Medication Management in Aged Care – Victoria

 Carer, Medication, Registered Nurse  Comments Off on Medication Management in Aged Care – Victoria
Feb 042016
 

To ensure that you have currency of information in respect to the legislation about medication management in aged care, it is useful to access the health.vic website where the Victorian State Government has developed a hub for health services.
The site provides a wealth of information as well as clearly details a number of medicine management areas including nursing roles and responsibilities, medication delegation and supervision, storage and security of medicines and procedural practices related to different drug schedules.
If you access the web page https://www2.health.vic.gov.au/public-health/drugs-and-poisons/medication-management-in-aged-care this information is available for your reading and review. The site also provides a resource kit that was developed specifically to support residential aged care homes in meeting their medication management requirements.

If you are seeking information in relation to specific medicine schedules, maybe advice about how they are classified in relation to the Drug, Poisons and Controlled Substances legislation, then I would suggest exploring the information detailed at https://www2.health.vic.gov.au/public-health/drugs-and-poisons/scheduled%20medicines
Remember, overall the classification of medicines and poisons into schedules is the responsibility of Therapeutics Goods Administration (better known as TGA) which is a strategic part of the Australian Government, Department of Health. Using the The Poisons Standard or SUSMP (Standard for the Uniform Scheduling of Medicines and Poisons) decisions are be made in respect to the classification of medicines and poisons. Strategic inclusion in these decisions are the safe use and storage of medicines, preventing overuse and abuse of medicines and related poisons, as well as overall supporting and maintaining the health and wellbeing of the individual and the community.
Through The Poisons Standard being a national legislative document, consistency in relation to the classifications of medicines and poisons is provided across all Australian States and Territories. In turn this also supports the directives and instruction that must be followed in relation to prescribing, dispensing and administration as detailed by relevant State and Territory legislation in their respective documents.
To learn more about the scheduling of medicines and/or The Poisons Standard go to https://www.tga.gov.au/publication/poisons-standard-susmp

Reducing Interruptions during the Medication Round

 Carer, Medication, Registered Nurse  Comments Off on Reducing Interruptions during the Medication Round
Jun 042015
 

ArArticle_NPSe interruptions during the medication round an issue in your aged care home? When a medication round is occurring, what risks do interruptions pose and how can they reduce the safety of medicine administration?

Interruptions to nurses have been implicated as a source of error during a number of stages within the medication process, especially the preparation and administration of medications. Interventions designed to reduce these interruptions have included wearing of specific aprons by staff administering the medications requesting quiet and not to be interrupted, as well as ‘no interruption zones’ for the preparation of medication. But do these strategies work? Do they result in other issues?

Interesting in one study the vest requesting quiet and do not disturb was shown to also be interpreted to the resident to whom the medicines were administered and consequently impacted greatly on conversation and communication with the resident in accordance to their needs and preferences. It also demonstrated that as these vests were often bright colours they quickly drew the attention of visitors to the staff administering medications and consequently saw them being sought out to discuss their questions or concerns.

The article also asks the question are interruptions the issue or is it distractions and other sources of stimulation in the surrounding environment the issue and consequently impacts on medicine administration safety?

Explore the impact of medication interruptions in the following article Interventions to reduce interruptions during medication preparation and administration by the Australian Commission on Safety and Quality in Healthcare (ACSQH), by downloading the pdf file here.

Medicine Management – Medicines and Behaviours

 

Residents requiring residential aged care often have a variety of medical conditions that result in impaired cognition as well as a variety of behaviour management needs. Sometimes this requires specific medicines to be administered as part of their ongoing care and clinical management. These medicines can include antipsychotic drugs and benzodiazepine medicines, all of which necessitate close observation and monitoring of the resident as well as specialised clinical management. This workshop not only explores the needs of the resident who has impaired cognition but also the specific medicines, clinical care and required management practices in relation to this area of nursing care.
A medicine validation activity is used in this area of the workshop to explore specifically the use of antipsychotic (risperidone) and benzodiazepine (temazepam) medicines. The activity consists of reviewing current medication administration practices to best practice recommendations for each of these medicine groups. This provides nurses with insight in relation to the correct administration practices and also clinical points regarding ongoing monitoring and evaluation of care for the residents taking these medications. Other clinical area that are included in these discussions are behaviour management, chemical restraint, falls prevention and assessment practices.

