1.1 This is a joint policy and practice initiative between Devon Social Services, the six Primary Care Trusts (PCTs) in Devon, and the Local Pharmaceutical Committee. It provides a common policy and procedure and one assessment tool across the NHS and Social Services in Devon.
1.2 The approach promotes both person centred assessment, care and medicines support that values an individual’s independence and assists people to remain in their own homes.
1.3 The Policy must be read alongside:
2.1 This policy sets out both the assessment process and the domiciliary support services available to support people with eligible needs to manage their medicines in their own homes.
2.2 The contact and overview assessments within the SAP will trigger the need for a medicine concordance assessment. This specialist medicine assessment will be used by NHS and Social Services staff to understand a person’s needs in relation to managing their medicines in a safe and empowering way and agreeing what, if anything, would assist them to do so. Staff undertaking this specialist assessment will be trained to do so.
2.3 A medicines concordance assessment may also be triggered through medication reviews or other assessments outside the SAP.
2.4 Following assessment, where people have eligible needs, a community support service may be arranged to meet an individual’s agreed medicine support needs using this policy and guidance. The outcome of the concordance assessment will indicate the level and type of assistance required using this framework.
2.5 This support service may be arranged from either the in house or independent sector and will be provided by staff who are trained and assessed as competent to do so.
2.6 This policy will:
2.7 State the roles and responsibilities of all staff working in a domiciliary care environment when assisting service users with aspects of medication management.
2.8 Lead to transparent and consistent decision making.
2.9 The policy is for:
3.1 This policy must be operated within the following principles:
3.1.1 Be non-discriminatory. Assessments and any services arranged by the NHS and Social Services must take account of an individual’s age, gender, ethnic group, religion, culture, disabilities, personal relationships or living and caring arrangements.
3.1.2 Ascertain the needs and wishes of each individual and, where possible, involve them in decisions about their management of medication.
3.1.3 Recognise that Dignity, Choice, Participation / involvement, and Respect are the foundations of good practice.
3.1.4 Be applied equally across all adult service user groups including adult carers.
3.1.5 Be based on the assessed needs of, and risks to, service users.
3.1.6 Be written in a way that is easily understood by staff, service users and carers and available within a range of formats.
4.1 It will improve the quality of assessment for service users and provide them with a service that is more appropriate and efficient in meeting their needs in the management of their medicines.
4.2 It contributes to the National Services Framework (NSF) requirement for improved medicines management by PCTs and the Domiciliary Care National Minimum Standards’ requirement to have clear policy and procedures around this area of work in place.
4.3 It will assist in meeting performance indicators / targets around emergency admissions and supporting people at home.
4.4 There is potential for cost benefits to the PCTs in terms of reduction in medicines wastage, reduction in use of monitoring dose systems (MDS), and more efficient use of Community Nurse time in addition to the reduction in emergency admissions.
4.5 It will mean more efficient use of staff time and facilitate the development of Generic Health / Social Care workers at different levels, which will also begin to create a career path for domiciliary care assistants.
5.1 The first part of this section sets out the procedures that assessors in the NHS and Social services must follow.
5.1.1 Vulnerable service users may be identified by health or social care worker, referred by an informal carer, or referred on discharge from secondary care.
5.1.2 A designated, appropriately trained officer / professional will assess the service user, using the Devon Concordance assessment tool to determine the support service required. This could take the form of simple adaptation to medication containers, provision of aids to assist the Service User in administering their own medication or a category of assistance to be provided by domiciliary care staff as listed in 5.2 below.
5.1.3 Personnel able to carry out the assessment could include the following:
5.2 Categories of Community Support Service
5.3 Direct Payments can include an element attributable to the cost of medicines administration support as long as the User also has eligible needs for community care services.
5.4 The Assessor (ref. 4.2) will liaise with the Domiciliary Care Manager to agree the care package.
5.5 The Service User or their representative will sign consent. (Consent form as at Appendix 1)
5.6 Detailed Operational Procedural Guidance will be followed as at Appendix 2
5.7 For complete process flowchart see Appendix 3.
6.1 If an individual’s need is confined to the administration of medication only and has no need of the provision of any social service, the medicines support service cannot be provided
6.2 Most people are responsible for managing their own medication and must always be encouraged to do so wherever appropriate to do so.
6.3 Community support services can only provide a higher level of assistance with medication if it is agreed as part of the package of care following an assessment of need and has the agreement of the service user or their carer.
6.4 Training: Domiciliary Care workers (DCWs) must not assist service users with their medication unless the CSW has undertaken the appropriate training and assessed as competent to do so. Training programmes will be run for the general tasks listed under Categories 1-3 with the training for those listed as exceptional, in 3 and 4, to be specific to the individual service user and delivered by a Community Nurse.
6.5 Service users always retain the right to refuse to take their medication. Under no circumstances will a service user be forced to take their medication. The Domiciliary Care worker should immediately report any refusal to the designated person.
6.6 If it is known that the service user lacks the capacity to understand the need for medication and / or how and when to take it, particular care is needed. It is not acceptable to conceal medication for example by hiding it in food, or to attempt to force service users (ref. 3.2.5.). If an individual resists essential medication, a multi-agency group should meet to agree the approach. This information should then be available to the Domiciliary Care worker and should form part of the care plan.
6.7 If an individual is a vulnerable adult as defined in the 'Protection of Adults at Risk ' procedures (ref 342), extra vigilance is required. Any concerns regarding such an individual's care by colleagues or informal carers or suspicion of abuse, must be reported back to the line manager.
7.1 All managers and staff involved in medication are responsible for maintaining full and accurate records of any tasks/procedures that they carry out.
7.2 Assessment responsibilities include:
7.3 Domiciliary Care workers are responsible for:
7.4 Domiciliary Care Managers are responsible for:
7.5 All Nurses are responsible for:
7.6 The GPs are responsible for:
7.7 Community Pharmacists are responsible for:
8.1 Complaints from service users or their Carers should be made to the relevant agency via their normal complaints procedure.
8.2 Disputes between the different agency staff should be resolved via their line managers and the usual interagency disputes process.
9.1 This policy will be reviewed following initial piloting and also during the phased introduction of the Medicines Support Service into Domiciliary Care generally.
9.2 The concordance assessment will be reviewed following initial piloting and also in line with the review arrangements for the Single Assessment Process.
Medicines Community Support Service. This is a service provided by Domiciliary Care Providers to enable service users to safely manage their medicines at home.
Assessor - this is the person who has, together with the Service User, identified any difficulties they have and has helped them to determine the most appropriate form of assistance required.
Single Assessment Process - a shared assessment framework between Health and Social Care which gives a standardised approach, reduces areas of duplication, ensures the individual‘s views and wishes are central to the assessment process and that the depth and detail of the assessment is proportionate to their needs.
Community Support Service Manager (CSSM) The person managing Domiciliary Care Services.
Medication - the terms ‘drug’, ‘medicine’, and ‘medication’ are used interchangeably.
Medicine - the terms ‘drug’, ‘medicine’, and ‘medication’ are used interchangeably.
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