The safety of medicines is a key priority for Home Group’s Director of Clinical Practice for specialist services. The organisation has invested in resource to ensure effective integration of medication support into clinical governance structures and process.
A medications practice development approach was taken where NICE Guideline NG67 and the 2019 CQC report Medicines in Health and Social Care have supported our clinical governance team to make a number of service improvements.
The medication practice development approach has 4 key deliverables:
1) The first corporately led baseline audit of NG67 standards in 8 CQC registered services, complementing service-led medication audits.
2) A review of policy guidance to incorporate NG67 standards.
3) The introduction of a new incident management system.
4) The establishment of quality governance panels and committees who receive, review and have clear oversight of audit findings, policy changes, medication incidents and risks.
Aims and objectives
Our aim was to review Home Group’s local medicines governance arrangements to ensure that it is clear who is accountable and responsible for providing medicines support.
We had three objectives:
- To establish current practice against best practice (NG67) through auditing medications support.
- To revise current policy guidance to include NG67 standards.
- To review the systems and processes for reviewing medication errors.
Reasons for implementing your project
Home Group is a housing association delivering integrated health, housing and care for older people, people with learning disabilities and people with mental health conditions.
We currently have 14 registered services and have ambitious plans to provide integrated health, housing, and clinically focused care for complex customers in the Transforming Care programme.
Home Group recognises that people receiving social care in the community may be at greater risk of medicine–related problems as a result of having multimorbidity and polypharmacy. In order to strengthen Home Group’s medications support practice and governance, a clinical governance team was recruited by the Director of Clinical Practice.
The team implemented a practice development approach by building on existing processes and policy, including service-led medication audits and medications policy guidance.
The publication of NG67 and QS171 at the time provided a golden opportunity to assess our current delivery of medications support and introduce evidence-based practice to improve outcomes and safety for customers.
How did you implement the project
Baseline Audit (Evidence 1)
We used NICE Guideline NG67 to develop an audit tool and criteria to audit the delivery of medications administration support. Data collection was undertaken in CQC registered services which was completed in quarter three of the 2018-2019 annual audit programme. All services providing medication support participated in the audit and 55% of customer records were audited.
Policy Guidance Review (Evidence 2)
The audit findings and best practice standards from NG67 and QS171 were used to revise the medications policy guidance. The review involved consultation with Registered Managers with support from the Clinical Governance team. The revised guidance is now being utilised to create a bespoke medications training package and a standardised medications administration competency assessment tool. Monitoring of compliance with training and competency assessment will feature in service Learning and Development Compliance Reports. To support this, a physical health nurse has been appointed to lead this work.
Incident Management System (Evidence 3)
We recognised that systems and processes for reporting and learning from medication incidents needed to be strengthened. Our analysis of the data was significantly hampered by the use of an incident reporting system which was unsuited to Home Group’s existing and future requirements. We completed extensive consultation across the business and invited risk management companies to submit tenders for a new system. Ulysses Risk Management system has been procured along with a very experienced systems manager. There is a project team who are responsible for implementing the new system and processes, including a customer safety campaign to embed a ‘just culture’ approach of reporting and learning of lessons. We are currently piloting the implementation of this system with its increased functionality, including a real-time data dashboard and incident drill-down.
New governance structures and processes (Evidence 4)
The Clinical Governance team have worked with colleagues from across Home Group to develop robust governance structures, including a Registered Manager’s Clinical Governance Panel and a Clinical Governance Committee. Audit outcomes, the revised policy guidance and new incident management dashboards are being shared with frontline colleagues via the Registered Manager’s Clinical Governance Panel and with Home Group Board and the Executive team via Clinical Governance Committee.
As a result the following actions were identified in the action plan:
- All colleagues to document sharing information about a customer’s medicines with their GP, supplying pharmacist, and prescriber in training and the updated medicines policy guidance.
- Registered Managers to ensure that customer documentation provides instructions on what to do when a customer is having a meal, sleeping, not in the building, has declining or fluctuating mental capacity or requires time sensitive medications and ensure that colleagues have the skills & knowledge to apply this in practice. Lessons learned bulletins demonstrate at a service level the actions taken. Policy Guidance Review (Evidence 2)
The most significant change in the revised guidance was in relation to recommendation 1.2 including o Working with customer strengths and abilities and actively encouraging them to participate in the management of their own medication.
o Minimising colleague responsibility for managing a customer’s medications unless an assessment identifies a need to do so.
o Adhering to the customer’s needs and preferences and identifying what they can do.
Incident Management System:
The level of reporting from the new incident management system is generating significant interest and as a Clinical Governance team we are now confident that this is one area of our practice development which will support us to evidence our approach to keeping our customers safe. During 2020, we will be embarking on a customer safety campaign which will use the improved data to focus on improving medication incident management. Governance structures and processes (Evidence 4+6)
Two key findings have arisen from sharing outcomes of the practice development approach with Home Group’s governance structures:
- Sharing the updated guidance at the Registered Manager’s Clinical Governance Panel has resulted in additional procedural guidance being drafted to support services.
- Assurance has been provided through updating key committees and meetings and has led to a greater focus on medications across
Key learning points
- The importance of senior management support for this practice development cannot be understated.
- Collaborative working between stakeholders within Home Group is fundamental to success.
- During the implementation of the NG67 standards the Clinical Governance team have remained focused on the improved safety of customer medication support.
- By implementing evidence-based standards we can assure the organisation and the regulator that our colleagues are suitably trained and assessed in their competency to provide medications support.
- As Home Group embarks on its ambitious plans to develop new models of care, which will see the organisation provide more medications support to increasingly complex customers, we have valued having access to appropriate and relevant NICE guidance.