Service Level Agreement for Advice to Care Homes

Service Level Agreement for Advice to Care Homes SLA between: Service Provider: Community Pharmacies in Warwickshire PCT Warwickshire Primary Care Trust Westgate House Market Street Warwick CV34 4DE Warwickshire LPC endorsement: 22 nd July 2008 following review of previous SLA (1 st August 2006) PCT endorsement 15 th July 2008 following review of previous SLA Due for review on: 15 th July 2009 Background (with evidence of need): In accordance with the Pharmaceutical Services (Advanced and Enhanced services) (England) Directions 2005, arrangements for providing additional pharmaceutical services in relation to the Directions to Health Authorities 1 st April 1999 cease at 31/3/06. A needs assessment has been carried out for the provision of pharmaceutical advice to care homes. In February 2006, The Commission for Social Care Inspection (CSCI) published its report, Handled With Care? Managing medication for residents of care homes and children s homes- a follow up study (www.csci.org.uk/publications). The report made recommendations to improve medicines management within care homes. Of particular note, the report made explicit the responsibility CSCI considered rested with Primary Care Organisations to ensure that Care Homes maintained patient safety through the highest quality services to residents when it stated, PCTs need to take more active steps to ensure that monitoring the prescribing of medicines in homes is given a higher priority and that support is given to homes in developing safe working practices NHS primary care organisations (should) acknowledge and act on their responsibility to support health care provision within private and voluntary care homes Community pharmacy is ideally placed to provide advice and support to the residents and staff within care home settings, over and above the dispensing essential service. Provision of this service can enable the home to achieve: proper and effective ordering of drugs and appliances clinical and cost effective use of drugs and appliances safe storage, supply and administration of drugs and appliances proper record keeping in relation to medicines management compliance against national minimum standards on medication (as assessed by CSCI) Description of Enhanced Service: It is considered that the Advice to Care Homes SLA contains elements of assessment and support. Assessment: Undertaking an initial assessment of the systems for medicines management (ordering, storage, supply, administration and disposal) within the care home. Using the assessment to produce a tailored action plan of work required within the home. Support: Providing ongoing support and expertise to implement the action plan and ensure ongoing compliance. Service Aims: 1) To improve patient safety within the care home with a particular focus on the following areas: ordering, storage, administration and disposal of medicines and appliances and use of residents own medicines (prescribed and purchased). Advice to Care Homes SLA Page 1 of 15

2) To ensure the appropriate systems are in place for the ordering, storage, administration and disposal of medicines and appliances 3) To ensure that appropriate recording systems are in place and are used to monitor the ordering, storage, administration and disposal of medicines 4) To ensure that appropriate systems are in place to facilitate the sharing of information about the person s medicines when they move from one care environment to another 5) The Advice to Care Homes service will be commissioned as a local enhanced service for Care Homes with a minimum of 10 beds The PCT will consult with the LPC regarding selection of pharmacies to be included in the scheme, but reserves the right to make the final decisions on commissioning this service. RESPONSIBILITIES and ROLES Pharmacy undertakes to: Training 1 Provide evidence that the pharmacist providing the service has completed the CPPE learning pack Supporting Care Homes with Medication Management 2 Provide evidence that the pharmacist providing the service has completed the CPPE learning pack Clinical effectiveness and record keeping 3 Ensure that the pharmacist providing the service attends a formal PCT briefing session before carrying out the Advice to Care Homes service Service 4 Complete and return a signed SLA for EACH care home where the service will be provided (i.e. a separate SLA is required for each home) 5 Undertake an assessment of the systems for the management of, storage, supply and administration of medicines within the care home. It is anticipated that the assessment and action planning will take approximately 2 hours. 6 Use the PCT Assessment & Action Plan document (Appendix 1) to produce a tailored plan of work required within the home 7 Submit the assessment and the action plan to the PCT PRIOR to first support visit. 8 Send a copy of assessment and action plan to local CSCI Inspector. 9 Provide the care home with a signed/dated copy of the assessment & action plan. 10 Work with the care home to implement and effect the action plan. The action plan should document the progress made against individual actions. Entries, additions and amendments to the plan should be dated and initialled by the pharmacist. 11 Assess progress against the action plan through the year 12 Formally visit the home 4 times per annum 13 Keep a written record of the visit timings and content. The care home will be required to counter-sign the record 14 Be entirely responsible for security and other health and safety procedures required for the provision of this service Communication 15 Liaise with local inspectors from the Commission for Social Care Inspection (CSCI) and successor organisations in respect of medicines management within the home when inspections are carried out. www.csci.org.uk 16 Ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service. 17 Ensure that pharmacists and staff involved in the provision of the service, are aware of and operate within local protocols. 18 Give 3 months written notice if no longer wishing to provide the service Paperwork & claims 19 Submit claims for payment in a timely manner by the 5 th of month following a visit using the Payment Claim & Summary document (Appendix 2) NOTE. A copy of the assessment & action plan MUST be Advice to Care Homes SLA Page 2 of 15