Key topics include:
– The Registered Nurse and Enrolled Nurses role and responsibilities related to medicines
– Medication legislation, regulatory requirements and professional guidelines, including exploring recent changes.
– Understanding of medication management, supervision and delegation.
A focus on behaviour medicines, in particular:
– Different types of behaviour medicines – antipsychotic drugs and benzodiazepine medicines
– PRN medications, short term drugs, and variable drug doses used in the management of behaviour and related medical conditions
– Monitoring and evaluation of medicine outcomes.
– Medicine administration practices for different behaviour medicine forms.
– Specific needs of the resident with cognitive impairment.
– Management of issues and contingencies that arise during medication administration.
Competency Assessment:
– Completion of a written learning review workbook.
– Practical competency assessment of specific medicine administration practices.
– Completion of related case studies and related scenarios.

Medicine Management – Care of the resident with diabetes

 

Residents in residential aged care often have a variety of medical conditions that require specific care planning, monitoring and observation. Diabetes, either type 1 or type 2, is one such condition and often the treatment of this health condition requires related medication treatment including oral hypoglycaemic drugs and / or insulin administration via subcutaneous injection. Nurses must be competent in these related medicine administration practices as well as understand the specific care practices required for this medicine administration including ongoing assessment and evaluation of medicine outcomes, care practices and related management plans.
A medicine validation activity is included in this workshop and used to explore specifically the administration of oral hypoglycaemic medicine, common prescribed medicine types and their actions as well as subcutaneous injection practices related to the administration insulin and use of an insulin pen. The activity consists of reviewing current medication administration practices to best practice recommendations for each of these medicine groups and administration routes. This provides nurses with insight in relation to the correct administration practices and also clinical points regarding ongoing monitoring and evaluation of care for the residents with diabetes and requiring these medications. Other clinical area that are included in these discussions are BGL assessment and monitoring, related urine testing assessment practices and care of the sick resident with diabetes.

Key topics include:
– The Registered Nurse and Enrolled Nurses role and responsibilities related to medicines
– Medication legislation, regulatory requirements and professional guidelines, including exploring recent changes.
– Understanding of medication management, supervision and delegation.
– Care of the resident with diabetes
– Management of hypoglycaemia and hyperglycaemia
A focus on hypoglycaemic medicines, in particular:
– Different types of hypoglycaemic medicines – insulin/ subcutaneous injection and oral hypoglycaemic drugs
– PRN medications – insulin sliding scales used in the management of diabetes and hypoglycaemia
– Monitoring and evaluation of hypoglycaemic medicine outcomes.
– Medicine administration practices for different related medicine forms.
– Specific needs of the resident with diabetes.
– Management of issues and contingencies that arise during medication administration.
Competency Assessment:
– Completion of a written learning review workbook.
– Practical competency assessment of specific medicine administration practices, including subcutaneous medicine administration and the use of insulin pens.
– Completion of related case studies and related scenarios.
– Medicine calculations related insulin and sliding scale medicines

S8 Medication Management

 

The workshop is designed to further develop and challenge the medication knowledge and skills of Registered Nurse and Enrolled Nurse in relation to the medicine management and administration of S8 medicines. The workshop will include an update in relation to the appropriate legal and regulatory requirements pertaining to S8 medications and closely examine the specific responsibilities of the nurse in relation to medication administration and reporting.
A practical competency assessment of S8 medication administration practices is completed through simulation scenarios allowing for the reflection and observation of skills pertaining to the management of a range of contingencies that may arise in relation to S8 medicines. This includes S8 medicine refusal, S8 medicine receival of stock, S8 medicine disposal destruction, and documentation practices (including correction of written errors) in the S8 register. The practical assessment is intended to review both the individual’s understanding and practical skills of medication administration.

Key topics include:
– The Registered Nurse and Enrolled Nurses role and responsibilities related to different medicine schedules, in particular S8 medicines
– Medication legislation, regulatory requirements and professional guidelines related to S8 medicines, including exploring recent changes as relevant to this area.
– Understanding of medication management, supervision and delegation in relation to S8 medicines.
– Medicine schedules and their meanings

A focus on S8 medicine management and related practices, would include:
– Different types of S8 medicines
– Different S8 medicine prescribed orders including PRN medications, short term drugs, and variable drug doses
– S8 drug register recording and reporting requirements
– S8 medicine safety and security including monitoring of stock and related storage areas
– Monitoring and evaluation of S8 medicine outcomes.
– Medicine administration practices for different S8 medicines and drug forms.
– Specific needs of the resident requiring S8 medicines.
– Management of issues and contingencies that arise related to S8 medicines.

