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Domain Two: Implementation and Delivery of Safe and Effective Homecare Services

Domain 2 describes the standards for the design, setting up and delivery of a homecare service

Standard 4: Effective Use of Homecare Medicines1 2

4.1 Homecare policy

A trust homecare policy should include the following statements/arrangements:

  • Contracting and commissioning, including procurement and responsibility for managing sub-contracted services

  • Initiation of homecare service and professional responsibilities

  • Maintenance of homecare treatment including management of change

  • Financial management

  • Information Governance

  • Clinical Governance

  • Quality management including feedback, complaints and performance management

  • Risk management including contingency planning and business continuity

     

Appendix 13 – Sample homecare policy

 

4.2 Homecare services procurement

When setting up a homecare service there are a number of documents which are essential building blocks to support the design and specification of a safe and effective service. The use of these documents ensures the responsibilities of all parties involved in the service are clearly defined and provides consistency of service through compliance with RPS professional standards. RPS recommends the following documents are critical to the development of homecare services:

  • Medicine pathway

  • Homecare service aims and rationale

  • Homecare service specification

  • Tender or proposal documentation

  • Service Level Agreement (SLA)

  • Key Performance Indicators (KPI)

  • Technical Agreement (TA)

 

4.3 Sourcing and purchasing of homecare medicines

Development of the output based service specification is the first step when developing a homecare service. Prior to undergoing a tendering exercise, NHS LPP will use their in-house procurement and pharmacy expertise to develop a service specification which includes:

  • What elements are required to deliver the aims of the service

  • Minimum acceptable standards or requirements and where improved services would be advantageous to the patient and the purchasing authority

  • Details where an enhanced service for specific elements would be advantageous

  • Details how the contract and supplier performance will be managed

  • Refers to the NHS Standard Terms & Conditions for purchasing goods and supply of services

 

Service Level Agreement (SLA) or Summary (SLS)

There should be no material difference between a service level agreement and summary. The difference between SLA and SLS is the legal status of the document. SLA forms part of the contract between parties whereas the SLS is for information only.

  • During public tender processes the supplier submission are binding. The tender submissions are often complicated and very wordy which can make it difficult for people to understand. SLS acts as a working document against which service reviews can be completed.

  • During commercial tendering request for proposal (RFP) documents then a SLA is produced as part of the commercial and contractual agreement between the provider and purchasing authority

  • If part of the service is delivered by a third-party with whom the purchasing authority has a working relationship but no contractual agreement (e.g. homecare supplier contracted to pharma) then the purchasing authority should ensure they fully understand the specification of the service

 

For more information on LPP frameworks visit the contracting page or framework page

 

4.4 Custom-made homecare medicines

Any homecare service which uses compounded, extemporaneously prepared, aseptically prepared, repacked and over-labelled medicines must be contracted using the principles of risk reduction and using licensed medicines where possible.

 

4.5 Imported unlicensed medicines

Unlicensed medicines must only be used where there is no licensed alternative and imported medicines must be approved by the pharmacist responsible for homecare.

 

4.6 Equipment and ancillaries

Where homecare services involves the use of equipment and ancillaries the purchasing authority should ensure appropriate risk assessments are in place to establish the safety within homecare settings. Patients must be informed on how to order and the proper use of associated equipment

 

Standard 5: Homecare Medicines Expertise

5.1 Expertise and competence of the homecare team

The pharmacy homecare team is expected to provide support to healthcare professionals prescribing, administering and monitoring homecare medicines. To support the team it is recommended to have the following:

  • An thorough induction programme and on-going training and education package in the best practice use of medicines for relevant clinical and support staff for homecare services

  • Access to a specialist (or appropriately trained) clinical pharmacist

  • Access to a Medicines Information service

  • Pharmacy supports prescribers through access to relevant information and guidance

 

5.2 Expertise for patient care

All pharmacy homecare team members should have an up-to-date job description and understand and works within their level of competence and expertise. Changes that impact on the area of professional responsibility of the homecare team are subject to a change control process.

