Medicines Awareness, Administration and Competency Assessment in Residential and Domiciliary Care Services

The project aims to ensure that the management of medication in residential and social care settings is of the highest standard possible through use of NICE Quality Standards and implementation of associated NICE guidelines.

Medicines management in residential and domiciliary care services will ultimately be safe, effective and demonstrate that a high quality service is being delivered, taking into account the wishes and expectations of the person receiving the care. This will result in a consistent high standard of care which is compliant with the CQC’s relevant regulations. The final outcome should be the best possible health outcomes for the individual and will enable close working relationships within the multidisciplinary team leading to further efficiencies within the health and social care system.

The training provides delegates with the knowledge and skills required to achieve the above aims by relating the daily management of medication to CQC expectations. The trainer demonstrates how this can be achieved by use of the relevant NICE Quality Standard and implementation of associated NICE guidelines.

The main learning outcomes of the training are summarised below:

• Understanding of the CQC and the standards expected
• Awareness of NICE guidance recommendations and Quality Standards
• Understand the Medicines Act and other legalities around medicines
• Understand all areas of the medicine cycle
• Understand the issues relating to the safe and secure handling of medicines
• Reduce the risks involved in managing medicines
• Understanding of medicine related incidents
• Importance of audit
• An understanding of transfer of care
• Understanding the importance of medicines reconciliation
• Understanding of covert administration
• Understand consent and respect an individual’s choice and confidentiality
• Support individuals to administer their own medication and remain independent
• Understand and implement the 6 ‘Rights of Administration’ (6R’s)
• Understand and demonstrate how to practically administer medicines safely
• Awareness of how to competency-assess carers when administering medication
• The importance of record keeping

In order to maintain the above standards, the training programme provides resources for registered managers to competency-assess staff during the course of their daily activities relating to management of medication for assurance that they are competent to handle medication in a safe and effective manner on an ongoing basis.

The borough of Blackburn with Darwen has a population of 147,000. There are 26 Older People’s care homes and 4 Learning Disability/Mental Health/Physical Disability homes. Prior to this project, the local authority commissioned medicines awareness training from the private sector, but despite this, the number of issues and incidents reported which related to medication, continued to rise.

The CCG Medicines Management Team was approached for advice regarding repeated incidents. Initial findings highlighted a number of areas within the medicines cycle where the modification of policies and procedures could result in risk reduction and efficiencies. It was felt that raising awareness amongst staff was a key factor to achieving these goals. The council’s overarching medicines policy for adults was also due for review and hence the council requested that the CCG support them in updating the policy and developing and delivering a robust training programme to reflect the updated policy and address recurring issues.

A number of meetings were held with senior managers from residential, domiciliary (including Shared Lives), respite and day services to discuss what they would like to gain from the training. Visits were also arranged at various sites to establish how each service operates. Following an incident in a children’s residential centre, training for staff working in childrens’ services was also added to the programme.

During these discussions NICE published their guideline ‘Managing Medicines in Care Homes’. As such, the policy was updated and the initial training programme was developed to reflect NICE guidance and the subsequent Quality Standards.

Due to significant differences between the services, separate training sessions were developed for Domiciliary, Residential and Children’s services. All the services follow the same schedule as follows:

• All employees to receive a competency assessment booklet. Section 1 consists of thirty questions and scenarios based which are to be attempted BEFORE attending the training. The same section is to be completed again AFTER attending the training as a reflection activity
• The remainder of the booklet consists of competency assessment records and assessments which should be completed with the manager within THREE months of attending the training course.
• A full day training course is to be attended upon employment by all staff including registered managers. The full day training must be completed every other year
• A half day refresher training course is to be attended every other year alternating with the full day course
• Half day managers training. A separate session is delivered for domiciliary and residential services
• The sessions aim to deliver training in an interactive, engaging manner which provides delegates with an opportunity to consider and reflect on courses of actions they may have taken in real life situations. This is achieved through activities and tasks which include:

• The alterations of Medicines Administration Records (MAR Charts)
• Obtaining information about medications with the use of resources such as the British National Formulary and Patient Information Leaflets
• Activities demonstrating inhaler technique
• Activities identifying medication errors and near misses
• Activities to practice the administration and application of certain medication dosage forms
• Case studies which challenge delegates around possible situations which may arise during the medication cycle.At the time of implementation, NICE had only published guidance the ‘Medicines Management for Care Homes’ guidance which did not address the different aspects of social care. In order to overcome this hurdle the training incorporated recommendations which were common to both settings and made reference to current good practice in existence at the time.
• The training also reflects on a number of NICE guidelines as it covers antibiotic resistance and awareness about medicines related falls. Delegates are asked to complete a questionnaire about antibiotics and discussions are based around areas of knowledge gaps.

Please see attached evaluation of feedback received. This is an ongoing programme which is currently being formally evaluated. It would appear that the initial aims and objectives have been met as updated policies which reflect NICE guidance have been implemented in both adult and children’s services in council run settings. There is also an expectation that the policies and procedures of private organisations within the borough are also in line with the council’s policy and NICE guidance which will promote consistent high standards of care.

Both the CCG, council and where necessary CQC continue to work closely to quickly identify areas of risk in order to rectify problems in a prompt manner. This is accomplished by delegate feedback and by the council collating medicines related incidents. This information is used to identify trends and areas the training needs to focus on in order to reinforce safe practice. The number of incidents has reduced since implementation of the programme and recurrence of the same type of incident no longer occurs. Where a specific concern of an urgent nature is raised, additional support is provided to resolve the problem immediately within the setting and, if deemed necessary, staff are provided with the opportunity to repeat the training.

It would appear that the ongoing training, evaluation and response to concerns raised reduces risk as well as medication waste and other resources. In addition, staff confidence and awareness is increased, thus promoting a culture of open discussion which ultimately benefits the people receiving care from these organisations.

The training is reviewed on an annual basis as a minimum, and due to the recent publication of the NICE guideline (NG67) Managing Medicines for Adults Receiving Social Care in the Community’, the domiciliary training has recently been updated.

The training has evolved to include guest speakers e.g. safeguarding, to cover specific issues around covert administration as well as to promote and highlight local initiatives. Examples of this include the Red Bag Scheme during transfer of care, reporting of soft intelligence through Connect and the Prescription Ordering Direct scheme for the ordering of medication - all of which reinforce guidance set out by NICE.

The training programme has provided an opportunity for ongoing development. To date, apart from developing an insight into CQC and NICE guidance and expectations, the key learning is the identification of variation within residential and social care and the challenges that are faced by these sectors when trying to implement guidance and good practice.

Therefore a clear understanding of the needs of the organisation and local population are essential to achieve and implement efficient medicines management policies and procedures. To start off with a basic approach which covers the essential quality standards would be advisable which could then be built on according to feedback and the specific requirements that are identified.

To overcome certain challenges a shift in current practice and culture may be required and it would be recommended that open and clear lines of communication are maintained with all the individuals and organisations that may be impacted.

With regards to the specific training many delegates have commented that the full day sessions are quite intense and there has been a suggestion that they could be split over two days. However the capacity to release staff may be an issue and hence this should be a consideration which may have been given more thought during the development of the training.

Finally initially a lot of the tasks involved group work and it became apparent that certain individuals lead whilst others within the group did not participate as much. There were a number of reasons for this but as the programme was reviewed and updated the new tasks which were introduced involved each individual having to equally participate ensuring that everybody had an opportunity to gain the maximum benefits that the training could deliver.