Local Enhanced Service Specification for the Supply of Pharmaceutical Services to Care Homes through Community Pharmacy

Transcription

1 Local Enhanced Service Specification for the Supply of Pharmaceutical Services to Care Homes through Community Pharmacy Contents: 1. Introduction and purpose 2. Period of Service 3. Aim of the Service 4. Service Outline 5. Strategic Plan and links to other services 6. Access, Referral and Discharge Arrangements 7. Record Keeping 8. Information Collection 9. Training and Accreditation 10. Adverse Incidents 11. Clinical Governance 12. Contract Termination 13. Contract variation 14. Quality Indicators 15. Financial Details 16. Signature Sheet 17. Review Reference: LESS Introduction Community pharmacists are independent contractors who provide NHS services to the public. This also includes the provision of services to residents or service users of care homes. Care homes are the broader definition to include what were formally known as nursing and/or residential homes. An annual agreement is signed by a contractor pharmacist and the care home manager to provide pharmaceutical care to the residents of the care home and support and advice to the care home staff. The purpose of this Service Level Agreement is to equip the commissioner (NHS Manchester), providers and practitioners (community pharmacists) with the LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 1

2 necessary knowledge, service and implementation details to safely deliver this service. 2. Period of Service The service will run from 1 st April th September Aim of the Service This service is available from a registered community pharmacy on the pharmaceutical list of NHS Manchester or other registered pharmacy on the list of a neighbouring PCT. The aim of the service is to maintain patient safety within the care home in respect of the medication and other medicines related issues. The services to be provided by the contractor are: Advice and an initial assessment of the clinical and cost effective use of medicines; A system for the management of, safe storage, supply and administration of medicines including making the appropriate recommendations to the care home; Ensuring that there are appropriate systems in place for the administration, safe storage, ordering and safe disposal of medication; Ensuring that there are appropriate recording systems in place for the administration, safe storage, ordering and safe disposal of medication; Ensuring the appropriate systems are in place to facilitate the sharing of information about a resident s medication as a person may move from one care environment to another; To conduct a risk assessment twice a year in respect of all of the above and return a copy of this assessment to the Primary Care Pharmacy Services Manager at the PCT. 4. Service outline The pharmacy contractor has an annual agreement to provide pharmaceutical services to the care home. This agreement is renewed using the form provided by the Primary Care Commissioning Team at NHS Manchester. The contractor and the care home manager are responsible for renewing the agreement and returning the form by 1 st April each year. (Appendix 2). The Primary Care Commissioning Team will notify the contractor pharmacist that they are registered to provide the service to the home. Responsibilities of the pharmacy contractor: The pharmacy contractor has a duty to ensure that all staff, including pharmacists, who are involved in the provision of this service, have the relevant knowledge and are appropriately trained in the operation of the service. The pharmacy contractor has a duty to ensure that all staff, including pharmacists, who are involved in the provision of this service, are aware of, and operate within local protocols. The pharmacy contractor must maintain the appropriate records to ensure an effective, safe and ongoing service delivery and audit. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 2

3 Accredited Pharmacist responsibilities: The initial visit to the care home by the pharmacist should include the provision of advice on the following: The safe and effective ordering of medicines; The storage of medicines; The clinical and cost effective use of medicines; The administration and record keeping of medicines; The safe disposal of medicines and appliances. The pharmacist must ensure that there is an adequate and timely supply of all drugs and appliances as agreed between both parties. Care Home responsibilities: The care home manager is responsible for: Maintaining medication records; Complying with recommendations by the accredited pharmacist; Keeping a record of interventions and recommendations; Maintaining a record of drugs and appliances for disposal for inspection by the pharmacist; Co-operate with any staff training relating to medicines management offered by the contractor pharmacy. 5. Strategic Plan and links to other services Preventative Treatment, Reducing Complications The accredited pharmacist by providing a timely and adequate supply of medication and appliances will ensure the most appropriate level of care. Reducing Health Inequalities The service is provided by community pharmacies across the city with a range of opening hours allowing an increase in access to a number of both nursing and residential care homes. In addition the pharmacies are a source of health information and advice. More Effective Care The provision of a risk assessment and where appropriate referring patients for an in depth clinical review will contribute to optimising patient care and reduce the risks associated with medication use. True Partnerships, Professionals, Patients and the Public The accredited pharmacist is working in cooperation with the care home manager, other care home staff, nursing staff, local GPs and other health care professionals together with residents and their families. There is a referral mechanism into the PCT for clinical medication reviews. Keeping Viable The service will contribute to a reduction in medicines waste and increase cost effectiveness. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 3

