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Yorkshire and the Humber Medicines Management Training Scheme Introduction to: Ward/Clinical Environments https://www.ewin.nhs.uk/groups/medslearning/activity Contact: Administration Team Pharmacy Development Unit Baines Wing School of Healthcare University of Leeds Leeds LS2 9JT T: 0113 343 7551 E: [email protected] Document Reference Number: PDU/MM/012 Review Date: Sept 2017 Version: 1.2 Supersedes: v1.1 0 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Contents Page Contents Page ........................................................................................................... 1 Introduction to the Module .......................................................................................... 2 Aims and Objectives............................................................................................................................ 3 Learning Outcomes ............................................................................................................................. 3 Benefits of a Medicines Management Technician .............................................................................. 4 Stage 1: Preparation Work ......................................................................................... 5 Preparation Work A – Reading ........................................................................................................... 5 Preparation Work B - Procedures and Policies.................................................................................... 8 Preparation Work C – Infection Control and Hand Hygiene ............................................................. 10 Preparation Work D - Introductory Medicines Management Modules ...................... 14 Stage 2: Practical Activities ...................................................................................... 16 A. Ward Based Tasks and Activities .................................................................................................. 16 B. Attendance at Study Days ............................................................................................................. 27 Stage 3 Assessment and Completion ...................................................................... 28 Assessment of Competence for Ward Based Role ........................................................................... 28 Summary of Achievements................................................................................................................ 29 Confirmation of Completion of Module ............................................................................................ 30 Appendix 1 - Common Abbreviations ....................................................................... 31 Appendix 2 – Yorkshire and Humber Medicines Management Training Scheme ..... 34 Appendix 4 - Competency Levels ............................................................................. 35 Appendix 5 - Self Reflective Log .............................................................................. 36 Appendix 6 - Continuing Professional Development ................................................ 38 This document has been produced by the Yorkshire and Humber Pharmacy Development Unit (Y&H PDU) to assist in the training and development of staff involved in Medicines Management. It should be read in conjunction with the Medicines Code and Procedures provided by the employing organisation. 1 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Introduction to the Module Pharmacy Technicians are fully involved in medicines management ward-based activities and these roles are being further developed and reviewed to provide an improved medicines service to patients and wards. Medicines management staff improve Medicines Management at ward level, help to reduce medicines waste, save time, ensure that patients receive the correct medicines, and maintain appropriate medicines supplies throughout the patients stay in hospital. These enhanced roles allow pharmacists time to concentrate on clinical duties. This module provides an overview of the main duties of medicines management staff and looks at the work they undertake, their responsibilities and how they work with patients and ward staff to provide an effective medicines management service. In this module there are a number of tasks which highlight the medicines management role and functions. The tasks focus on observations of real situations, assessment of risks and benefits and topics for discussion. This module is one of three introductory modules that you will need to complete as part of your preparation and induction to Medicines Management within the Yorkshire and Humber Medicines Management Training Scheme which includes: Introduction to: Medicines Calculations Introduction to: Communication Skills Pharmacy staff completing work based learning: 1. Will find it helpful to have a nominated learning mentor to support them through this module. A mentor may be a different member of the pharmacy team for each module. Your mentor may be a technician or pharmacist. 2. At the end of this workbook there is a final CPD evaluation sheet which you should complete as evidence for GPhC CPD. It is recommended that you keep up to date with your skills through CPD. 3. Ask your mentor to complete the Confirmation of Training Package Completion form and forward it to the Yorkshire and Humber Pharmacy Development Unit (Y&H PDU). A certificate will be issued to confirm successful completion of modules of the Yorkshire and Humber Medicines Management Training Scheme. The information contained in this booklet provides a variety of training and assessment methods, which may be adapted to address the content and depth of training required. 