Medication management: Commonwealth Aged Care Accreditation achieving - PowerPoint PPT Presentation

Outline Medication management: Commonwealth Aged Care Accreditation achieving accreditation Standards • Achieving Standard 2.7 – Managing Medications Safely and Correctly S HANE J ACKSON • 2012 Principles for Medication Management in Residential Aged Care Facilities C ONSULTANT P HARMACY S ERVICES Experts in medicines 2 Aged Care Accreditation Standards 2. Health and personal care • 2.3 Education and staff development 1. Management systems, staffing Management and staff have appropriate 2. Health and personal care and organisational development knowledge and skills to perform their roles effectively. Accreditation Standards 3. Resident lifestyle 4. Physical environment and safe systems 3 4

Educational modules Aged Care Standards • 2.7 Medication management – Residents medication is managed safely and correctly 5 6 2.7 Medication management 2.7 Medication management Results • Right resident, right Processes • Interviews with at least 10% • • Management demonstrates residents’ – – Are policies and procedures of residents/representatives medication, right dose, medication is managed safely and documented and made available correctly. right route at the right • Minimum 10% of to staff? Management can demonstrate staff – time. medication records and care – How are staff practices compliance with the medication management system. developed and monitored to plans – Looking at home processes Management can demonstrate the ensure understanding and – medication management system is safe, • Minimum 10% of • Residents individual needs compliance with processes and according to relevant legislation, procedures? For example, are medication incident forms • Staff skill levels regulatory requirements, professional quality assurance audits standards and guidelines. • Ordering procedure conducted and reviewed, and Residents/representatives confirm they – • Storage does supervision of staff occur are satisfied that medication is managed safely and correctly. including in relation to the use of • Administration assessment tools, equipment, • Incident reports and methods of managing medication? 7 8

Specifics 2.7 Medication management • How does the home allergies • each resident’s cognitive ability • ensure regular each resident’s pain management • evaluation and review needs of residents’ medication each resident’s swallowing and • other physical abilities needs and preferences medication side effects including as undertaken by a • polypharmacy effects pharmacist or medical monitoring of doses which may • officer? For example, need to be regularly adjusted (for example, psychotropic does this include medications, warfarin and consideration of: insulin)? 9 10 2.7 Medication management 2.7 Medication management • Are medication side Is there proper recording and • Does the storage of Does administration of medications • • to residents by staff include: ordering of medication orders? medication include: effects reported to the the correct identification of residents For example, are: – – a level of security of medications administration record entries which do not resident’s medical – orders reviewed for • contain alterations or erasure of drugs appropriate for the medication appropriateness officer? For example, of dependence (as prohibited by law) and circumstances – documented methods of alteration and – orders current, legible, signed – refrigeration of medications as are staff aware of • administration and any equipment used to appropriate and dated, with the dose and alter medication (for example, for the follow ‐ up actions and crushing of the medication) time prescribed – dating of opened medications as ensuring residents receive the correct – appropriate (creams, ointments, protocols as a result of medications ordered using a medication, in the correct dose via the • etc) correct route and at the correct time secure communication system adverse drug reactions – correct and safe storage of assessment of the skills and knowledge of – urgent and out ‐ of ‐ hours orders • all staff administering medications medications for residents who and adverse pathology catered for? administering of medication in a manner – self ‐ administer? which promotes residents’ rights? results? 11 12

2.7 Medication management 2.7 Medication management Does self ‐ administration of Do nurse ‐ initiated medications How does the home ensure regular Does the home respond to actual • • • • evaluation and review of the medication medications by residents and PRN medications include or potential adverse drug events, management system including: include: indications of: significant adverse drugs processes for reviewing residents’ – reactions, and medication errors? – assessment of the resident’s – reason for administration medications (including the use of PRN, ability to self ‐ administer psychotropic medications, drug For example, how does the home – maximum dosages interactions, and the use of nurse ‐ initiated – education for the resident to ensure medication incidents are – route of administration and any medications as appropriate) self ‐ administer in a safe and other administration documented, reported and regular review/use of multidisciplinary – correct manner instructions teams where possible appropriately addressed? medication ordering processes, including – regular monitoring of the – – authorisations by each How does the home ensure emergency supplies • resident self ‐ administering resident’s doctor? correctness of medications against appropriate disposal of – – consultation with medication records and orders medications including that of residents/representatives and medication administration processes – ceased, contaminated, damaged others (medical officers and including for residents who self ‐ administer health professionals) about the and out ‐ of ‐ date medications? monitoring of the effectiveness and – appropriateness of assessment tools? self ‐ administration? 13 14 Links to other standards Links to other standards • Expected outcome 1.7 Inventory and equipment Expected outcome 2.2 Regulatory compliance There are various • Problems with the ordering, storage and disposal of state and territory laws and guidelines which govern medication management practices. While assessors do not assess compliance medications may indicate gaps in expected outcome with such requirements, the home should be able to demonstrate 1.7 Inventory and equipment. how its processes are in accordance with relevant protocols and are • Expected outcome 2.1 Continuous improvement hence ‘correct’. Medication management data (which may include Other expected outcomes of Standard Two Various expected • prevalence of medication errors or use of outcomes relating to health and personal care may involve the psychotropic medications) may be used by the home administration of medication. Therefore, identification of gaps within these expected outcomes (for example, relating to pain to identify opportunities for improvement within the management, continence management, behavioural management home in relation to medication management and or sleep) may indicate subsequent gaps in the home’s systems linked expected outcomes. relating to medication management and vice versa. 15 16

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Guiding Principles of medication Principles management in RACFs 1. Medication Advisory Committee • Revised in 2012 2. Information Resources • 17 principles 3. Selection of Medicines 4. Complementary, alternative and non ‐ prescription medicines 5. Nurse ‐ initiated medicines 6. Standing orders 7. Medication Charts 8. Medication review 22 21 Principles 9. Continuity of medicines supply 10.Emergency stock • Advise on legislation, standards and processes 11.Storage of medicines in medication management 12.Disposal of medicines • Advise on information and education needs 13.Self ‐ administration of medicines 14.Administration of medicines • Advise on clinical issues 15.Dose Administration Aids • Advise on policy and procedures 16.Alteration of dose forms • Advise on evaluation and review of practices 17.Evaluation of medication management in the facility Terms of reference and agendas available in the new document 23 24

• Australian Medicines • RMMR Handbook • DUE • MIMS 25 26 27 28

30 29 • RMMR – Needs to be a process 31 32

• Refrigeration • Regular assessment and review • Storage in DAA • Cytotoxics • Trolleys, cupboards etc. • Stock control and rotation 33 34 Self ‐ administration • A patient may choose to administer their own medication following an assessment by a medical practitioner that medication administration can be safely carried out by that individual. Documentation by the medical practitioner that the patient is to self ‐ administer medications should be made on the patient ’ s medication chart, care notes or health record. • Policy – form of competency assessment for self medication; – monitoring and documentation; – frequency of re ‐ assessment of competency; – possible forms of assistance which will be made available; – communication with prescriber and resident; and storage guidelines 35 36

Medication management: achieving accreditation S HANE J ACKSON C ONSULTANT P HARMACY S ERVICES Experts in medicines 37