Care Homes Flashcards
Definition of social care (Health and Social Care Act 2008)
Social care includes all forms of personal care and other practical assistance provided for individuals who for reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs, or any other similar circumstance, are in need of such care or other assistance.
Types of Care Service
Care homes with Nursing
Nurses on duty 24hrs
People living in Care Homes with Nursing need nursing care 24 hrs per day
Visiting GPs and other healthcare professionals provide additional support for health needs
Care homes without Nursing
Formerly know as Residential Homes
Majority are elderly
Health needs met by visiting GPs and other healthcare professionals
Nursing services e.g. injections, changing dressings provided by visiting Community (District) nurses
Often have a Nursing unit
Other Care Homes With or Without Nursing Younger Adults Physical or Learning Disabilities or Acquired Brain Injury Drug and Alcohol Rehabilitation Domicilary Care Help people in own homes Time varies – couple of hours to 24hr care 2 type of
Domiciliary Care Agency
Introduction Agency
Employer
Shared Lives Schemes (formerly called Adult Placements)
Like fostering for Children
Individuals, Couples or Families act as Carers to 1-3 adults
Life in community and share family life
Children’s Homes inc. Boarding Schools
Providers of care and accommodation either wholly or mainly for children
Includes Boarding Schools
Specialist Colleges
Learning and/or Physical Disabilities
Education, Care and Training
Independence
Who runs care services?
- Local Authorities
- Private companies / individuals
- Voluntary organisations
- Informal
Who pays for care services?
- Local Authorities (fully or part –funded)
- NHS
- Individuals
Who regulates care services?
- England – Care Quality Commission (CQC)
- Wales- Care and Social Services Inspectorate Wales (CSSIW)
- Scotland – Care Inspectorate
- NI – The Regulation and Quality Improvement Authority (RQIA)
- Children & Specialist Colleges - OFSTED
CQC - Care Quality Commission
- Came into being April 1st 2009
- Replaced Commission for Social Care Inspection
- Established by Health & Social Care Act 2008
- Registers all health and social care providers (including NHS)
- Conducts and publishes reviews and investigations
- Protects and promote health, safety and welfare of health and social care users
How the CQC regulates - It asks 5 questions:
–Are they safe? –Are they effective? –Are they caring? –Are they responsive to people’s needs –Are they well-led?
Then it gives the care service one of four ratings:
- Outstanding
- Good
- Needs improvement
- Inadequate
It publishes a report on its website.
If administration by carers or nurses occurs then NICE recommends that the 6 R’s should be followed. The nurse or carer should check they have:
the Right resident the Right medicine the Right route the Right dose the Right time and the resident's Right to refuse.
Medication Administration Records (MAR charts)
Must be a formal audit trail from time medicines enter the home to the time they leave (or are destroyed)
Formal record of administration of medication
Can become evidence in court / inquest cases –medication must also be kept for seven days in the event of a death of a resident
Must be clear, accurate, up to date
Must be kept for 3 years from date of last entry (indefinitely for children)
Staff sign initials on administration / refusal(two signatures if controlled drug)
Variable doses - need to record what actually given
Topical medicines - sometimes have a separate MAR chart with a body map to record where administered topical medicine
Reasons for refusal- need to record
Discontinued or destroyed medicines - need to remove from MAR chart asap to avoid errors. Need second person to witness.
Emergency supplies - if handwritten on to MAR chart need second person to witness.
Administration good practice
Record as soon as resident take medicine -not before, not much later
Ensure administration process complete before moving onto next resident
Correct errors with a single line through error and sign and date. Do not use correction fluid.
Monitored Dosage Systems (MDS) or Multi-compartment Compliance Aids (MCAs)
“MCAs or monitored dosage systems (MDS) are the terms used to describe a range of medicines storage devices divided into compartments to simplify the administration of solid oral medication. They were designed to make it more convenient for the patient who is self administering to manage their medicines and act as a visual reminder as to whether the drugs have been taken or not. When used appropriately in a selected group of older people they can promote independence and facilitate adherence to taking medicines.” NHS Lambeth (2011) There are many different types of MDS.
Boots Manrex
All medicines are packed into separate packs, allowing the resident to retain the freedom to take their own medication
Medicines are placed in separate compartments allowing the patient to be given the correct medicine and dose at the correct time
Reminder cards are included to ensure that the carer does not forget any medicines that are not packed in the MDS (like liquids)
The system comes with all the paperwork necessary to ensure that clear audit trails
See Boots Manual
Nomad
The majority of medication contained in one compact unit,so storage is easy.
Manufacturers claim “Using the system will also significantly reduce the time taken for administering the medication and for stock checks.”
It can hold up to 7 days worth of medication for up to 6doses per day.• The combination of insert tray and seal protects the medication by greatly reducing moisture permeability.
The Cassette is supplied by the pharmacist to the care home with clear and precise details of all medication contained within. Details are also provided for those items not included such as drops and creams.