submitted with the first claim and a copy of the front sheet MUST be submitted with the last (4 th ) claim. Payment will not be processed without submission of the appropriate document. 20 Maintain appropriate records to ensure effective ongoing service delivery and audit. eg Provision must be in place for continuation of service in the event of any change of pharmacist 21 Maintain a record of interventions and advice given during visits. Copies of any action plans agreed with the care home should be retained for review at future visits. 22 Advise the care home on the content of their medicines related policy documents, including the administration of medicines for acute conditions, use of homely remedies and procedures when there are alterations to residents medication regimens. 23 Send a copy of action plan and progress to local CSCI inspector PCT undertakes to: 1. Provide a standardised assessment tool for contractors to use. This will be the only assessment tool which can be used in providing the enhanced service 2. Provide a formal briefing session for pharmacists and/or contractors wishing to provide the service 3. Provide formal notification to contractors that service delivery can commence (following agreement on the action plan based on the assessment) 4. Provide a framework for the recording of service delivery information for the purposes of audit and the processing of payments 5. Effect prompt payment of the assessment & support fees via PPA which will appear as Advice to Care Homes Summary of Payments Available: Assessment visit (approx 2 hours) @ 40 p/h = 80 Support visit (approx 1 hour) x 3 per year @ 40 p/h = 120 p/a Audit arrangements: Assessment & Action plan (Appendix 1) Payment claim and summary document (Appendix 2 ) Submission of Claims information: Completed Claim Form must be returned to the PCT promptly, to arrive no later than the 5 th of month following a visit Method of Payment: PCT will authorise payment via PPA local electronic payments: Payments will appear as Advice to Care Homes Advice to Care Homes SLA Page 3 of 15

Acceptance of Advice to Care Homes SLA Name of Care Home Care Home Details Address of Care Home Phone number of Care Home Named Contact at Care Home Signature Date Pharmacy name Pharmacy Details Pharmacy address Phone number Fax number Name of pharmacist signing SLA RPSGB number Evidence of completion of CPPE Supporting Care Homes with Medication Management sent to PCT Evidence of completion of Clinical effectiveness and record keeping sent to PCT Signature Date PCT Name PCT address YES / NO YES / NO Phone number 01926 493491 Fax number 01926 495074 Name of person signing SLA Position in PCT Signature Date PCT Details Warwickshire Primary Care Trust Westgate House, Market Street Warwick, CV34 4DE Notes 1. The contractor agrees and undertakes to provide the Advice to Care Homes service per the SLA agreement 2. Please note that the PCT has the right to withdraw this Service Level agreement if the requirements are not being met, giving three months written notice. If the Pharmacy wishes to withdraw from the scheme, three month s written notice is required. 3. The PCT reserves the right to decide which services to commission, and from where. 4. A signed copy of this agreement will be kept by the Pharmacy, the Care Home and the PCT Advice to Care Homes SLA Page 4 of 15