2 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Aims and Objectives Aim This training programme aims to set out a structured approach to work outside the pharmacy department. It introduces the candidate to the work of medicines management staff and may help to prepare them for this extended role. It also looks at what happens at ward level, and introduces the candidate to problems and risks associated with providing this service. Objectives On completion of this package, the candidate will have a basic understanding of and be able to discuss the varied role of medicines management staff. Learning Outcomes Be able to identify and understand common ward abbreviations To understand the different roles of medicines management staff within Y&H framework To understand the importance of infection control and good hand hygiene in a clinical setting Demonstrate an understanding of the procedures and organisational policies when carrying out ward based duties. Have a basic understanding of situations when a referral to a pharmacist/senior member of staff would be required. Have a basic understanding of and be able to discuss the benefits and risks associated with the medicines management service provided by pharmacy staff. For completion of this introductory module the following must be achieved: Observation and completion of tasks and activities Testing of Knowledge using questions & answers and discussions Assessment of competence for ward based role Completion of 3 self reflective logs 3 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Benefits of Medicines Management Staff Allows the ward pharmacist time to concentrate on clinical duties. Increases patient contact – improved patient experience and care Reduces the number of drug charts sent to pharmacy, and off the ward Waste reduction-Cuts down on unnecessary dispensing and cost with the recycling of PODs Waste reduction-reduces returns to pharmacy, reduces dispensing time in pharmacy Reduces number of prescribing discrepancies – accurate drug history obtained Saves time, money and improves the pharmaceutical care of the patient Improved relationship with other ward-based health care professional 4 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Stage 1: Preparation Work Preparation Work A – Reading Complete the essential and further reading lists below as appropriate to your role. Make notes on the most important and relevant points for your learning and understanding. Discuss these with your mentor. Essential reading Date Completed Medication Errors – Safety in Doses ‘Improving the use of medicines in the NHS’ (2009) http://www.nrls.npsa.nhs.uk/resources/?entryid45=61625 Notes for discussion: Risk Management - Reducing harm from omitted and delayed medicines in hospital (Feb 2010) Rapid Response Report RRR009. www.nrls.npsa.nhs.uk Notes for discussion: NPC 5 Minute Guide Introduction to Medicines Management www.npc.nhs.uk/five_min_guides.php (if available -archived website) Notes for discussion: 5 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Date Completed Taking drug histories — an audit of technician accuracy. Hospital Pharmacist 2007;14:351-352 (November 2007) Notes for discussion: Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NICE Guideline 5 (NG5) March 2015 http://www.nice.org.uk/ Notes for discussion: The candidate has demonstrated learning from this reading Candidates signature …………………………… Date ……………………… Mentor signature………………………………… Date ………..……………. 6 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Further Reading (suggested content depending on role) Date Completed Thomas et al, Empowering technicians to work in extended clinical roles, Hospital Pharmacist, 2008, Vol 15, p145-146 Notes for discussion: Acres, S New Professional Body- are technicians in or out? Hospital Pharmacist, 2008, Vol 15, p107-8 Notes for discussion: Standards of Conduct, Ethics and Performance see latest edition at GPhC website http://pharmacyregulation.org/ Notes for discussion: Communication Skills - Being Open Framework www.nrls.npsa.nhs.uk/beingopen Notes for discussion: The candidate has demonstrated learning from this reading Candidates signature …………………………… Date ……………………… Mentor signature………………………………… Date ………..……………. 7 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Preparation Work B - Procedures and Policies List organisational and department procedures relating to wards/clinical environments below. Read and make notes on areas you think are most important to your understanding and learning. Discuss these with your mentor (see q&a record sheet below) Title Date completed 8 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Question and Answer Review Form Student and Mentor to document questions and answers during discussions below: Q1. Q2. Q3. Q4. Q5. Q6. Q7. Q8. Q9. Q10. The candidate has demonstrated an understanding of knowledge and learning. Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 9 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Preparation Work C – Infection Control and Hand Hygiene Task 1 Hand Hygiene Task Completed Read: Clean hands save lives (Patient Safety Alert 2008) Ref:0773 Clean hands save lives hand cleaning techniques Ref:0773C Both documents are available to download at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59848 Read and follow your organisations guidelines on Hand Hygiene Complete observed hand washing check list (on next page) Read the information below on Infection Control in Clinical Areas. Q1. What have you learnt from the hand washing checklist (task 2) Q2. What have you learnt from the clean hands save lives campaign documents? Q3.How will you put this into practice? Q4.What would you do if you saw someone on the wards not washing their hands/following hygiene procedures correctly? Q5.List at least four important things to remember when visiting wards in relation to infection control and hand hygiene. The candidate has demonstrated an understanding of above task. Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 10 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 2 HAND WASHING CHECKLIST Performed Adequately and Completely Turns the water and adjusts the temperature Wets hands before applying hand washing agent Step 1 – PALMS Rubs palms together to create a lather and spreads the lather throughout hands Step 2 – BACKS OF HANDS Rubs right hand over back of left hand with fingers interlaced. Changes hands and continues Step 3 - INTERLACED Rubs palms together with fingers interlaced. Changes hands and continues Step 4 – CLASPED Clasps fingers together, interlock and rub back of fingers into palms. Changes hands and repeats Step 5 – ROTATE ROUND THUMBS Rotates right hand around left thumb and thumb tip. Rotates left hand around right thumb and thumb tip Step 6 - FINGERTIPS Uses finger tips to cleanse centre of palms and tips of digits Step 7 – WRISTS/FOREARMS Rotates right hand around left writs. Rotates left hand around right wrist All rings and wrist watches removed from fingers and hand Or If wearing a plain wedding band; moves band to wash and dry under band Rinses hands and shakes off excess water Dries hands thoroughly from hand to wrist Turns off tap without re-contaminating hands, using elbows or paper towels Disposes of paper towels in household waste bag using foot pedal Has taken at least 15 to 30 seconds to complete hand washing Observation completed and hand washing performed adequately and completely. Candidates signature ………………………………… Date………………………… Mentor signature……………………………………… Date………………………... 11 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Infection Control on wards and in clinical areas This section provides general information about how to deal with patients at ward level that have or are vulnerable to infection and how to minimise the risk of spreading infection. The aim of infection control is to prevent the spread of infection via equipment, patients, staff and environment. The following patients are most vulnerable to acquire infections: Neonates/elderly patients, this is due to them having a less efficient immune system. Drug therapy – use of immunosuppressive drugs, broad spectrum antimicrobials. Patients undergoing surgery or instrumentation. Invasive procedures eg catheterisation. Likely Sources of Infection Hands of staff involved with patient. Objects. Clothes. Dust particles and droplets. What you can do to minimise the risk of infection Ensure your hands are washed according to hand washing procedures at ward level. Wear protective clothing when advised to do so. Use a ‘Non touch’ technique eg not touching bed linen, resting on equipment/ surfaces. When working at ward level you should be aware of the above and prevent yourself being put in a compromised position e.g. not intruding on a dressing change or not wearing appropriate protection if the patient has an infection. Barrier Nursing/Patient Isolation On occasions patients are isolated in a side room for either (a) barrier nursing (b) reverse barrier nursing. See below for explanation of these two terms. 12 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Barrier Nursing The type of patient that would receive barrier nursing are those patients with MRSA, contagious diseases, e.g. glandular fever and chicken pox. They are barrier nursed to control the spread of pathogenic organisms. They can transmit the infection to other patients, visitors and health care staff. The patient can be confined to a single room with their own washing and toilet facilities where entry to the room is limited. Staff needing to attend to the patient will need to wear protective clothing such as apron and gloves (over-shoes and masks if more serious). The patients file containing the drug chart should be kept outside the room, restricting the number of staff needing to enter the room. Look for: A barrier nursing sign outside the door. Isolation signs outside the door Prescription chart outside the room. Speak to the nurse in charge of that patient before entering the room. If you do enter the room, ensure you adhere to the ward procedure for that patient. Reverse Barrier Nursing Reverse barrier nursing is used to protect the patient from sources of infection. Healthcare staff attending the patient should wash their hands with a bacterial/cidal hand rub prior to entry. Speak to the nurse in charge of that patient before entering the room. Always remember to: Wash your hands before and after a ward visit. If you come into contact with any infected person or immunocompromised patient wash hands before and after visiting the patient, before you continue with your duties. Ensure you speak to the nurse in charge if you are not sure what to do. Follow organisational and department procedures on hand washing and infection control Each organisation will have its own policies and procedures on infection control and hand hygiene. These may change or be updated on a regular basis so make sure you access the latest information for your organisation. 13 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Preparation Work D - Introductory Medicines Management Modules Complete or be working towards the completion of the following workbooks from the Yorkshire and Humber Medicines Management Training Scheme: Title: Date started/completed Introduction to: Communication Skills Introduction to: Medicines Calculations Related training programmes and schemes Core Skills – Level 1 for National Accreditation These are covered in three module workbooks within the Y&H Accredited Medicines Management Training Scheme (AMMTS) which are: o Module 1: Managing supplies for individual patients o Module 2: Assessment of Patients own Drugs o Module 3: Medicines History Taking Training Workbook and Assessment Workbook To promote development and competence as a safe Registered Pharmacy Technician and effective Medicines Management Practitioner, the following underpinning skills