Competency Assessment:
– Completion of a written learning review workbook.
– Practical competency assessment of specific S8 medicine administration practices.
– Completion of related case studies and related scenarios.

Medicine Management – Pain management

 

This education workshop is designed to promote an understanding of pain management and the related medicine and no medicine management strategies that are used in the clinical management of this symptoms and related health conditions which are associated with it. In order to ensure appropriate pain management and quality of life outcomes for the resident learning in this workshop includes areas pertaining to appropriate clinical assessment, medicine related treatments, available non medicine care strategies and ongoing monitoring and evaluation practices.
A medicine validation activity is included in this workshop to explore specifically the use of analgesia medicines including different schedules of medicines within this group of drugs and routes of administration. The activity consists of reviewing current medication administration practices to best practice recommendations for different analgesia medicines and routes of administration. This provides nurses with insight in relation to the correct administration practices and also clinical points regarding ongoing monitoring and evaluation of care for the residents taking these medications. Other clinical area that are included in these discussions are pain management protocols, pain assessment and related resource tools, and related analgesia side effects including constipation and the risk of falls.

Key topics include:
– The Registered Nurse and Enrolled Nurses role and responsibilities related to medicines
– Medication legislation, regulatory requirements and professional guidelines, including exploring recent changes.
– Understanding of medication management, supervision and delegation.
– Understanding of pain and its different types, routes and schedule

A focus on analgesics and pain management, in particular:
– Different types of analgesia medicines
– Pain medicines prescribed as PRN medications
– S8 pain medicines
– Monitoring and evaluation of medicine outcomes.
– Medicine administration practices for different pain medicine forms.
– Specific needs of the resident requiring pain management and related health conditions.
– Management of issues and contingencies that arise during medication administration of analgesics.

Competency Assessment:
– Completion of a written learning review workbook.
– Practical competency assessment of specific medicine administration practices including administration of medicines via injection.
– Completion of related case studies and related scenarios.

Making Risky Business Safe

 

While medications contribute significantly to the health and well-being of an individual, they also have a potential to cause harm if not stored, checked, and administered safely. This training session explores the required safe practices related to each of these areas, to ensure medicines provided to the older person accomplishes the outcomes for which they were prescribed. Fundamental to safe medication administration is also recognising the responsibility of each member of the professional team involved with medicines and ensuring that appropriate communication occurs, especially when changes in the resident are observed or issues arise. In line with the organisation’s policy and procedures, the required documentation and reporting requirements are explored and practiced through different case studies incorporated within the education workshop.
Understanding the different ways medicine require to be administered as well as reviewing current individual practices to ensure that they are reflective of best practice is a key area of this education. In this area of the training the appropriate storage, security and expiry of medications are also discussed and reviewed.
Medication charts and associated documentation processes are looked at within this education including understanding of the medicine care plan and related documented information on medicine charts pertaining to medicine allergies and side effects and administration requirements.

Key topics include:
– The scope of practice of personal care workers in the administration of medications
– The roles and responsibilities responsibility of other members of the professional team involved with medicines.
– Ways to ensure safe and appropriate medication administration in aged care, including reading of medicine orders and chart areas to ensure understanding of required practices.
– How to safely administer medicines to a resident with a swallowing issue, including the risks associated with crushing medications.
– Infection control practices related to medication administration, including related cleaning practices and maintaining of medicine stocks in the medication trolley.
– Different modes of medication administration and how to safely administer these medicines in accordance with best practice.

Competency Assessment:
Included in this training is a range of competency assessment activities to assess both currency of skill and knowledge of the medicines as well as associated administration practices.
This includes:
– Completion of a written learning review workbook.
– Practical competency assessment of medicine administration, including from a DAA and for different medicine forms.
– Completion of case studies that require management of different medicine issues and resident needs and preferences.

Medication Audit Tools and Resources

 

Medication audit tools are used to review and identify areas for improvement within the operational medication system within the aged care facility. They are an integral part of the quality system within the home and serve to ensure that medication systems are not only safe but adhere to required legislative and regulatory requirements, professional guidelines and reflect evidence based practice.
Below are two audit tools available for your use within your aged care home.

