Spotlight on medications in new standards

Quality use of medicines is a key feature of the strengthened standards that home care providers need to be across, writes Natalie Soulsby.

Medication management has a far-reaching impact on all our consumers. Clearly the higher the package the more likely there will be a need for medication support for that individual.

The residential aged care sector has access to credentialled pharmacists as part of a government-funded program where they receive Quality Use of Medicines services. This concept is new for community care but is an important part of the expectations of the strengthened standards.

In the first article in this series, we looked at the implications of Standard 5 Clinical Care for home care providers and delved into Standard 5.1 Clinical governance. Here we take a closer look at Standard 5.3 Safe and quality use of medicines. Below is a summary of the actions and expectations that providers will be expected to implement.

Medicines-related information

You should have medicines-related information available to ensure a deeper understanding of the medications prescribed for your consumers.

For this to be available, you’ll need access to appropriate medication information sources. This could be via a subscription, such as to eMIMS, or a medication management app if the consumer is registered with one.

Transitions of care

Dr Natalie Soulsby

You’ll need access to consumers’ up-to-date medicines lists and other supporting information at transitions of care.

Transitions of care are instances where our consumers are at their most vulnerable. This is especially true if there have been changes to their medications as this information may not be communicated with their general practitioner in a timely manner. There can also be confusion from consumers about those changes.

Assessment for safe administration

You’ll need to conduct an assessment for safe administration of medications such as swallowing ability, suitability of crushing medicines and using alternative formulations.

This is important from a risk mitigation perspective, and you’ll need a robust process in place. If the consumer is unable to swallow their medications, discuss this with their local community pharmacist or a credentialled pharmacist who can provide a home medicines review, suggest suitable alternatives and make those recommendations to the GP.

Timely access to new medicines

When a new medicine is prescribed or there is an urgent change to medications, you’ll need to ensure there is timely access to these.

This is more likely to affect residents in aged care. However, for those consumers who are reliant on carers for their medications it is important to have processes in place to ensure that the prescription is sent to their community pharmacy in a timely manner and that it can be collected for them or delivered to them.

Documentation

You’ll need to ensure a current, accurate and reliable record of all medicines is documented and that the clinical reasons for the treatment are stated, including PRN medicines. Key things to consider:

  • in the community setting the medication list provided by the GP cannot be relied upon as it will not include any over-the-counter medications bought by the consumer and is not always up to date
  • if the consumer is using a dose administration aid, then this can be used to initially record their medications
  • there are apps available for consumers to use where all medications can be recorded – but it is reliant on them to keep the list up to date
  • to ensure that an accurate medication list is available a Home Medicines Review by a credentialled pharmacist is recommended for all participants receiving medication management support as part of their package.

Remote prescribing

You should support remote access for prescribing. This is helpful for those consumers who are unable to visit their GP. However, this may be difficult to enable due to the current restrictions for telehealth services.

Acute illnesses

You should review, plan and make changes to medicines for the older person when they are acutely unwell. For those people who have, for example, diabetes, asthma, COPD or heart failure, ensure they have sick day or action plans in place and carers are aware of what must happen during these times.

Medication reviews

You should ensure medication reviews are conducted as necessary. Triggers for a Home Medicines Review include when:

  • care commences, transitions from one setting to another, and annually when care is ongoing 
  • there is a change in diagnosis or deterioration in behaviour, cognition or mental or physical condition
  • there is polypharmacy and the potential to deprescribe
  • a new medicine is commenced, or a change is made to an existing medicine or to the medication management plan
  • there is an adverse event potentially related to medicines.

Allergies and vaccinations

Ensure allergies, adverse events to medications and vaccination status are documented. This information would be included in the GP handover letter and if an HMR has been conducted. Vaccination status is available on a consumer’s My Health Record.

High-risk medicines

You should be able to identify, monitor and mitigate risks related to the use of high-risk medicines, including reducing the inappropriate use of psychotropic medicines. To support this, educate your staff on which medications are considered high risk and ensure your policies include what steps need to be taken to advocate for changes in prescribing of these medications.

Adverse events

Report adverse medicine and vaccine events to the Therapeutic Goods Administration.

The TGA monitors adverse events, such as side effects, related to medicines and vaccines to safeguard and enhance the health of the Australian community. Unfortunately, it is not possible to know all potential adverse events of a medicine or vaccine before it is approved for use.

Reporting these events for a particular medicine or vaccine helps to monitor the safety of those products. Understanding and identifying these events will allow for appropriate reporting to occur.

Effective systems

Regularly review and improve the effectiveness of your system for the safe and quality use of medicines. Connecting with an expert can give you invaluable support for all things medication management.

Natalie Soulsby is head of clinical excellence at Embedded Health Solutions

Follow Community Care Review on Facebook, Twitter and LinkedIn and sign up to our newsletter.

Tags: Aged Care Quality Standards, clinical care, medication management, Natalie Soulsby, safe and quality use of medicines, strengthened quality standards,

Leave a Reply

Your email address will not be published. Required fields are marked *