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Care homes and intermediate care

RPS publishes training resource for pharmacists redeployed to care homes

A new tool from the Royal Pharmaceutical Society will help pharmacists deployed to care homes self-assess, identify and fill gaps in their knowledge base.

RPS publishes training resource for pharmacists redeployed to care homes

Source: Science Photo Library

Pharmacists who are deployed to care homes during the COVID-19 pandemic will be able to make use of a new tool from the Royal Pharmaceutical Society

The Royal Pharmaceutical Society (RPS) has published a training resource for pharmacists and pharmacy technicians deployed to care homes during the COVID-19 pandemic. It includes a self-assessment tool, and links to learning resources and case studies, to help pharmacy professionals identify gaps in knowledge and upskill where necessary. It also includes a care home consultation and review tool to help pharmacists deliver high-priority clinical reviews, or consultations with residents and their families.

The resource emphasises that working in a care home during the pandemic may be “very challenging”, and advises pharmacy professionals to “look after yourself with the same energy as you care for your residents”.

The training resource was developed with input from bodies including NHS England, the Centre for Postgraduate Pharmacy Education, the Association of Pharmacy Technicians UK, the Primary Care Pharmacy Association, the Royal College of GPs and the Specialist Pharmacy Service.

In a statement accompanying the resource’s publication, the RPS said that care homes “are now at the centre of the fight against coronavirus” and that the guidance would help pharmacists to become “part of the multidisciplinary team looking after some of the most vulnerable in society”.

According to data from the Office for National Statistics, 10,636 deaths involving COVID-19 were reported in care homes between 10 April 2020 and 22 May 2020.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208003

Readers' comments (1)

  • Who is administering medication?

    It is important that pharmacists in care homes are aware of the qualifications and position of those administering medication to vulnerable people in care homes . The unregulated nature of healthcare assistants (HCAs) has been highlighted in studies and reports and this is an issue for patient safety, professional conduct, educational standards and defining a scope of practice . Pharmacists should know ‘Who is administering medications?’

    Several common issues associated with medicine administration errors have been highlighted including:
     Incorrect crushing or cutting of medication
    Not supervising medicines intake, particularly for residents with dementia
     Incorrect timing
     Omissions due to medicines not being available
     Wrong drug or wrong dose .
     Inhalers and liquid medicines are much more likely to give rise to medication errors than tablets or capsules
     Antibiotics may be particularly prone to errors, and missing doses can jeopardise treatment
     It has also been observed that errors are more common in the morning because there are more interruptions during the preparation and administration of medicines.
     Systems must also be in place to ensure staff administering medicines check for allergies or sensitivities, and know how important these checks are to reduce the risk of harm.

    The literature does not say anything about training HCAs in understanding prescription dose ranges. Ensuring the correct dose is administered is crucial, whether administration is done by a registered nurse ( RN) or HCA. Accountability for this rests with the delegating RN but delegation and accountability need to be well understood by RNs and HCAs.

    Non registered/regulated care staff administering medications to vulnerable people in care homes ( may include people with intellectual/learning disabilities) must
    •be able to recognise when someone is at risk of choking taking medicines
    •refer appropriately to speech and language therapy services and other health professionals such as the pharmacist
    •be aware of medication safety issues and have access to expert information
    •receive training around understanding and recognising dysphagia and the difference in the prescribed fluid and solid food diets and the effect on the administration of medication
    •understand First Aid to be given when someone is choking on medicines or food/drink
    •consistently report choking incidents with medicine administration.

    The duties of unregulated care staff administering medicines may include
    • share information ( with GP, prescriber, community/ dispensing pharmacist, nursing staff, family, person etc. etc.) about a vulnerable person’s medicines, including when they transfer between care settings e.g. are admitted to a general hospital
    • provide medicines information in an accessible format to people with intellectual disabilities
    • ensure that medication management records are accurate and up to date e.g. confirm receipt from pharmacy, take responsibility for safe keeping, document any returns, medication discarded etc.
    • identify, report and review medicines‑related problems e.g. refusal by person to consume vital medications
    • keeping residents safe i.e. safeguarding in medicine use process
    • ensure accurate transfer of medicines and medicines information i.e. medicines reconciliation
    • review medicines with prescribers, pharmacist, behaviour support specialist
    • order medicines from pharmacy
    • account for medicines
    • receive, check, store and dispose of medicines
    • help residents to look after and take their medicines themselves if appropriate i.e.self‑administration
    • have an understanding of issues in relation to covert administration
    • have an understanding of consent to treatment and the person’s rights
    • have an awareness of confidentiality.

    The administration of medicines by care staff will require
     recording medicines information in the person’s care plan/medical notes
     recording information in the MPARs i.e. the medicines prescribing and administration record
     recording information from correspondence and messages about medicines, such as emails, letters, text messages and transcribed phone messages
     recording information in transfer of care letters and summaries about medicines when a person with intellectual disability is away from the home for a short time
     what to do with copies of prescriptions and any records of medicines ordered
     responsibility for transferring medicines and health information to prescriber
     monitoring of response to medications
     following instructions for ‘as required’ medications and recording effect
     ‘protected time’ to limit distractions, interruptions etc. during medication administration.

    Care staff administering medication must also know how to manage the following risk situations
     what to do if the person is having a meal
     what to do if the person is asleep
     how to administer specific medicines such as patches, creams, inhalers, eye drops and liquids, vaginal tablets, nebulisers, patches etc.
     using the correct equipment depending on the formulation (for example, using oral syringes for small doses of liquid medicines)
     how to record and report administration errors and reactions to medicines
     how to manage medicines when the resident is away from the care home for a short time (for example, visiting relatives).

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