Appendix 1 Care Home Medication Standards ASSESSMENT AND ACTION PLAN Date NB. Copy of whole document MUST be sent with first claim and copy of front sheet MUST be sent with last (4 th ) payment claim Name of Care Home Name of pharmacy Name of Care Home staff Name of pharmacist Signature of Care Home staff Signature of pharmacist Section 1 Section 2 Section 3 Section 4 Section 5 Medicines Management Storage Dispensed Medication Controlled Drugs MAR Charts Support visits: 1 st support visit due: Actual date Care Home signature Pharmacist signature 2 nd support visit due: Actual date Section 6 Self-Administration Section 7 Homely Remedy Policy Section 8 Disposal Care Home signature Pharmacist signature 3 rd support visit due: Actual date Care Home signature Pharmacist signature Advice to Care Homes SLA Page 5 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 1 : Medicines Management 1.1 Does the home have a medicines management policy? 1.2 Is ordering of medicine included within the policy? 1.3 Does the policy suggest the home see the prescriptions before they are dispensed? 1.4 Is administration of medicines included within the policy? 1.5 Does the administration policy cover a PRN medicines care plan for each individual patient? 1.6 Does the policy cover storage? 1.7 Does the policy cover key holders and key security? 1.8 Does the policy cover disposal of medicines? 1.9 Is there an up to date list of staff and their initials trained on this policy? 1.10 Date of last CSCI Inspection 1.11 Name & contact details of the local CSCI Inspector Advice to Care Homes SLA Page 6 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 2 : Storage 2.1 Are all medicines kept in suitable locked cupboards? 2.2 Where are the keys kept and are there spare keys available? (if so where?) N/A N/A 2.3 Is there an up-to-date list of keyholders and their signatures? 2.4 Is the drug trolley locked and attached to the wall? 2.5 Are there any stockpiles of medicines dressings or appliances (no more than 28 days supply should be present spot check the drugs cupboard) 2.6 Does it appear that stock is rotated? 2.7 Is there a separate fridge for medicinal items? 2.8 Does the policy cover fridge cleaning and defrosting? 2.9 Are there items in the fridge that shouldn t be? (give details) 2.10 Is the fridge locked? 2.11 Is there evidence that temperature is checked and recorded daily? (i.e., minimum/maximum temperature acceptable range 2 C to 8 C) 2.12 Are enteral feeds kept? Where? And are they stored at a suitable temperature? Advice to Care Homes SLA Page 7 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 3 : Dispensed Medication 3.1 Are all medicines labelled for individual patients? 3.2 Does it appear that residents share any medicines? 3.3 Are topical preparations labelled on the product and the packaging? 3.4 Are feeds labelled for individual patients? 3.5 Are fridge items clearly marked as such? 3.6 Are limited life products clearly marked with an expiry date? (i.e. marked with date opened?) 3.7 Is all stock that is in use, in date? 3.8 Are eye drops labelled appropriately? Advice to Care Homes SLA Page 8 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 4 : Controlled Drugs 4.1 Does the home have a controlled drugs policy? 4.2 Is there a separate controlled drugs cupboard fixed to the wall? 4.3 Is there a bound and page numbered controlled drugs book? If not how is the stock recorded? 4.4 Who checks in controlled drugs? N/A N/A Enter name and position 4.5 Who administers controlled drugs, and is this witnessed? N/A N/A Enter name and position 4.6 Are there any other drugs (i.e., Benzos or Z drugs) subject to these conditions under the home s policy? 4.7 Are all controlled drugs that are no longer required recorded in the register? 4.8 Is this documented and witnessed? Advice to Care Homes SLA Page 9 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 5 : MAR Charts - minimum sample of 5 5.1 Do all charts contain: Residents name and date of birth Care home address Name of GP Name of pharmacy/dispensing practice? Name of medication and dose Route and time of administration Start date Known allergies 5.2 How are residents identified (i.e., photo, room number, etc.) N/A N/A 5.3 Is every pharmacy item checked in to the home by a member of staff on delivery? 5.4 Is the checking-in process recorded on the MAR (or in a separate book/file)? 5.5 Are items that are discontinued recorded? 5.6 Are all boxes on the MAR chart filled in appropriately? (including omissions and refusals) 5.7 Is the use of topical preps, dressings, appliances, nebules, inhalers feeds and PRN medication always recorded on the MAR chart? 5.8 Are any doses initialled on the MAR as being administered, but they are still in the blister or box? (i.e., not given) 5.9 Is a written explanation given for missing doses/gaps on patients MAR? 5.10 For medicines with a variable dose, (e.g., 1 or 2 nocte), is the actual quantity of medicine that is given recorded on the MAR every time? 5.11 If homely remedies are used, is there administration recorded on the MAR chart? Advice to Care Homes SLA Page 10 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 6 : Self Administration 6.1 Does the home have a self-administration policy? 6.2 Does the policy cover the use of specific products? (ie Inhalers, Insulins) 6.3 Does the policy cover the need for resident s signature? 6.4 Does the policy cover reassessment dates? 6.5 Does the policy cover care home access to resident s medication? 6.6 Are the drugs stored in a locked cupboard or drawer in resident s room? 6.7 Do residents keep custody of keys, with masters being kept by staff member in charge? Section 7 : Homely Remedy Policy 7.1 Does the home have a homely remedy policy? 7.2 Does the policy include a list of medicines? 7.3 Does the policy cover doses given? 7.4 Does the policy cover GP consent for each patient? 7.4 Does the policy cover maximum length of treatment before contacting GP (48 hours)? Advice to Care Homes SLA Page 11 of 15

Indicator Assessment General comments and/or action required (enter compliant N/A if no action is required or the actions required to remedy the non-compliance) By whom By when Section 8 : Disposal 8.1 Are all recently discontinued or date-expired medicines identifiable, and kept separately in a suitable secure area? 8.2 Does the home have a suitable method of disposing of waste medicines? 8.3 Has a controlled waste transfer note been completed? (if appropriate - nursing homes only) 8.4 Are records kept of all medicines disposed of or returned (for any reason)? 8.5 Does documentation include quantity and description of medication? Enter name of contractor/pharmacy 8.6 Does documentation include name of resident? 8.7 Does documentation include reason discontinued/for disposal and date of transaction? Advice to Care Homes SLA Page 12 of 15

