The Care Quality Commission’s (CQC) recent State of Care report found a steady decrease in the number of residential care homes, while domiciliary agencies continue to grow and increase in number, a pattern of change that has been constant for the past five years and is expected to continue.
Providing care to people in their own homes can be complex, with a number of challenges and considerations, all posing a risk to the comfort and safety of patients. Medication management may be one of the most significant of these, meaning that, understandably, it is an area CQC places under extreme scrutiny during inspections.
With the huge potential consequences for patients, it is surprising to see so many reports of care providers being placed in special measures for inadequate administration of medication. In community care, with so many stakeholders across a number of locations, the risks to patient safety are heightened and could prove costly.
Taking time to monitor the number of medicines being taken, particularly by older people, is an important step to ensure you are managing clients’ medication correctly. Seen by most in the sector as the use of five or more medicines on a daily basis, polypharmacy can considerably increase the associated risks of individual drugs when combined with other treatments. By working closely with clients to monitor their reactions and any concerns about new medications, care providers can go some way to prevent any problems from going unnoticed.
For homecare providers, NICE guidelines highlight the need to ensure that workers spend enough time with the client to have a conversation. This is a vital opportunity for care workers to discuss the impact of medications, as well as any problems or side-effects. However, with some councils still commissioning care visits of 15 minutes, care workers are facing stringent time constraints.
As a result, this opportunity for conversation is often lost, and the chance of errors in the management of a client’s medication is increased. It is vital to ensure, where you can, that care workers are reporting any signs of side-effects or medication issues, so that problems can be identified and resolved.
Security of medication
Although care homes offer a more controlled environment than caring for someone in their home, in theory enabling better medication management, there are various factors that could breach regulations or risk patient wellbeing.
For example, care homes are more at risk of a failure to adequately store and dispose of all medicines. Depending on individual support needs, a number of different storage methods could be required, with some patients requiring easy access to take their own medication.
In these environments, extra precautions should be taken to ensure that medication that could cause harm is appropriately secured.
Training is essential
Well-trained staff are generally less likely to make mistakes, so ensuring that all involved in the administration of medication are fully-trained and competent is an essential starting point for care homes and homecare workers. Guidelines from NICE stipulate that service providers should be providing adequate induction training to new employees, continued learning and development, and an annual review of competencies of all staff involved in the medicine administration process.
Service providers should look to develop internal training programmes or work with an accredited external provider so that those managing the medication process are fully-trained and will be compliant if inspected by an external assessor.
Another advantage of an effective training programme is that well-trained staff have greater job satisfaction, so providers should see improved retention rates and reduced recruitment costs.
The issues with paper charts
Given that we know CQC, the Care Inspectorate and clinical commissioning groups place so much importance on medication records being accurate, legible and consistent, care providers failing to take adequate steps to ensure the highest level of client safety run the risk of action being taken against them, a negative CQC inspection result, or even being placed in special measures.
Paper Medication Administration Record (MAR) charts are still used by many care providers. These paper records are far from perfect in reducing the constraints of care workers. Maintaining accurate and legible records can be challenging when staff are left to scribble down notes and put information into small boxes and it can be extremely difficult to ensure that care workers record medication in a consistent way.
The biggest worry of all is that, with reduced time to spend with clients, the care worker forgets or doesn’t have a chance to record all of the relevant information on the MAR chart at all.
Gaps in communication between prescribers, care workers and administration staff is a problem that not only impacts on patient safety, but also on administration work and costs, particularly for homecare providers.
For example, if a prescription is changed, or a course of antibiotics is prescribed, in most cases the provider is responsible for ensuring that paper MAR charts are updated and replaced in the client’s home. If an up-to-date MAR chart is not available to care workers, they will not be able to give the person the correct medication or dose.
To tackle this, more providers are choosing to adopt digital eMAR systems. These automatically update computer-based systems with all the information the care worker inputs on a remote device (such as a smartphone), including any detailed notes.
Is eMAR the solution?
The aim of eMAR charts is that gaps in medication records are reduced or avoided completely. eMAR systems can also help to ensure that records are consistent, understandable and comprehensive. Care workers can use an app to view the correct dosage for each client and can see any additional medications that were or were not previously administered.
To go back to the antibiotics example, when using paper charts, these infrequent courses of medication can cause issues if records are not updated accurately. An eMAR system would alert the care worker that an additional drug should be given. The systems prompt care workers to log their actions, and back office staff are alerted to any missed medications, so problems can be investigated and resolved, meaning clients are less likely to miss their medication.
The ability for family members to view detailed information from care workers on a smartphone app is also beneficial. Most systems allow family to check that medication has been administered correctly, as well as access further notes about their loved one’s general health or happiness.
Additionally, by integrating digital technology, homecare providers can create more efficient scheduling for their staff. Information about the time at which each client requires their medication can be used to create adaptable schedules that then feed into the daily tasks for each care worker.
Concerns have been raised that, if medical information is required in an emergency, digital records could be inaccessible.
However, this could be overcome with the use of on-call staff who are able to access the eMAR charts. Paramedics, for example, could then still see detailed information about a patient when needed. This may prove to be safer than the use of paper charts, which could be inaccurate or difficult to read.
Compliant medication management
The impact of the CQC in improving standards of service quality cannot be understated, but there is still work to be done by providers to ensure that outstanding standards are retained and improved in the future.
To deliver outstanding, safe and sustainable care, more providers need to think beyond traditional practices. New technology has to be central to the strategy of providers moving forwards. The challenges of such a displaced service, particularly for managing medication, will not go away, so implementing new ideas and solutions into care services will be crucial.
Above all, the most effective method to ensure a successful and compliant medication process, for both domiciliary care providers and care homes, will be focused on an effective strategy, encompassing security, training, learning and development, up-to-date records and continued assessment.
Have you implemented an eMAR system in your business? How did it impact on your service? Or if you haven’t, what are your reasons for holding back? Share your opinions in the comments section below.