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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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People should be given the medicines they need when they need them, and in a safe way (outcome 9)

Meeting this standard

We checked that people who use this service

  • Will have their medicines at the times they need them, and in a safe way.
  • Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf.

How this check was done

Our judgement

People who use services have personalised care through the effective use of medicines.

User experience

The patients we spoke with on a medical ward told us staff provided them with information about their medicines, including their effects and side effects. They confirmed they received their medicines when they needed them and they felt their pain was well controlled.

We spoke with one patient who told us he was well supported to self-administer his medicines; a nurse had spent half an hour discussing his medicines and his safety when administering them himself. He kept his medicines in a lockable drawer in the bed-side locker, and he described keeping the key safe. We saw the pharmacist discuss with him his supply of medicines to ensure he had sufficient to take home.

The trust shared with us the results of outpatient surveys from January to March 2011: around a third of patients who had been prescribed new medication at the hospital said they were not told about its side effects. These results were not reflected in the trust findings from CQC’s Survey of Adult Inpatients in the NHS (April 2011).

Other evidence

We visited a medical ward and saw there were systems in place to ensure that each patient had the opportunity to discuss any issues with their medicines. The ward pharmacist told us she spends time with each patient discussing their individual needs and support when taking medicines. She told us that people have a choice regarding their medicines and their wishes and cultural requirements are accommodated wherever possible, for example vegetarians who do not wish to have gelatine capsules, or people who fast during religious festivals. These issues are included on the medicine record sheet to ensure they are always considered when prescribing.

We looked at records that documented how staff made sure people were properly assessed for their safety with administering their own medicines. Risks were reviewed each day to ensure that any changes in a person’s condition were considered. We spoke with three patients who all confirmed that nursing staff and the pharmacist had spent time with them discussing any support they needed to self administer medicines where they were able.

The pharmacist explained how she monitors medicines prescribing and provides guidance on the effect of medicines to reduce the risk of any adverse reactions. We spoke with four staff about adverse events relating to medicines and they were all able to describe how to report such events and how lessons learnt are fed back to them so that the risk of it happening again is reduced.

We saw that medicines were stored securely in lockable cabinets and trolleys. We looked at records of controlled drugs (prescription medicines that are controlled under the Misuse of Drugs legislation) and saw they provided a clear audit trail of receipt and administration, complying with the relevant legislation. We saw the pharmacist checking people’s medicine supplies and discussing with them the security of the medicines. We checked the number of controlled medicines in the minor injuries unit, which demonstrated accurate recording and twice daily audits. We saw records that showed medicines which required cold storage were monitored by staff twice a day to ensure they were being stored at the correct temperature.

We looked at the arrangements in three clinical areas and saw that medicines required for resuscitation and other medical emergencies were accessible to staff and kept in tamper proof packaging that allowed them to be used as quickly as possible.

We spoke with four staff who all confirmed that they had received medicine competency training at the start of their employment. They all confirmed receiving mandatory updates in medicine administration and said they felt competent to undertake their role. We saw medicines being handled and administered properly to reduce any risk of mistakes. We looked at the medicine records of 3 people and saw that staff recorded when medicines were administered and taken by the person using the service as part of their plan of care. We saw how the pharmacist produces a printed document that people take home with them, it gave clear information on the type of medicine they were taking, how often and what it was used for.

We asked staff about access to evidence-based and good practice guidance published by appropriate professional bodies and alerts about medicines management. They told us they have electronic access to a range of guidance provided by the trust. They also receive a regular newsletter which is produced to keep staff up to date with any new guidance and changes in hospital policy. They told us the hospital lead for controlled medicines is available for advice and provides them with relevant information.

Current legislation requires every hospital to appoint an accountable officer who takes organisational responsibility for controlled drugs, and each primary care trust (PCT) to establish a local intelligence network (LIN) comprising accountable officers from local NHS and independent healthcare organisations, along with reg