4 6. Access, Referral and Discharge Plans The service is accessed by a registered care home with an agreement for the service to be provided by a community pharmacy. The Primary Care Commissioning Team at NHS Manchester maintain a list of pharmacies providing this service. The agreement for providing this service is renewed on 1 st April each year. All residents of a care home will have access to the service provided by the accredited pharmacy. A care home resident would only be discharged by a pharmacy if the resident moved to another care environment. The pharmacy should provide information about a resident s medication to the new carer. The accredited pharmacist can refer a resident requiring a more in-depth medication review to the GP or other relevant healthcare professional. The pharmacist should maintain records of such referrals. The service should be accessible during the times that the pharmacy is open. 7. Record Keeping The accredited pharmacist should ensure: The Care Home receives a visit from an accredited pharmacist every six months. A record of these visits and any interventions and advice given must be maintained. (Appendix 1). This record must be retained by both parties and a copy returned to the Primary Care Pharmacy Manager at the Primary Care Trust (PCT). A copy of any action plan agreed with the care home should be retained for review at future visits; A record of any unused/unwanted drugs and appliances be kept for the care home and checked by the pharmacist at least every six months; That a risk assessment (Appendix 3) is carried out every six months. The completed form must be returned to the Primary Care Pharmacy Manager at the PCT. Failure to return this risk assessment will result in the withholding of fees by the PCT; A copy of the risk assessment must be supplied to the care home and a record kept at the pharmacy for a period of three years; The risk assessment includes the provision that should a resident require a more in-depth medication review they should be referred to the GP. Is aware of any medicines related issues raised during a care home inspection organisation visit to the home; They are able to advise on the content of the care home medicines related policy documents, including the administration of medicines for acute conditions, the use of homely remedies and procedures when there are alterations to residents medication regimes. 8. Information Collection Full and complete records must be maintained in such a way that the data and details are readily accessible for inspection when required by the PCT. The pharmacist must comply with the Data Protection Act and keep these records confidential. 9. Training and Accreditation All community pharmacists providing the service are required to complete an open learning pack and on-line assessment from the Centre for Pharmacy Postgraduate Education (CPPE) entitled Supporting Care Homes as proof of accreditation to provide the service. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 4

5 The accredited pharmacist is encouraged to actively engage with training and update sessions provided either by the PCT or the Nursing Home Forum. Training schedules or relevant continuing professional development records should be made available to the commissioner on request. The appropriate qualifications and registration with professional bodies for the service provided must be maintained and copies of such should be provided to the commissioner if requested. 10. Adverse Incidents The pharmacist should record all adverse incidents via the Yellow Card procedure or the PCT incident reporting scheme as appropriate. 11. Clinical Governance The pharmacy contractor should ensure that only appropriately qualified staff provides the service to the same professional and ethical standards of care and treatment as provided for by the provisions of the Dispensing or Repeat Dispensing Essential Services. The pharmacy contractor is responsible for maintaining adequate staffing levels to provide the service. A standard operating procedure should be place for the provision of the service. The community pharmacist is responsible for maintaining adequate staffing levels to provide the service and for maintaining a personal development plan. The pharmacy contractor is responsible for completing the annual declaration to the PCT of the names and designation of the staff qualified to provide this service. The contractor is required to comply with all relevant legislation and have regard to all relevant guidance issued by the PCT including the Safeguarding Children and Vulnerable Adults Policy (version February 2011). As part of this, the practice is required to have regard to the Department of Health s Code of Confidentiality and NHS Manchester s safeguarding issues for Children & Vulnerable Adults including referral processes and sharing of information. This requirement is outlined in the NHS Manchester s Child Protection Step by Step Guide, and will be reviewed as part of the post payment verification practice-visiting programme. 12. Contract Termination The PCT and the Provider (community pharmacist) may agree, in writing, to terminate the Contract and, if agreement is reached, the date on which the termination should take effect, with a minimum notice period of 30 days. The Provider should notify the PCT in writing immediately of any incidents that occur in the course of performing this agreement, which may affect the execution of this service. This includes absence of an accredited pharmacist, adverse incidents, unforeseen circumstances e.g. long-term sickness, issues with premises etc. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 5

