Medicines Management for Residential and Nursing Homes

A Toolkit for Best Practice and Accredited Learning

Roy C. Lilley, Paul Lambden, Siddhartha Goel

• Publisher: CRC Press
• Year: 2018
• eBook ISBN:
  9781315342443
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This practical toolkit informs readers of ways to ensure the right medication in the right dose, for the right patient at the right time. It covers every aspect of looking after and delivering medicines in the care home environment. The easy-to-read format, with questions and exercises for individuals and groups, makes the text ideal as a framework for teaching and accredited learning. This handbook is vital for care professionals working in residential and nursing homes, their managers and supervisors. It is also invaluable for trainee care and nursing assistants including students in further education. 'When inspectors said thousands of care home residents were being given the wrong medication - the image of a grotty, poorly run nursing home reared its stereotypical head. How could something so simple as giving a patient their daily dose of tablets be going so wrong, so many times over? But according to care professionals, management of residents' medication is one of the most complex areas of running a nursing home, and unless fail-safe practices are adhered to, the results can be very damaging to both the resident and the care worker. Clearly, it's time to sort this out!' - Roy Lilley and Paul Lambden with Alan Gillies, in the Introduction.

SECTION THREE: MEDICINES MANAGEMENT

Here, in more detail, are all the issues about medicines management. Take you time to read through the sections and complete the exercises, with colleagues, as an aid to learning and then online for your accredited learning.

MEDICINES RECORD

There are several references, in the book, to ‘the medicines record’.

It is at the heart of medicines administration. Everything you need to know. What medicine, how much, when and by whom administered.

Later in this section there is an image of what a medicines record looks like. It is taken from the records that are supplied by the pharmacist, Boots. Most pharmacists will provide a similar record sheet. However, the one we reproduce is clear, comprehensive and is how it should be done! Well done Boots.

A medicines, or medication record at the very least, should include all the following information:

Name of patient
Date of birth
Address - that is the room or suite number
Allergies
The doctor's name

So far, so simple …
Next you need a record of:	OK

• what medication
• when the course is started
• the time of administration
• the dose
• the prescriber's signature
• the ‘route’, i.e. oral etc.

Next, we need to know:
	OK

• who administered the medication
• the full record of administration over a period weeks, or the full course of medication.

… And, when things don't go right:
	OK

• if the medication was refused
• medication refused and destroyed
• medication returned to the pharmacy or destroyed
• nausea or vomiting
• patient in hospital
• away on holiday, with family (sometimes referred to as social leave)
• special instructions about timing or method of administration
• a space for other notes, to record occurrences and unusual observations.

For real best practice a photograph of the resident should be attached to the record. This is an invaluable idea to ensure agency or new staff don't make a mistake and administer the medicine to the wrong patient. It saves having to keep asking for verification of the patient's name. And should patients become confused – the benefits are obvious.

You must keep the records for a minimum of three years from the date of last entry, and make doubly sure they are retrievable for inspection – not stuck in the loft, or in a box in a shed and are clean and dry!

Think all this stuff should be done on computer – you're right. It will be. We are already heading in that direction. You'll be interested in looking at this: www.connectingforhealth.nhs.uk/crdb/boardpapers/all_images_and_docs/crbb/emm_report_v08.pdf.

WHERE ARE THE MEDICINES COMING FROM?

One of the keys to good medicines management is a good relationship with the local pharmacy.

‘Local’ is good, as there will be times when a quick trip to the pharmacy is what's required. However, don't sacrifice efficiency for local. A residential home of, say, 20 or more residents, most of whom could be expected to be on at least one medication (and some many more), might place quite a strain on a small pharmacy to provide the level of service that you will want.

Here are some of the basics that you will definitely need. Be sure the pharmacy can offer them, this time, next time and every time.

IT WOULD BE REALLY GOOD IF THE PHARMACY CAN DO ALL THIS?

• It goes without saying the service from the pharmacy should be timely and accurate and able to work to deadlines and timelines.
• Can they provide advice? The administration of medicines, the contraindication of some medicines and even the mix of medicines a resident may be taking – the pharmacist should be a sound first port-of-call for advice.
• Can they help with staff training? As the administration of medicines gets more complicated and names and packaging more confusing, a pharmacist might be a good source of basic familiarisation training for new staff, and refresher training for established staff.
• Can they deliver medicines? Is the service available for routine and urgent prescriptions?

Four ticks in the box and you have a pharmacy to die for!

Also, be sure the pharmacy can supply all of the residential home's requirements, drugs and equipment.

...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• About the Authors
• Acknowledgements
• Dedication
• Introduction
• How to get the Best from this Book
• Accredited Learning
• Section One: Introduction
• Section Two: Controlled Drugs
• Section Three: Medicines Management
• Section Four: More Interesting Stuff!
• Section Five: Nutrition
• Section Six: Hand Hygiene
• Index