Our Medicines - Our Way: A person centred approach to supporting adults with a learning disability to manage their medicines

• To provide high quality medicines support to adults with a learning disability 
• To develop an evidence based policy to guide practice
• To further develop person centred support plans in relation to medicines support
• To facilitate greater independence and involvement for the people we support
• To source appropriate staff skills to further develop skills and knowledge

At the beginning of our project we set out to improve the quality of medicines support.  Our first milestones were to develop an evidence-based policy and source staff training

The NICE guidance on optimising medicines support identified the importance of understanding the experience of the person and involving them in decisions about their own medicines.

Our literature review identified that at the time there was little evidence-based practice guidance aimed at people receiving support within their own homes.

In February 2016 our service was inspected by the CQC and through discussion discovered that the CQC also did not have access to guidance specifically relevant to a domiciliary care setting and had been advised to measure domiciliary services against criteria that had been developed for a care home setting. This was difficult in some areas as the criteria did not facilitate decision making by individuals, e.g. it indicated that the company should have a relationship with a pharmacy rather than an individual being enabled to choose a pharmacy. We received “good” rating for safe services, and “outstanding” overall. This was an important milestone on the journey, and one of our aims was to embark on a journey to transform “good” into “outstanding”.

We continued our policy development including the principle that people should be as independent as possible. To support this we signed up to the STOMP campaign and carried out an internal audit.

We became aware of the NICE consultation on NG67 Managing Medicines for Adults Receiving Social Care in the Community and welcomed it’s publication in March 2018. The guidance highlighted that people should be in control of their own medicines, but that individuals may need varying levels of support.

This was another important milestone on our journey. The new guidance was a good fit with the existing values of our organisation and key principle of “people at the centre of everything we do”. The guidance supported the work we had done to date and provided us with the “next steps” for our project. We took the decision to implement the NICE guidance (NG67) as fully as possible. This was further supported the following year (February 2018) with the publication of NG86: People’s experience in adult care services – which reinforced the concept of supporting people to have control over their own medicines, and supporting people to take managed risks.

We included the medicines project in the business plan for 2018. Following the publication of NG67 we set out to complete a NICE baseline assessment.

As our approach was based on co-production we began by raising the profile of the NICE guidance and asking questions to enable the people we support and families and staff to contribute.

Some of the things we learned included:

• Staff would like more training
• Further detail could be included in Medicines Support Plans
• Further developing independence could be included in Support Plans
• The NICE guidance is quite complex
• It was quite difficult to engage people with a learning disability in the process

We identified some next steps:

• To identify a medicines lead as recommended in the NICE guidance
• To source training and to undertake as a whole organisation – we had to try out more than one training provider as training evaluations indicated that some training was not providing what staff felt they needed
• To re-assess medicines support with individuals – this has now been completed and every person that we support has an assessment and a person-centred medicines plan. This lead to further learning including: Medicines information was too complex.
• To incorporate NICE guidance into our policy – this has now been completed and has also incorporated information published by the CQC. This included designing some key tools to help people with the implementation
• The Medicines Incident Form was revised to reflect the medicines cycle and capture information about all incidents relating to medicines support:

-           When required protocol

-           Preparing for my medicines review

-           Recording advice sought when using over-the-counter medicines.

• To raise the profile of medicines

Raising the profile

Video, as a media option, had previously been used in a recruitment project. The learning from this was that the process of being involved in and making the video encouraged discussion and learning and that people related to and were engaged with this methodology. We applied for and successfully obtained funding to make a video. This part of the project is currently ongoing but as with our previous video has led to lots of other discussions including:

• Designing a medicines mnemonic which has meaning to people receiving support
• Making a medicines tea towel – with key messages about medicines
• Sharing ideas about how people can be involved in different parts of the medicines cycle

All of the initial aims and objectives were met:

• There is a medicines based policy incorporating NICE and CQC guidance
• Every person we support has had their medicines support re-assessed
• Every person we support has been supported to develop a more detailed support plan
• All staff (including managers) have received training and competency assessment
• The Medicines Incident Form has been redesigned

In addition there have been additional findings and results:

• Easy read information was important in helping people to understand medicines – every person now has some easy read pictorial information about their medicines. These leaflets have been produced by the Medicines Project Lead and approved by the community pharmacist.
• Accessing support from other professionals has led to increased partnership working with GPs, Community Pharmacists, Consultants, Medicines Support Team
• We are continually learning about existing resources to help people become more independent. These include:

-           Blister packs/monitored dosage systems

-           Blister pack poppers

-           Eye drop applicators

-           Cream applicators

-           Reminder clocks and gadgets

• Sharing ideas and developing resources. Finding out about ideas and sharing them has helped to give the people we support and the staff supporting them the confidence to try things out

Case Study: One person had very strong views about how he would like to be supported with his medicines. He found this difficult to articulate in a face-to-face conversation with support staff. His views were gathered and clarified with him and he was supported to use a talking (audio) photograph album to take pictures and record his requirements.

Case Study: One person who was finding it difficult to take their medicines at the times they were prescribed has been helped to find a better routine which fits with their lifestyle. This was facilitated through partnership work with the Medicines Project Lead, support staff, Medicines Support Team, GP and Pharmacy.

Time for the Project: Having a Project Lead – don’t try and incorporate into exiting workstreams.

Organisational Learning: Everybody in the organisation undertaking training at a similar time led to a culture of openness, discussion, sharing and questioning.

Reviewing the Incident Form: The review of the Incident Form led to an increased number of Incident Forms being submitted (2016 – 16, 2017 – 23, 2018 - 59). The change in title to Medicines Incident and Action Form alongside profile raising led to a wider range of issues being submitted and key information about current practice, issues and themes.

Case Study: When the forms were analysed we were able to identify a trend that related to one of our local pharmacies. The Medicines Project Lead discussed the issues that were arising with the pharmacy who took steps to look at their own processes.

Listening: This was extremely significant and sometimes what people were telling us changed the direction of the project. For example – the training was not meeting people’s needs, people did not understand the medicines information.

Finding out about roles and responsibilities of other professionals: As we progressed through the project other professionals became more and more useful and there was some very strong partnership working. It may have been useful to dedicate some time earlier in the project to finding out about roles and responsibilities of others and how to work together.

Bite sized chunks of information: It is easy to feel overwhelmed with the amount of information available which can mean that you do not get started.