are also assessed during accreditation: o Communication skills o Professional and interpersonal skills o Clinical and problem solving skills Optional Skills – Level 1 Regional Certification The Y&H Medicines Management Training Scheme has been designed to support the varied roles involved in medicines management and provides a variety of regional training modules which are all relevant to the technician role today. These are covered in module workbooks within the Y&H Medicines Management Training Scheme which are: o Inhaled Therapy o Transcribing o Anticoagulation o Assessment for Self Administration o Patient Counselling and Consultation Skills o and the three introductory workbooks: • Communication Skills • Wards and Clinical Environments • Medicines Calculations The Yorkshire and Humber Accuracy Checking Technicians Training (ACT) Scheme has been developed to train registered pharmacy technicians to confirm the final accuracy check of dispensed items. 14 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Visit the MedsLearning website at https://www.ewin.nhs.uk/groups/medslearningresources/activity for more information on these and other training available to you in the Yorkshire and Humber region. Certificate in Continuing Professional Development for Pharmacy Technicians. A level 4 HE qualification available from Huddersfield University. The full programme supports accuracy checking, medicines management foundation skills and CPD skills. NHS Pharmacy Education and Development Committee (NHSPEDC) Nationally Recognised Competency Framework for Pharmacy Technicians: The Assessment of Medicines Management Skills. Nationally Recognised Framework for Final Accuracy Checking of Dispensed Items for Pharmacy Technicians. Visit the NHSPEDC website at www.nhspedc.nhs.uk for full details. Y&H Pharmacy Development Unit (PDU) Study Days - Recommended: Introduction to Medicines Management Study Day Customer Care and Communications Study Day For bookings visit https://ewin.nhs.uk/groups/medslearning-resources/events Medicines Management e-learning modules - Optional Provided by NHS Yorks & Humber, this is a useful online training programme, which is a useful introduction to Medicines Management as a whole. There is a knowledge review at the end of each module with a certificate of completion. Visit https://www.ewin.nhs.uk/groups/medslearning/resources/item/5216/medicinesmanagement-training To commence ANY medicines management training within Y&H region candidate induction process should include: A structured form of local medicines management induction process must be followed. Organisational specific documents or Y&H approved documents must be used. Induction should include: Medicines Management study day and/or local induction day CPD/Self reflection preparation Shadowing Pharmacist/Senior Technician on wards Online learning Training and development plans 15 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Stage 2: Practical Activities A. Ward Based Tasks and Activities The following tasks and activities are designed to introduce you to the responsibilities and work of a medicines management technician in a clinical setting. Most of the activities involve shadowing a technician or a pharmacist during ward visits. There are also sections that you are expected to complete on your own. You will need to make notes, and write down questions and points for discussion throughout. You will be assessed on these. Reflection on learning is introduced here and is an important part of the learning cycle. A self reflective learning log is used to record your thoughts on learning. It is also used throughout other training programmes and schemes as part of the assessment process. Here are the tasks you need to complete: Task 3 Ward Clinical Area Visit Task 4 Patient Case Study Task 5 Drug Administration Task 6 Supply (one-stop and non-stock) Task 7 Patients own Drugs (PODs) Task 8 Self Administration (SAM) Task 9 Patient Counselling (Inhalers and Anticoagulation) Task 10 Medicines Problems Task 11 Medicines History Taking Task 12 Transcribing 16 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 3 Ward Clinical Area Visit Task Completed Arrange a ward visit Ask the ward pharmacist/technician to give you a brief induction to the ward/clinical area you will be working on, including information regarding the speciality, layout, and introductions to the different personnel. Also when discussing the layout of the area identify where information regarding the patients is stored (patient notes, care plans and charts also take a brief look at the different types of charts). Ask the pharmacist/technician to outline briefly all the equipment around a patient's bed/clinical area and how each piece of equipment helps with the care of the patient. In particular identify where the nurse call button is, so that in the event of an emergency you can call for help. Further Learning-Medical abbreviations see local policy Complete a GPhC CPD record (this should start at reflection) Q1. What have you learnt from this visit? Q2. What staff did you meet and what were their roles on the ward? Q3. How many charts did you identify and what were they? Q4. What would you do in the event of an emergency on the ward you are visiting? