Castle Froma Care Centre provides long-term and respite care plus rehabilitation for neurological conditions.
Following a Care Quality Commission (CQC) inspection, specific challenges around the management of medicines were highlighted. The Arden & GEM Medicines Optimisation team were approached by Castle Froma to review their approach and deliver recommendations to improve performance.
The challenge
The CQC report listed several areas of concern with respect to medicines management at Castel Froma Specialist Care Centre. These included:
- Medication storage – recommended storage temperatures exceeded
- Receipt of medicines into the home
- Completion of Medicines Administration Record (MAR) sheets
- ‘As required’ medication instructions
- Expiry dates of medicines not clearly recorded.
Our approach
An initial meeting was arranged at the home to meet with the senior managers and all staff members with responsibility for medicines. At this meeting, the CQC report was discussed and the required outcomes for the care centre were agreed.
- A medicines management assessment was completed. This highlighted several areas of concern.
- A medicines round performed by the nursing staff was observed.
- A visit was made to the community pharmacy which supplied the care centre. The specialist supply system which the pharmacy employs, Biodose®, was viewed. Several areas were discussed with the staff, particularly the production of the MAR sheets, ensuring that all medicines have clear expiry dates on them, and their responsibilities for providing information on medicines were clarified, ensuring that an audit trail of medicines could be clearly seen.
- A review of the repeat prescriptions was performed.
- A meeting was arranged with the GP that provides medical support at the care centre. The CQC report was discussed. It was agreed that the repeat prescriptions would be amended to ensure that they all have complete instructions on them so that there was no ambiguity for staff. For example, there would be no ‘as directed’ instructions. There would be clear instructions for medicines which are given on ‘as required’ basis, giving dosing intervals and a maximum quantity allowed in 24 hours.
- A draft medicines policy was produced for the care centre to adapt to their needs. The structure for the medicines policy was taken from the NICE guidance on ‘Medication in Care Homes’ and the CQC standards.
- A report was produced, pulling together all the information obtained from the visits and observations.
As a result of all these actions, it is hoped that all the issues that were raised by the CQC report have been addressed.
What we learned
One significant delay in the process was meeting with the GP that provided medical care to Castel Froma. Contact with the GP practice could have been made at an earlier stage, and an appointment arranged, to ensure the project was delivered with the maximum efficiency.
The outcomes
It is anticipated that following implementation of the recommendations and suggestions made in the report presented, Castel Froma Specialist Care Centre will comply with CQC standards. This will therefore benefit patients by ensuring safe and effective medicines management.
"During the review, you not only looked at issues at Castel Froma but also at our community pharmacy and the GP surgery. This meant that the whole system from the ordering to the supply was audited by yourself with a robust action plan to implement by all parties concerned.
We were able to implement many of the recommendations straight away and other items were left until your report was finalised. Your thorough review has enabled us to make the necessary changes to our systems to ensure we are compliant with the regulatory bodies who govern our service and to keep our residents safe.
The information in your report along with the updated policy has been shared with the Nursing team so that they are all aware of the issues raised and how to rectify them. The whole review was seen as positive for our team as it has allowed us to update our practices and review the way we work within the organisation."
Sandra Holmes, Registered Manager, Castel Froma Specialist Care Centre, Leamington Spa
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