6 The PCT will notify the Provider if there is a failure to meet any of the obligations in this contract by; 1. notifying in writing, to the Provider, the nature of the breach 2. providing the requirement of the provider to take any specified action to correct the breach 3. specification of the timescale in which to remedy the breach. If the provider fails to remedy the breach, repeats the breach, or otherwise breaches the agreement resulting in either a remedial or further breach notice, the commissioner shall be entitled to terminate this agreement immediately, by written notice to the provider. However, the agreement will remain in force in relation to the clients already in the care of the pharmacist in order to protect their health, safety, well being and dignity until they are discharged from the pharmacist s care. The PCT will, if necessary, terminate this agreement on giving written notice of 30 days. 13. Contract Variation NHS Manchester as the commissioner reserve the right to vary any part of this agreement at any time as a result of any Act of Parliament or direction of Central Government or outcome of review or audit, providing that notice thereof has been given in writing of not less than thirty days to the providers to this effect. In the event of such variation incurring additional costs to the provider then these costs may be negotiated with the commissioner with a view to a variation to the overall contract price and/or this contract. A variation to this agreement shall not be effective unless it is in writing and signed by both parties. 14. Quality Indicators The pharmacy contractor should ensure the following: all goods used in the performance of the agreement should be of a satisfactory quality and be fit for the purpose for which they are used; reviews the standard operating procedures on an annual basis; the pharmacist and staff involved in the service have undertaken CPD relevant to this service; the pharmacy has a complaints procedure for monitoring the procedures provided; co-operates with any review of the client experience; completion and return to the PCT of the risk assessment every six months; completion and return to the PCT of the intervention and advice record for the care home. In addition the routine visits by the care home inspection organisation should highlight any shortfalls in the systems for the management of storage, supply administration and disposal of medicines. 15. Financial Details. An annual payment per resident bed in the care home, will be paid, via the Prescription Pricing Authority (PPA) payments to the contractor pharmacy. And appears on the FP34 statement as Local Scheme 5, at the end of the financial year in which the service was provided. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 6

7 Name and address of Community Pharmacy Name of visiting pharmacist. Name and address of Care Home.. Name of Care Home Manager Date of Visit Issues arising from the visit: ISSUE RESOLUTION DATE OF AGREED ACTION PLEASE SUPPLY ONE COPY TO THE CARE HOME MANAGER, ONE COPY TO BE RETAINED IN THE PHARMACY, ONE COPY TO BE RETURNED TO THE PRIMARY CARE PHARMACY SERVICES MANAGER. LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 7

8 (Appendix 1) PHARMACY CONTRACT FOR SERVICES TO CARE HOMES This agreement states that the services outlined below will be provided By Pharmacy name & address: To Care Home name & address: No. of beds: as of (date) Manager s name: Manager s name: From (date) To (date) The pharmacist will comply according to the detail in Local Enhanced Service Specification for Care Homes (LESS 07). Advisory Services The pharmacist will visit the care home twice yearly at six-monthly intervals. The pharmacist will give advice on: The proper and effective ordering of drugs and appliances for the benefit of service users in the home; The proper and effective administration and use of drugs and appliances in the home; The safe and appropriate storage of drugs and appliances in the home. Supply The pharmacist will ensure adequate and timely supply of all drugs and appliances as agreed between both parties. Disposal The Care Home Manager is responsible for ensuring the removal of waste medicines by a recognised waste disposal contractor or if appropriate by the community pharmacy. Any unwanted drugs and appliances must be removed for safe disposal and must not be reused. A record of any unused/unwanted drugs and appliances must be kept by the care home and checked by the pharmacist during the routine visit to the home. Medication Review The pharmacist will conduct a risk assessment twice a year for the Care Home and identify any patients/residents requiring a higher level of medication review. Records Records of visits made including advice given must be retained by both parties and will be made available to the Primary Care Trust for inspection if requested to do so. This agreement may be terminated by appropriate Primary Care Trust. notice in writing given by either party to the other and to the Signed (Pharmacist) Date Signed (Manager/person in charge of home) Date LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 8 Appendix 2

