets. He drew up a list of “homely remedies” and
a protocol approved by the local GP for when care staff should refer
the resident to the GP. He believes one of the reasons the home got the
highest score for medication is teamwork between himself, the home and
the local GP.
The NCSC has designed practical tools to help inspectors identify potential
problems with services, called “pharmacy triggers”. The report
recommends that “care providers take account of the NCSC’s
pharmacy triggers in developing good practice in the management of medicines
in their homes”. It also recommends that the Department of Health
takes the initiative in developing accredited training in handling medicines
for care staff throughout England. Further information Further guidance
on the safe handling of medicines is provided by the Royal
Pharmaceutical Society. The full NCSC report can be accessed at www.carestandards.org.uk
Article p387, (PDF 150K) |
The
Pharmaceutical Journal