Quality Use of Medicines in

1
Quality Use of Medicines in
Residential Aged Care Facilities
2
National Medicines Policy

• Medicine is defined as
• Prescription
• Non prescription
• Complementary
• Patient is the centre of the policy

3
Standards for QUM

• Pharmaceutical Society of Australia
• Structured process and part of RMMR service by
  the pharmacist

4
Quality use of Medicines

• Treatment should be considered and if medicine is
  used
• Medicines chosen wisely
• Medicines used at the lowest, effective dose
• Medicines stored safely
• Medicines administered safely
• Reflected in Standard 2.7

5
National Medicines Policy
6
Standard 2.7 also includes

• Incident reporting
• Medicine available by legible GP order
• Regular review of medicines

7
Resident Rights, Aged Care Act 1997

• Resident has the right to
• Give informed consent for any intervention
• Refuse medication
• Counselling if they require
• Privacy and confidentiality
• Use the pharmacy services their choice
• Have CMI

8
To ensure those rights

• The facility must ensure they have systems in
  place to
• Minimise the risk of medication misadventure
• Safely administer medicines
• Store medicines safely
• Quality use of medicines by staff and residents

9
Guidelines

• APAC guidelines Nov 2002 3rd edition Guidelines
  for medication management in residential aged
  care facilities
• NSW Health Policy on dealing with Challenging
  Behaviour
• All available to help staff, GPs, pharmacists
  and other health care professionals

10
Education of Staff

• Regular updating of staff with information about
  medications can be a useful way of creating a
  culture of better medicines use
• Topic examples
• Medications that cause incontinence
• Medications that affect central nervous system
• To crush or not to crush?
• Medicines that can add to falls risk
• Best practice for sleep

11
Medication Advisory Committee

• Policy making committee
• Staff, GPs, Pharmacists
• Meets every 3 months
• Creates a way to identify better practice and
  implement

12
QUM for staff

• Can you identify a quality improvement?
• Have you filled in an incident form lately?
• Are you observant?
• What do you do if a resident is found to be
  asleep every lunchtime?
• What do you do if you find tablets on then floor?
• Can you identify a resident for medication review?

13
Administering medication

• Identify resident
• Select correct blister pack
• Check medication chart
• Press blister contents directly into medication
  cup
• Assist resident to take medication if necessary
• Watch them take the medicine
• Sign administration chart
• Check for any other blister packs for resident

14
Safety issues

• Trolley locked
• Cupboard locked
• Check blister with med chart
• Remove out of date or unused medication
• Administer medications without interruption

15
Incident Forms

• These can lead to continuous quality improvement
• Help identify when problems occur
• Help identify why problems occur
• Help identify communication gaps.
• For example when a GP changes a medication, the
  pharmacy needs to be notified, if not an error
  will occur

16
Surveys on medicine use

• These can help improve Quality Use of Medicines
• Crushed medicines
• Psychotropic medicines
• Benzodiazepine use
• PRN meds
• Medicines without a documented diagnosis
• There are many other surveys that can help QUM

17
PRN Meds in High Care

• Label needs to indicate how often it can be used
• Who decides?
• What are the triggers for providing the PRN meds?
• Documentation
• Med chart to show it has been given/date
• Notes to indicate why

18
PRN Medicine Low Care

• It is to be administered on resident requests
• Record dose given
• Record in care notes