Care Homes News
Medicines Management Team
Edition: 8 | July 2019
In This Issue:
- Ordering Repeat Medication on-line in Care Homes
- NHS.net email and the use of faxes
- Medicines in health and adult social care (CQC Report)
- National Flu Immunisation Programme 2019/20 – care staff eligible
- Thick and Easy® (starch) thickener – important changes
- Urinary Tract Infections (UTIs) in care homes and Hydration
Ordering Repeat Medication on-line in Care Homes
Our care home team is supporting the roll out of on-line ordering of repeat medication in care home settings across Bedfordshire (this includes learning disability homes). This project has been led by Sharon Tansley (Senior Prescribing Support Technician) who has produced an information leaflet and flowchart which explains on-line ordering and the process (see attachments). This information is to support care home managers, staff, residents and their families should they wish to order regular repeat medication on-line. All GP surgeries across Bedfordshire are aware of and fully support this project and local pharmacies will also be notified.
Following a few simple steps as explained in the leaflet, this process would allow you to order repeat medication on-line (via SystmOne) directly from the GP surgeries website. All GP surgeries across Bedfordshire use the same clinical system called ‘SystmOne’ and this includes the patient online service called ‘SystmOnline’. Please note, you can only order medication that is on a ‘repeat prescription’, therefore this does not include any ’acute’ or ’one-off’ prescriptions for short term use (e.g. antibiotics).
Advantages of on-line ordering via SystmOne:
Movement to a seamless paperless system
An efficient system – reducing practice workload
Empowering care home staff to manage their resident’s medication
Improving access to medicines (ensuring residents do not miss medication due to inadequate
stock and they receive their medication on time)
May help to reduce errors and minimise medication waste
Improving the audit trail of repeat medication ordering, allowing prescriptions to be tracked.
If you have any questions or concerns regarding on-line ordering or if you need further support with the process, please contact either Sharon or Lindsey. Contact details can be found at the end of this newsletter.
NHS.net email and the use of faxes
You may recall in a previous newsletter we informed you of the ‘Digitisation in care homes’ project. One important part of this project is setting up a secure email for care homes and the use of NHS.net email. This will enable secure basic sharing of information to and from care homes, GP practices, acute settings. NHS mail is the only NHS approved method for exchanging patient data by email, but only if both the sender and recipient use an NHSmail account or an equivalent.
The continued growth of email and other electronic means of sharing data is leading towards a transition away from the use of faxes. Some GP practices are already discontinuing the use of fax machines and using NHS mail. This is following the Department of Health and Social Care (DHSC) announcing in December 2018 that NHS organisations and GP practices should have fax machines phased out by April 2020.
To be able to use NHS.net email and obtain an NHS.net email address the Level 1 Information Governance (IG) training must be completed. We continue to encourage care homes across Bedfordshire to work towards obtaining an NHS.net email account. For those care homes that already have NHS email accounts we would encourage the use of NHS.net for the safe transfer of any medical information for your residents.
Reference used: Use of fax machines in the NHS – Pharmaceutical Services Negotiating Committee (PSNC)
Medicines in health and adult social care (CQC report)
Last month the Care Quality Commission (CQC) published a new report entitled ‘Medicines in health and adult social care: Learning from risks and sharing good practice for better outcomes’. The report shows what CQC found about the common areas of risk when using medicines and also shares good practices and describes lessons for better medicines optimisation across health and social care.
Information relevant to care homes is available from pages 36-41 and the findings are based on an analysis of inspection reports, enforcement notices and statutory notifications that CQC received. Several key themes identified included errors in medicines administration and record keeping, and managing ‘when (PRN) medicines’. The full report can be accessed via the CQC website (link below) and we would encourage our care homes to have a read of the relevant pages suggested.
National Flu Immunisation Programme 2019/20 - care staff eligible
We would like to remind our care homes early on of the importance of the uptake of the flu vaccination as part of this years immunisation programme. As you know it is very important that all your care home residents are vaccinated as those 65 years and over, and those in long stay residential home are offered the vaccination each year. It is equally important that all carers are also vaccinated.
All health and social care staff, employed by a registered residential care/nursing home or registered domiciliary care provider, who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza are eligible for a free flu jab as part of the programme.