9 Checklist for Community Pharmacist Visit to a Care Home This checklist should be completed every six months. This list is by no means exhaustive and is intended as a guide only. There may be other issues highlighted during the visit. A copy should be provided to the care home and the Pharmaceutical Adviser at the PCT. Name of Care Home.. Date of Visit Pharmacist conducting the risk assessment.. Issue Yes No Comments 1. Medication Policy A) Does the Care Home have an up to date Medication Policy? B) Has the pharmacist / staff seen a copy? C) Is there a policy for residents who are self administrating? 2. Record Keeping A) Is there a record of Medicines received into the Care Home? B) Does this record include the following information: Date of medicine receipt Name, strength and dose of medicine Quantity received Patient/resident name Signature of the staff member receiving and booking the medicines into stock need to be 2 members of staff C) Are stock balances stated on the MAR or rolled over from one MAR sheet to the next if necessary? 3. Administration of medicines A) Is there an up to date photo of each resident to formally identify them LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 9

10 Issue B) New residents - is the medication verified with the GP or a hospital discharge form before administering? c) Return from hospital is medication verified with a discharge form before being administered (possible discontinued / new items)? D) Are Medicines Administration Records (MAR) charts used? E) Are these MAR charts supplied by the pharmacy? F) Are allergies recorded on the MAR chart? G) Are dosage directions correct no as directed or if required? H) Do if required preparations have an indication included in the directions? I) Is there a record of variable doses? J) Is the digoxin pulse always recorded? When is it recorded? K) Is there a record of BMs for diabetic patients? L) Are there any hand-written additions / alterations to the MAR charts? If so what is the reason for this addition? M) Are these hand-written additions / alterations signed by two people & dated? N) Are copies of the prescriptions kept? O) Are these prescription copies referenced to the MAR charts? P) Are the MAR charts completed by staff correctly? Q) Are there any gaps in the completed MAR charts? R) Is every administration time completed by a member of staff? - Is this done appropriately? S) Are there any additional instructions / warnings added to the MAR chart? T) Are there any medicines which are regularly out of stock? U) Have any homely remedies been administered? V) Is there a record of this administration on the MAR chart? W) If MAR charts are not being used what other record is being kept? X) Is there any evidence of medicines being administered to a patient / resident for whom the medicines are not labelled? Y) Is there any evidence of medicines being administered to a patient / resident for whom they are not prescribed? Z) Have you witnessed a medicine round? Is there a policy for medicines administration error? - It is a requirement that CSCI are informed of medication errors Y es N o C omments LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 10

11 Issue Yes No Comments Is there any evidence of covert administration of medicines with no written evidence to support the practice? 4. Self Administration of Medicines A) Are any patients / residents self medicating? B) Is there a record for self administration by a patient / resident? C) Are patients given a risk assessment before self administering medication (including inhalers & creams) & how often? D) Is self administration recorded on the MAR chart? 5. Disposal Of Medicines A) Does the care home have a Waste Medicine Disposal Policy? B) Does the care home have a Waste Medicine Disposal Contractor? C) Is a record kept of medicines to be disposed of? D) Does this record detail the following information: Date of placing in disposal bin Name and strength of medicine Quantity removed Patient/resident for whom the medicine was prescribed Reason for medicine disposal Staff signature E) Is this disposal witnessed by another member of staff? F) Are there any medicines / dressings retained in the home that are no longer in use resident deceased or out of date? 6. Labelling of Medicines A) Does each medicine have a dispensing label showing: Patient/resident name Date of dispensing Name and strength of the medicine Dose and frequency of the medicine B) Are all medicines not supplied in an MDS s uitably labelled? LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 11

12 Issue Yes No Comments C) Is there any evidence that MDS packs have been tampered with? D) Is there any evidence of mixed batches in the packs? E) Is there sufficient stock of each medicine for 28 days? F) For multiple containers is each container labelled? G) Does the pharmacy label contain suitable cautionary and advisory instructions? H) Is there any evidence that labels have been altered by care staff? I) Does each medicine have a PIL supplied? J) Do any medicine labels not contain dosage instructions? K) Any medication not labelled? L) Are expiry dates written on liquid / external preparations when opened? M) Is there a record of opening of short dated medicines e.g. eye-drops have 28 day expiry, GTN tablets 8 weeks etc moved from administration? N) Are dressings labelled for individual patients and in date? O) Is a pharmacy label affixed to external medicine as well as outer packaging? 7. Prevention of Fraud A) Does the care home manager or designated person initiate the ordering of prescriptions? B) Does the care home see the prescriptions before sending to the pharmacy? C) Are the prescription forms matched to the prescriptions requested by the home? 8. Recording of Messages A) Does the Care Home have a policy for recording verbal messages? B) Does the Care Home ask for written clarification from the GP regarding any changes re medication? 9. Homely Remedies A) Does the home keep a stock of non-prescription medicines? B) Is there an authorisation from the GP to supply such medicines as needed? C) Is there a record of such a supply to a patient/resident? LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 12