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 17 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 4 Patient Case Study Task Completed Prepare information relating to one new patient, their reason for admission/attendance and subsequent treatment. Preview their PODs and document this according to organisational SOPs. Present this information to the ward clinical pharmacist/technician and discuss the format of the medical and nursing notes, and the information contained within them. Read: PODs procedures (see Preparation work B) Q1. What problems did you encounter? Q2. Did you find any errors? If yes what were they, and how will they be corrected? Make notes below and discuss with your mentor. The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 18 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 5 Drug Administration Task Completed Arrange a visit with a nurse Accompany the nurse during a drug administration round. Observe with particular reference to: What problems face a ward nurse during their administration rounds? How your input can improve the efficiency of this activity. Identify if doses were given or not, and if not, what record of the reason is kept. Following the ward round, talk through your observations with the medicines management technician/clinical pharmacist. Read: Common ward abbreviations (see appendix1) Reducing harm from omitted and delayed medicines in hospital (Feb2010) Rapid Response Report RRR009 (from your pre-reading) NPC 5 Minute Guide Multidisciplinary Team Working in Medicines Management www.npc.nhs.uk/five_min_guides.php (if available) Q1. What staff did you meet and what were their roles on the ward? Q2. What were your main observations? Q3. What if anything went wrong during the drug round? Q4. What did you learn from this visit? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 19 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 6 Supply of Medicines Task Completed Familiarise yourself with the process for supply of non-stock medicines and one-stop medicines to the ward/clinical area. Accompany a medicines management technician on their ward visit to gain a clear understanding of the process involved before a request for medicines arrives in pharmacy for supply. Identify if there are any areas where discrepancies/problems may occur with medicines getting to the patient accurately and promptly. Read: Supply SOPs (including non-stock items and one-stop supply) Non formulary medicines SOPs (see Preparation work B) Y&H Medicines Management Supply Workbook NPC 5 Minute Guide One Stop Dispensing www.npc.nhs.uk/five_min_guides.php (if available) Complete a self reflective log entry Q1. How can effective management of supplies help patients, ward staff and pharmacy workload? Makes notes below and discuss this with your mentor. Don’t forget to include situations where patients have missed doses The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 20 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 7 Patients own Drugs (PODs) Task Completed Familiarise yourself with the process for the use of patients own drugs on the ward/clinical area. Accompany a medicines management technician on their ward visit to gain a clear understanding of the process involved. Identify if there are any areas where discrepancies/problems may occur with medicines being re-used. Read: PODs and RUPO SOPs (see task 4 and preparation work B) Medicines Management PODs Workbook NPC 5 Minute Guide One Stop Dispensing & Re-using patients own drugs www.npc.nhs.uk/five_min_guides.php (if available) Complete a self reflective log entry. Q1. Briefly describe the process for PODs below Q2. Briefly list some of the communication methods used during your observations. The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 21 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 8 Self Administration (SAM Scheme) Task Completed Familiarise yourself with the process for patients to self administer medication on the ward/clinical area. Accompany a medicines management technician on their ward visit to gain a clear understanding of the process involved. Identify any areas where discrepancies/problems may occur with patients self medicating. Read: Self Administration of Drugs SOPs (see preparation work B) Medicines Management Self Administration (SAM) Workbook NPC 5 Minute Guide Self Administration of Medicines www.npc.nhs.uk/five_min_guides.php (if available) Complete a self reflective log entry Q1. List any problems that were found during the ward visit Q2. How were these problems solved? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 22 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 9 Patient Counselling Task Completed Familiarise yourself with the process for counselling patients. Accompany a medicines management technician on their ward visit to gain a clear understanding of the process involved in preparing to counsel a patient. Observe a patient counselling session on at least three occasions with a variety of counselling needs. Identify areas where problems may occur when counselling patients. Read: Patient Counselling SOPs (see Preparation work B) Y&H Medicines Management: Patient Counselling and Consultation Skills Module, (also look at Inhalers Module and Anticoagulation Module if possible) Y&H Medicines Management Communication Skills Module Q1. What have you learnt from this visit? Q2. Were there any problems encountered during the counselling sessions? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 23 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 10 Medicines Problems Task Completed Ask a clinical pharmacist/technician/mentor to identify a situation when you can interact with a patient to resolve a single medicine related problem. Prior to this task discuss with the pharmacist /technician/ mentor how to approach the situation, possible ways to resolve it and required outcome. Read: SOP’s on patient consent, maintaining confidentiality (where applicable) NPC 5 Minute Guide Patients and their medicines NPC 5 Minute Guide Reducing medication errors www.npc.nhs.uk/five_min_guides.php (if available) Q1. What have you learnt from this experience? Q2. How did you prepare for the consultation? Q3. Were there any other actions that you could have taken? Q4. How did you feel about the planned interaction with the patient before and after? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 24 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 11 Medicines History Taking Task Completed 1. Accompany a ward pharmacist /technician/mentor to observe them interacting with a patient and taking a medication history. 