To gain access to your free flu vaccination you should ideally take with you some 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. You can access the flu jab at most GP surgeries or most pharmacies. For further information on the programme, please click on the link below:
Thick and Easy® (Starch) thickener - important changes to note
Manufacturers of thickeners are in the process of changing their labelling and instructions in line with the International Dysphagia Diet Standardisation Initiative (IDDSI). The IDDSI have developed a standard terminology with a colour and numerical index to describe texture modification for food and drink. We have previously informed care homes of the new scoop and mixing instructions for Nutilis® Clear and Resource® Thickenup Clear.
Fresenius, manufacturers of the Thick and Easy® (starch based) thickener have also changed their descriptors from ‘Stage’ to ‘Level’ and have changed the dosage and scoop size of their thickener from 4.5g scoop to 1.5g scoop in response to the new IDDSI guidance. However, there is a potential risk as the old tins may still be in circulation, so GPs are unable to choose which tin to prescribe, also pharmacy suppliers can still order both tins. This means the product arriving may not be consistent making it difficult to ensure the correct directions are added.
We do not use Thick and Easy® as our thickener of choice across Bedfordshire but it is still very important that you are aware of these changes in case you have any residents using this product. The Thick and Easy® Clear thickener is already IDDSI compliant.
We have attached some information which includes a conversion chart with the new instructions for use should this be required for any of your residents.
Urinary Tract Infections (UTIs) in care homes and Hydration
Older people are particularly vulnerable to UTIs, therefore the early detection and treatment is important to reduce the risk of complications such as sepsis and chronic kidney infections.
Why should we worry?
- E.coli bacteria is the most common cause of UTI
- Urinary tract infection is the most common source of E. coli Blood stream infection (BSI) – 45%
- Most cases are community onset (73%) rather than hospital onsetUrine dipsticks
‘Asymptomatic’ bacteriuria is bacteria in the urine which does not cause any clinical symptoms and can live harmlessly in the bladder of older people. This may be mistaken for a UTI and antibiotics started when not needed.
A urine dipstick may be positive for nitrates and leucocytes, but doesn’t tell us if it is an infection or not. Urine dipsticks DO NOT diagnose a UTI in older people and 60% of the time when the dipstick is positive the resident will not have a UTI. Often this leads to antibiotics being prescribed unnecessarily leading to unpleasant side effects such as:
- allergic reactions (e.g. rashes)
- stomach upset and diarrhoea
- multi-drug resistant infections such as Clostridium Difficile (C.diff) which can be life threatening.Inappropriate antibiotic prescribing can also increases the chances of any future UTIs being resistant to the antibiotic prescribed, so they won’t work when the person really needs them.
Antibiotics are powerful and are precious drugs so must be used wisely
What can you do to help your residents?
- Recognise and keep individual hydrated
- Encourage high fluid foods (drinks, jelly, soups, stews etc)
- Remember ‘Food First’We have attached with this newsletter the Bedfordshire CCGs ‘Hydration – Drink well’ leaflet. Please use this leaflet to keep your staff informed on the importance of hydration in older people and how they can achieve this and be a positive influence.
We have also attached the CCGs ‘UTI Symptom flowchart’. This simple flowchart can be followed and completed by care staff for those residents with a suspected UTI. This can support care staff to decide what action needs to be taken.
Our CCG Antimicrobial Primary Care Guidelines have recently been updated. For treating UTIs the drug of choice for both men and women (non-pregnant, over 16) is Nitrofurantoin (if kidney function good), second line is Pivmecillinam and the alternate (third line)
Trimethoprim. Fosfomycin is also recommended for women (non-pregnant over 16) as an alternate third line option.
Drink well for health
Ensure residents are drinking
1.5 – 2 litres of fluids per day* Promote Rehydration Stations
A recurrent UTI is currently defined in our guidelines as – 2 infections in 6 months or 3 infections per year. Self care is the primary intervention for recurrent UTIs e.g. ongoing fluid intake and for women, vaginal oestrogen can be considered (if clinically appropriate).
Antibiotics prescribed for preventing recurrent UTIs is a second line intervention and these must be reviewed at least every 6 months.
For residents with a catheter, antibiotics should only be prescribed if they have clinical symptoms and should not be started based on urine samples alone.
Remember – Prevention is better than cure!
Reference used: Infection control and Antibiotic update presentation by Sue Marchant, Care Home Pharmacist