13 Issue Yes No Comments 10. Storage of Medicines For Self - Medicating Patients/Residents A) Is there a secure, lockable cupboard/drawer to store their medication? B) Is the temperature of the storage suitable for the medication so stored? C) Is there sufficient room to store all the medication? 11. Storage of Medicines For all other patients/residents A) Is there a secure, lockable cabinet for medicines storage? B) Is a trolley used for the storage of medicines? C) If the trolley is mobile, is there a facility to lock and fix to a wall? D) If yes, is this trolley clean and of a suitable material and of a size appropriate to the needs of the care home? E) Is there sufficient capacity for each resident s medication to be stored separately? F) Was the medicines cupboard / trolley locked on your arrival? G) Who is responsible for the keys to the medicines storage? H) Is the storage area below the temperature of +25 o C? I) Are internals and externals stored separately? J) Are medications purchased by the residents stored separately to those prescribed & labelled that they are purchased by resident? K) Is there any excess medication due to inappropriate system of ordering? L) Are there hand washing facilities in the clinical room? M) Are there any sticky bottles? 12. Cold Storage A) Is there a separate, secure and dedicated refrigerator available in the care home? B) Is a daily record of maximum and minimum temperatures of the refrigerator kept between +2 o C to +8 o C? C) Is there a record of regular cleaning and defrosting? D) Are there only medicinal items stored in the refrigerator? LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 13

14 Issue Yes No Comments E) Is there evidence of items that should be stored in the refrigerator not being so stored? 13. Administration of Medicines Away from the Care Home A) What is the procedure for supplying medication should the patient/resident be absent from the home for any length of time 14. Oxygen A) Are any pat ients/residents receiving oxygen B) Is there a statutory warning notice regarding the use of oxygen? I.e. Compressed Gas. Oxygen: No Smoking, No Naked Lights 15. Controlled Drugs A) Does the home carry any controlled drugs? B) Is there a suitable, lockable cupboard for storage? - refer to the Misuse of Drugs (Safe Custody) Regulation 1973 C) Are any other items stored in the Controlled Drugs Cupboard? D) Is there a Controlled Drugs Record Book? E) Is there a record of controlled drugs administration which should be a bound, hardback book or a register with numbered pages? F) Is there a running balance after each drug administration? G) Is there evidence of a regular balance check? H) Does the balance of the register match that of the cupboard? I) Are two appropriately trained members of staff signing the administration record? J) Does the CD register include records of CDs that are not in the care home? K) Is there a record of controlled drug destruction? L) Does the Care Home have the facility to dispose of controlled drugs? M) Are two suitably authorised members of staff witnessing the destruction of controlled drugs? LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 14

15 Issue Yes No Comments 16. Staff Training A) Is there a record of staff that have accessed medication training? B) Who has provided the training? C) Was the training provided accredited? D) How many members of staff have been trained in medicines use? E) Have any other training needs been identified with regard to medicines use? F) In residential only care homes (no registered nurse), is there any formal training for staff around the safe handling of medicines and techniques such as giving insulin, rectal preparations & using PEG tubes? G) Do Staff regularly fill compliance aids and / or set up medication in advance without specific training, authorisation and cross referencing? 17. Medication Review A) Is there any evidence of a medication review carried out in the last six months? B) If yes, who carried out the medication reviews? C) Are there a number of GP practices serving the Care Home? D) Have all the patients / residents received a medication review? E) Are there any gaps in the provision of medication reviews? F) Are there any patients / residents for whom you would recommend a medication review? 18. Any Other Issues A) Is the homely remedy agreement signed by the GP and up to date? B) Is there an up to date BNF in the home? C) Is the list of staff signatures together with their initials up to date? (Based on RPSGB June 2003 The Administration and Control of Medicines in Care Homes and Children s Services ) Appendix 3 LESS 07 Care Homes Supply NHS Manchester 01/02/2013 Page 15