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Care Homes News

Medicines Management Team

Edition: 12 | October 2020

In This Issue:

 New Bedfordshire, Luton, Milton Keynes CCGs (BLMK) Medicines Management website
 COVID-19 – Important guidance links for care homes
 Flu Immunisation Programme 2020/21 – Residents and Staff
 Emollients and risk of severe and fatal burns – New resources
 SMR – What is it?
 Thickeners – reminder

medicine-for-home-page

New Bedfordshire, Luton, Milton Keynes CCGs (BLMK) Medicines Management website

From the 1st April 2021, Bedfordshire CCG will be merging with Luton and Milton Keynes CCGs to become the newly created Bedfordshire, Luton and Milton Keynes CCGs, also known as BLMK CCG. The Medicines Management team for BLMK have launched its new website (link below).
BLMK Medicines Management – https://medicines.blmkccg.nhs.uk/
This website includes a link to the ‘Care Home’ page (purple box) which includes our care home guidance documents (e.g. Homely remedies toolkit, Covert administration guidance, ‘PRN’ guidance) and our care home newsletters.
This website is replacing the ‘GP Ref’ website which will cease to exist from November 2020.
Please visit the ‘Care Homes’ page as circled

COVID-19 – Important guidance links for care homes

We understand that these are challenging times for care homes and are conscious that you may be receiving a lot of information from various sources. For this reason we have produced links (below) to a few of the key guidance documents:
Coronovirus (COVID-19): admission and care of people in a care homes
British Geriatric Society – Guidance on managing the Covid-19 pandemic in care homes
COVID-19: infection prevention and control (IPC)
Coronavirus (COVID-19): getting tested
COVID-19: how to work safely in care homes
Coronavirus (COVID-19): looking after people who lack mental capacity
Coronavirus (COVID-19): adult social care action plan
Adult social care: our COVID-19 winter plan 2020 to 2021 – *new policy*

 

Flu Immunisation Programme 2020/21 – Residents and Staff

This year the national flu immunisation programme is more important than ever for our care home residents and the staff workforce who provide care and support to our most vulnerable adults.
With the potential risk of flu and COVID-19 co-circulating this winter, engagement of all health and social care staff in the flu immunisation programme is absolutely essential to protect vulnerable care home residents and support the health and resilience of our workforce in care homes.
The flu vaccination is free for health and care social workers employed by a registered residential care/nursing home or registered domiciliary care provider.
How to obtain flu immunisations for:
 Care Home Residents – across Bedfordshire this may vary as some care homes are using their aligned GP surgery to vaccinate their residents and other homes are using the ELFT nursing teams (e.g. District nurses or CCT nurses) to vaccinate residents.
 Staff – via GP surgery or local community pharmacy offering flu vaccination service
To gain access to your free flu vaccination via a surgery or pharmacy, we would advise staff to take some form of identification that includes your name and the name of your employer. This could be an ID badge, a letter from your employer or a recent payslip.
The National Capacity Tracker will be used to record and track the number of staff and residents who have had their flu vaccination. Please ensure this is completed regularly for your care home setting. There will also be weekly ‘check-ins’ conducted to identify any new residents who have not any had their vaccination.
We would encourage all care home staff to obtain their free flu vaccination as soon as possible. Thank you for your help and all your efforts ahead of the winter months.

Emollients and risk of severe and fatal burns: New resources

We would like to inform our care homes of the recent campaign and new resources to support the safe use of emollients.
There is a risk of severe and fatal burns with all emollients, whether they contain paraffin or not. Emollients can transfer from the skin onto clothing, bedding, dressings, and other fabric. Once there, they can dry onto the fabric and build up over time. In the presence of a naked flame, fabric with emollient dried on is easily ignited.
Although emollients are not flammable in themselves or when on the skin, when dried on to fabric they act as an accelerant, increasing the speed of ignition and intensity of the fire. This accelerant effect significantly reduces the time available to act to put out a clothing or bedding fire before serious and fatal burns are sustained
In July 2020, the Medicines and Healthcare products Regulatory Agency (MHRA) in partnership with the National Fire Chiefs Council, charities, and organisations from across health and social care launched a campaign to raise awareness of this important risk.
A toolkit of new resources (e.g. leaflets, posters, stickers) is now available to support the safe use of emollients (link below to access free resources). Please use these materials to inform residents, relatives and staff of the risks with emollient products.
https://www.gov.uk/guidance/safe-use-of-emollient-skin-creams-to-treat-dry-skin-conditions
Reference: Drug Safety Update. Emollients and risk of severe and fatal burns: new resources available. Aug 2020 https://www.gov.uk/drug-safety-update/emollients-and-risk-of-severe-and-fatal-burns-new-resources-available

SMR - What is it?