 

Standard 6: Safe Use of Homecare Medicines

6.1 Safe Systems

Homecare services are subject to regular risk assessments and appropriate action taken to mitigate risks. The design or updating of homecare service documentation involves appropriately trained stakeholders. The following elements are essential for a safe homecare system:

  • Prescriptions are clinically validated by a trust pharmacist prior to transmission to the homecare supplier

  • There is support for the implementation of relevant national therapeutic guidance and a procedure for reviewing national patient safety alerts and MHRA recalls that are relevant to homecare services

  • Operator and patient safety systems are in place for high hazard medicines

  • A robust complaints and incidents procedure is in place to capture untoward, near misses and never events. A review of these logs are used to identify lessons learnt and to improve patient safety

 

6.2 Safety culture

Homecare services must be delivered within a culture of high level medicine safety and governance. The services must establish processes for:

  • Dealing with patient safety incidences and learning from these events to improve practices

  • Information governance

  • Identification and reporting of safeguarding incidents

 

6.3 Clinical Governance

The chief pharmacist or equivalent must engage with appropriate specialists to ensure governance and safeguarding standards are implemented with homecare services. The following processes can help trusts to identify if they are meeting these standards:

  • Complete clinical risk assessments into the development of homecare services

  • Homecare services are subjected to regular clinical audits including:

    • Expected vs actual outcomes

    • Patient safety incidences

    • Adherence to procedures

    • Assurance of the quality of services and good clinical governance

 

 

Standard 7: Supply and use of homecare medicines

7.1 Patient services

Patients should be provided with signposting to appropriate support mechanisms and sources of information. Clinicians and homecare team members must have clear lines of communication and understand the process for managing changes in patient treatment.

 

7.2 Clinical checking of homecare prescriptions

All homecare prescriptions must be legally valid and it is recommended that trust collaborate with homecare suppliers to create a prescription template which minimises the risk of prescribing/dispensing errors. The following steps should be implemented for the prescription validation process:

  • A clinical checking procedure with roles and responsibilities clearly defined

  • All homecare prescriptions are clinically screened by an appropriately trained pharmacist

  • Records of clinical checks are clearly documented and communicated (e.g. complete the validation box on the prescription instead of randomly signing on the document)

  • Directions for the patient takes into consideration that the patient will not receive counselling at the point of dispensing

 

7.3 Dispensing

Dispensing activities are carried out by the homecare supplier. The purchasing authority must ensure the SLA details that prescriptions are reviewed, medicines dispensed or prepared accurately and delivered in accordance with agreed service levels.

 

7.4 Labelling and patient information

The SLA should detail the standards for labelling homecare medications, taking into account the diversity of patients accessing homecare medicines including those with disabilities. Patient information leaflets must be provided with each homecare delivery.

 

7.5 Distribution and Storage

In the SLA homecare suppliers are responsible for the risk assessment of their storage, packaging and delivery processes. Where risks are identified they should demonstrate appropriate risk mitigation strategies.

There must be robust audit trails and governance processes in place to ensure product quality and integrity up to the point of administration. The homecare company must be licensed (or use a subcontractor who is licensed) by the Environment agency to carry waste materials so that collections of medical waste can be safely made from the patients home.

 

7.6 Medicines administration and compliance services

If applicable, the homecare SLA must detail the homecare companies responsibility to assess the competency of patients and/or carers to self-administer medicines (and the use of associated equipment/ancillaries)/

Homecare SLAs which includes the administration of medicines by the homecare nursing service must clearly state the protocol and requirement for the nurse to have a copy of the prescription when carrying out the service. Appropriate clinical records must be completed and made available to the purchasing authority.

When the homecare service is administering or supervising the administration of medicines then they are required to exercise their professional responsibility and accountability in the best interest of the patient.

 

 

References

1 Professional standards for Homecare Services in EnglandRoyal Pharmaceutical Society (2013)

2 Handbook for Homecare Services in England Royal Pharmaceutical Society (2014)

 

 

 

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