Audit Tool (1) – Medication Management
ThDoHA_Guiding_Prinicplese first tool is aligned to the Department of Health and Ageing 2012, Guiding Principles for medication management in residential aged care facilities, Commonwealth of Australia, Canberra, Australia – A copy may be downloaded via the download page link below

The Guiding Principles for medication management in aged residential aged care facilities is a publication designed to promote safe, quality use of medicines and appropriate medication management within the aged care home. The publication details 17 guiding principles that are reflective of evidence based practice and should be used to review and measure the safety, and performance of the medicine management processes operational within your facility. Each guideline also reflects relevant legislative and regulatory requirements, professional guidelines and aged care quality and accreditation standards and conditions.
After completing the audit tool, any identified areas requiring improvement should be actioned and appropriate staff education facilitated.

Free download Audit tool (1)

 

Audit Tool (2) – PRN Medication Management
This second tool is aligned to requirements for the management including administration of PRN medicines. PRN medicines are if required or needed medicines and clinical assessment and approval by the Registered Nurse is required prior to administration of these medicines by the Enrolled Nurse of Personal Care Assistant.
The audit tool will assist in evaluating the use of PRN medicines in your home as well as meeting of best practice guidelines and requirements. Assessment areas include not only PRN medicine administration but also follow up and evaluation of PRN medication use and reporting and recording requirements associated with the use of these medicines.
After completing the audit tool, any identified areas requiring improvement should be actioned and appropriate staff education facilitated.

Free download Audit tool (2)

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Please contact us for further information, purchasing and costs.

Medication Competency Assessment System

 

IMGP2837_Red-001Competency is an observable measure that demonstrates not only the ability to perform a skill to a required standard of practice but involves the consistent and committed application of knowledge to ensure repeated procedures are similarly to this expected level. In competency assessment appropriate evidence is collected upon which professional judgements are made that reflect the meeting of required standards of practice and knowledge levels. It is the assessor’s responsibility to collect this evidence and upon evaluation conclude whether the achievement of competency has been established.

Specific resources are needed to not only detail the expected standards of competency that are required but also to document and provide evidence in relation to the assessment undertaken and achieved outcome. The Medication Management Competency Assessment System is designed to meet the needs of Residential Aged Care Facilities in accordance with assessing the competency of staff aligned to medicine administration and management. The system has been developed in accordance with legislative and regulatory requirements as well as professional standards and guidelines, with appropriate references provided for further review and reflection.

Overview – Resources for Medication Competency Assessment
Pathways medication competency assessment system includes the following resources:

  • Competency Assessment Policy and procedure – these are the foundations for the competency assessment system and cover all competency practices within the organisation.
  • The medication competency assessment tools are made of three parts including:
    • Competency Standard (CS) – Presents an overview of the area of competence that is to be assessed, including the assessment environment and any related professional, legislative or statutory guidelines that need to be maintained.
    • Practical Competency Assessment Guidelines (CAG) – Detail the expected competency that is to be achieved throughout the assessment area, including the individual elements that must be met by the participant in order for a judgement of competence to be made. Guidelines are reflective of the required performance standards of relevant legislative and regulatory authorities, as well as organisation performance requirements.
    • Practical Competency Assessment Form (CAF) – This is the documentation on which individual recording and reporting of the competency assessment outcomes are documented by an Assessor.
  • For each of the medication competency assessment guidelines there is a library of competency assessment resources that provides suggested tools to assess the knowledge and attitude (commitment) to the elements contained within the assessment form. These include case studies and scenarios that can be easily completed in a mock setup in the workplace.
  • A range of competency assessment tools for specific modes of administration including injections. This enables performance management of staff following a medicine incident (involving a particular mode of medicine administration) or where staff were unfamiliar with some of the different medicine modes.
  • Learning Review Workbook Resources – These are used to assess the knowledge and understanding of related competency areas as well as evaluate skills in accordance with a range of scenarios and different settings. Different assessment methodologies are used in the workbooks including multiple choice, true or false, case studies and short answer questions. Answer guides assist the assessor in reviewing and marking the learning review resources, as well as ensuring conformity across the organisation. These are available for Registered Nurses and Enrolled Nurses and a separate book for Personal Carers.

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Download the free Sample Handwash Competency here

 

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Download the Medication Competency assessment system – Table of Contents here

 

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Please contact us for further information, purchasing and costs.