A SMR is a ‘Structured Medication Review’. A SMR is a critical examination of a person’s medicines with the objective of:
1. Reaching an agreement with the person about treatment
2. Optimising the impact of medicines
3. Minimising number of medication-related problems
4. Reducing waste
Primary Care Networks (PCNs) are a group of GP Practices. PCNs who have signed up to the 2020/21 Network Contract DES Specification are required to deliver SMRs and medicines optimisation for their patients.
Patients can be identified for a SMR in different ways, some examples below:
 Surgeries using electronic clinical search tools to find ‘high risk’ patients
 Self referral via patients or care home self referral (e.g. adverse drug reactions, not coping, poor compliance etc)
 Healthcare Professional referral (e.g. via GP, nurse etc)
Who would benefit from an SMR?
 People living in care homes
 Patients with complex and problematic polypharmacy, specifically those on 10 or more medications
 Patients taking medicines commonly associated with medication errors
 Patients with severe frailty, who are particularly isolated or housebound or who have had recent hospital admissions and/or falls.
 Patients using potentially addictive pain management medication.
Further prioritisation for a SMR may be needed in the following cases:
 Acute illness (including COVID-19) that may need changes to medicines
 Optimising medicines at end of life (e.g. prescribing & deprescribing)
 Recent discharge from hospital
 New care home residents: rapid clinical review (with the MDT if needed)
 Other at-risk groups (e.g. severely frail, kidney dysfunction, high risk medicines including insulin, anticoagulants, lithium, and falls risk)
 Unmonitored high-risk medicines
 High risk conditions in COVID-19 e.g. COPD
 Abnormal test results where medicines could be implicated
Who can do a SMR?
Only appropriately trained clinicians can undertake SMRs. This will primarily be Clinical Pharmacists, although suitably qualified Advanced Nurse Practitioners (ANPs), as well as GPs can also do them.
Our full SMR process for Pharmacists can be found in the care home folder on the BLMK website:
https://medicines.blmkccg.nhs.uk/guideline/structured-medication-reviews-smr-process-for-pharmacists-blmk/
Reference:
NHS England. Structured medication reviews and medicines optimisation. Sept 2017
https://www.england.nhs.uk/publication/structured-medication-reviews-and-medicines-optimisation/

Thickeners - reminder

Thickeners are used to thicken fluids for people with dysphagia (swallowing difficulties).
Thickeners should only be prescribed on the recommendation of a Speech and Language Therapist (SALT)
SALT will advise on how to thicken fluids as this will depend on the person’s degree of dysphagia, and desired consistency.
In a previous newsletter (Edition 4: July 2018) we included information of a Patient Safety Alert entitled ‘Resources to support safer modification of food and drink’. This alert highlighted a number of incidents involving thickeners, including two patient deaths. This led to the development of manufacturers of thickeners changing their labelling and instructions in line with the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. So previous descriptors for thickeners changed from ‘Stage’ to ‘Level’.
There are a various brands of thickeners available (e.g. Nutilis® Clear, Resource® ThickenUpTM Clear etc.). Nutilis® Clear is the first choice thickener used across Bedfordshire but we appreciate other local areas and hospital trusts may use other brands.
Important points:
 Please ensure you follow the directions as advised by SALT (e.g. ‘Level’ and ‘number of scoops’ to be used) – this can also be added to the pharmacy label and MAR chart as per prescription direction
 Please contact SALT if you have not been provided with appropriate directions for safe use
 A thickener must not be shared between residents in a care home, unless it is part of a ‘Bulk Prescribing’ scheme. Any ‘bulk prescribing’ requires an initial prescription to be produced for individual residents. Our ‘Bulk Prescribing’ protocol can be found on the new BLMK website care home page: Bulk Prescribing Protocol link
 Please ensure thickeners are stored safely and appropriately to minimise risk to residents. Whilst it is important that products remain accessible, all staff need to be aware of the potential risks to patient safety. Individual risk assessment and care planning is required to ensure that vulnerable people are identified and protected.
References:
 NHS England. Patient Safety alert: Resources to support safer modification of food and drink. June 2018.
https://www.england.nhs.uk/publication/patient-safety-alert-safer-modification-of-food-and-fluid/
 NHS England. Patient Safety alert: Risk of death from asphyxiation by accidental ingestion of fluid/food thickening
powder. Feb 2015 https://medicines.blmkccg.nhs.uk/guideline/protocol-for-bulk-prescribing-in-care-homes/

Care Homes Newsletter October 2020 PDF version:

 

Contact Us

If you would like to get in touch with us, please contact the Medicines Management Team:
bedccg.bedsmeds@nhs.net or 01525 624 375

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