See Care Home Medicines.net
Biodose
Capable of dealing with solid oral and liquid medicines
Individually sealed and individually removable tamper-evident pods
28-pod trays with drug & patient information printed on every pod
Built in protection helps to prevent MRSA
Blister Packs e.g. Venalink, PlusPak
Generally used for domiciliary care
Seven days medication – up to four dose
Light packaging
Space for labels and identifying marks
Homely Remedies
“Homely remedies are ‘medicines that can be obtained without a prescription from a pharmacy or supermarket’. Examples of homely remedies include mild pain relief medicines, cough medicines, antihistamines (type of medicine that is used for treating reactions to allergies), anti-diarrhoea (type of medicine used for treating diarrhoea) preparations and laxatives (type of medicines used for treating constipation). A homely remedy may be purchased by the resident or their family or carer, or by the care home.” NICE Managing Medicines in Care Homes (2014)
Not on a named patient basis
Need a homely remedies policy in place.
Staff who administer should be named in the policy and they should sign the process to confirm they have the skills to administer the homely remedy and acknowledge that they will be accountable for their actions (NICE 2014)
Need a process for use of homely remedies (e.g. National Care Forum has one available for care homes to use)
The process should include: the name of the medicine or product and what it is for which residents should not be given certain medicines or products (for example, paracetamol should not be given as a homely remedy if a resident is already receiving prescribed paracetamol) the dose and frequency the maximum daily dose where any administration should be recorded, such as on the medicines administration record how long the medicine or product should be used before referring the resident to a GP.
Advantages of boxes and bottles
- Maintain resident dignity and independence
- Enable residents to take medicines as if in their own homes
- Avoid re-dispensing
- Take up less space than MDSs
- Support the provision of patient information leaflets
- Help residents to identify medicines
- Are less wasteful
- May be beneficial for residents who go out on short-term leave
- Are easier to amend following medication changes
- Carry a lower risk of infection
Disadvantages of boxes and bottles
• More work for carers and nurses?
Advantages of MDS
- Increase adherence in some cases
- Provide medicine storage which is easily accessible to the patient- The closures on many of the devices are designed to be easily manipulated by patients with impaired manual dexterity and / or visual acuity
- Reduce the complexity of adhering to a regimen- Medicines are pre-organized into individual compartments so the patient does not need to select doses form individual packaging
- Minimise dose, amount and timing errors? - The dose to be taken and timing is pre-set by the organization of the medicines in the MCA
- Act as a memory aid.- Patients can identify whether or not doses have been taken
- Some are tamper evident.
- Time saving for staff in care homes during drug rounds- more time to carry out other duties.
- Easy visual check on whether medicines have been given.
Disadvantages of MDS
• They may de-skill care home staff
• They may result in issues with high-risk medicines
• They can cause difficulties if medicines are stopped, need to be omitted or otherwise identified
• They require two systems to be used — MDSs plus original packs for acute and “when required” medicines
• They require separate arrangements for residents on short-term leave
• They carry a risk if staff over-rely on MDSs so fail to look at the medicine label or description
• Stability
• Cost - Additionally, there is an added cost included in the physical blister pack as compared to original packs ranging from £2-£10 per pack. Also MDS drug trolleys add another cost; ranging from £500 up to £1000 per trolley.
• No payment to pharmacy for dispensing in MDS
• Extra training needed
• Time to fill
• Error risk from secondary dispensing - MCAs are not designed to address intentional non-adherence
• May reduce patient autonomy by making it difficult for them to identify which medication they would like to omit but will not force a patient to take medication if they do not wish.
• Only suitable for solid dosage forms that are to be swallowed whole. Dispersible, buccal or sublingual dosage forms cannot be included in MCAs, as such instructions cannot be applied to only one type of medication contained in the MCA.
• Medication prescribed to the patient on a “when required” basis as it may result in the patient unnecessarily taking it regularly. MCAs therefore, have
the potential to create more confusion if some items are stored in the MCA and others in their original containers. Long term stability unknown
• Risk of packaging ingestion with blister pack MCAs and certain monitored dosage systems
• Hygiene problems are associated with reusable MCAs- Can become contaminated with bacteria and the powder of previously stored medicines.
• Many do not have child resistant closures- It is professionally accepted that all dispensed medicines should be supplied in containers with child resistant
closures unless otherwise requested by the patient.
• Doses can become ‘mixed up’ if the MCA is dropped -When some MCAs are dropped, dosage units can move between compartments or fall out of the device.
• Transportability Patient acceptability in terms of the size of a MCA and hence ease of transport.
Warfarin 1mg tablets
Tramacet tablets
Esomeprazole 40mg tablets
Amber - No stability data is available. There are theoretical concerns with use in CAs, which may be mitigated by risk - minimisation. However NPSA guidance recommends that they do not be included in MCA/MDS due to frequently changing doses.
Amber - No stability data is available, the manufacturer does not, or cannot recommend use in CAs but there are no theoretical concerns with the product.
Amber - Stability data is available in an alternative container (not CAs) that may be extrapolated to support storage in CAs.