Appendix 2 Payment claim & summary document To be submitted by 5 th of month following visit Name of Care Home Date of visit Type of visit (please circle as appropriate) Initial Assessment Support visit 1 Support visit 2 Support visit 3 80 40 40 40 Attach complete Assessment & Action Plan Complete section below Complete section below Complete section below & attach front sheet of Assessment & Action Plan Doc ref Brief description of non-compliance Achieved Y/N Date Doc ref Brief description of non-compliance Achieved Y/N Date Name of pharmacist submitting claim (please print)..... Signed. RPSGB number... Date. Pharmacy Stamp or Name and Postal address Declaration 1. I hereby claim the stated monetary amounts. 2. I declare that information given on this form is true to the best of my knowledge 3. I understand that action maybe taken against me if I make an incorrect claim. 4. I consent to the disclosure of relevant information on this form for the purposes of fraud prevention, detection and investigation. Return this form to: Kate Butler, Medicines Management, Warwickshire PCT, Westgate House, Market Street, Warwick, CV34 4DE. Advice to Care Homes SLA Page 13 of 15

Appendix 3: National Minimum Standards on Medication Source: The Commission for Social Care Inspection (CSCI) report, Handled With Care? Managing medication for residents of care homes and children s homes- a follow up study. February 2006 Care Homes for Older People: Medication within the Home. Dept of Health 3 rd Edition 2006 ISBN 0 11 322607 1 OUTCOME Service users are protected by the home s policies and procedures for dealing with medicines and, where appropriate, are responsible for their own medication. 1. The registered person ensures that there is a policy and staff adhere to procedures, for the receipt, recording, storage, handling, administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 2. The service user, following assessment as able to self-administer medication, has a lockable space in which to store medication, to which suitably trained, designated care staff may have access with the service user s permission. 3. Records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. A record is maintained of current medication for each service user (including those self-administering). 4. Medicines in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971 and nursing staff abide by the UKCC Standards for the administration of medicines. 5. Controlled Drugs administered by staff are stored in a metal cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. 6. Medicines, including Controlled Drugs, for service users receiving nursing care, are administered by a medical practitioner or registered nurse. 7. In residential care homes, all medicines, including Controlled Drugs, (except those for selfadministration) are administered by designated and appropriately trained staff. The administration of Controlled Drugs is witnessed by another designated, appropriately trained member of staff. The training for care staff must be accredited and must include: a. basic knowledge of how medicines are used and how to recognise and deal with problems in use b. the principles behind all aspects of the home s policy on medicines handling and records 8. Receipt, administration and disposal of Controlled Drugs are recorded in a Controlled Drugs register 9. The registered manager seeks information and advice from a pharmacist regarding medicines policies within the home and medicines dispensed for individuals in the home 10. Staff monitor the condition of the service user on medication and call in the GP if staff are concerned about any change in condition that may be a result of medication, and prompt the review of medication on a regular basis 11. When a service user dies, medicines should be retained for a period of seven days in case there is a coroner s inquest. Legal and other requirements on care homes Care homes in England must register with CSCI and are legally required to conduct their business in accordance with the Care Homes Regulations 2001.4 Care homes have a legal obligation to look after the medication of the people for whom they care. Alongside the regulations, national minimum standards (NMS) are published by the Department of Health for care homes. Although these standards are not legally enforceable, they do set out achievable outcomes for people using these services and therefore identify what care providers need to do in order to meet their legal obligations. The standards address issues of: Privacy and dignity; Residents choice and control over their own lives; How cultural and social, spiritual and educational needs are met; Health and well-being; Advice to Care Homes SLA Page 14 of 15

The quality of the physical environment; and Protection from harm and abuse physical, emotional, financial or sexual Medication is included in the group of standards concerned with the health and personal care of adult residents, and those concerned with the quality of care of children in care homes. The importance of standards on the management of medication in homes The standards on medication provide a baseline for assessing the management of medicines in care homes for older people and younger adults, and in children s homes. Homes bear day-to-day responsibility for the care of their residents, many of whom have complex physical and mental health needs. Where adults and children need medicines, they differ in the degree to which they are able to manage the administration of medicines themselves. Some residents may be fully self-sufficient while others may be wholly reliant on the support of care workers in the home. In many cases they may be vulnerable to the risk of mistakes being made and at worst, some may be in danger of abuse through the willful mal-administration of medication. All homes are therefore expected to manage the administration, storage and disposal of medication appropriately with the precise requirements varying in detail according to the type of home and the capacity of the individual concerned. Advice to Care Homes SLA Page 15 of 15