2. Make notes on how they approached the situation, how the session was conducted including any positive and negative points. Make your notes below 3. Comment on how / if you would have done it differently. 4. Identify areas where discrepancies/problems may occur when taking a medication history. Read: Medicines History Taking SOPs (see Preparation work B) Y&H Medicines Management -Medicines History Taking Training Module Q1. Make notes on :Types of patients/communication difficulties Q2. Q3. Q4. The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 25 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Task 12 Transcribing Task Completed Assess an example of a transcription where possible. (this could be paper based or electronic) Note any amendments, intentional or not and discuss with the clinical pharmacist/technician. Identify areas where discrepancies/problems may occur when transcribing. Read: Transcribing SOPs (see Preparation work B) Y&H Medicines Management Transcribing Module Q1. What have you learnt from this experience? Q2. What problems did you encounter? The candidate has completed the above task Candidates signature ………………………………… Date………………….…… Mentor signature……………………………………… Date………………………. 26 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber B. Attendance at Study Days Write down any study days you have attended or will be attending. Also include any CPD that you have already completed or would like to complete related to medicines management. Y&H study day Title Date attended/booked Introduction to Medicines Management Customer Care and Communications In-house study days Title Date attended/booked CPD Title Date completed/booked 27 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Stage 3 Assessment and Completion Assessment of Competence for Ward Based Role Candidates Name: Environments Organisation: You must demonstrate you have the following skills: Module: Introduction to Ward/Clinical Mentor signature and date Comments Communication Skills Have appropriate interpersonal skills (patients/ward staff/other members of multidisciplinary teams) Use effective and polite communication skills Demonstrate empathy and develop rapport with patients and carers Use a range of communication skills Professional Skills Present a professional image Demonstrate confidence in work and abilities Ability to follow procedures and have safe systems of work Ability to work accurately and efficiently Demonstrate effective problem solving and decision making skills Demonstrate an awareness of ward issues Awareness of own limitations and when / how to refer Awareness and ability to maintain patient confidentiality Awareness of equality and diversity Ability to reflect on work and situations Infection Control Identifies infection control hazards and responds accordingly Follows good hygiene procedures I confirm that this candidate has completed the above assessments of competence. Signed (Senior Technician/Pharmacist):__________________________ Name (Please print): Signed (Candidate): ___________________ Date: ___________ ___________________________________Date: __________________ 28 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Summary of Achievements Introduction to Ward/Clinical Environments Candidate name………………………………….Organsiation…………………………………… All of the following criteria must be completed and signed by the authorised clinical pharmacist or medicines management technician. Requirement Signature Date Stage 1 Preparatory Work Essential and further reading Procedures and Policies Infection Control and Hand Hygiene (tasks 1+2) Introductory Meds Management Modules Stage 2 Practical Activities Ward Based Tasks and Activities (tasks 3 to 12) Study Days + CPD booked or completed Stage 3 Assessments and Completion Assessment of Competence sign off Question and Answer Sessions sign off Discussion sessions sign off Completion of Self Reflective Logs x 3 I confirm that this candidate has completed the above requirements for this module. Signed (Senior Technician/Pharmacist):__________________________________ Name (Please print): _____________________________ Date: ___________ Signed (Candidate): ______________________________Date: ___________ Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 29 Humber Confirmation of Completion of Module Candidate’s Name: Workplace Address: Contact Telephone No: Name of Module: Comments from Senior Technician/Pharmacist: I confirm that this candidate has completed the above module and passed all relevant assessments. Signed (Senior Technician/Pharmacist): ______________________________ Name (Please print): _____________________________ Date: ___________ Signed (Candidate): ______________________________________________ Please return this sheet to Pharmacy Development Unit, Baines Wing, School of Healthcare, University of Leeds, Leeds, LS2 9UT [email protected] A certificate of completion will be issued to Yorkshire and Humber pharmacy staff on receipt from a recognised mentor. Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 30 Humber Appendix 1 - Common Abbreviations Abbreviations are commonly used at ward level they may be used to describe symptoms, diagnosis, treatments, routes of administration etc. *This document lists common abbreviations which may be used on wards* Supply Abbreviations Supply abbreviations are annotated onto the drug chart by either the ward based pharmacy technician or the ward pharmacist. S TTO CD POD - Stock item on ward - TTO stock on ward - Controlled drug item - Patients own drugs Route Abbreviations The table below lists ‘route’ abbreviations; these indicate how the patient will receive their medication. PO - orally Top - topically PR - rectally IT - intrathecally PV - vaginally IA - intra-articular IV - intravenously Buccal - (between upper lip and gum) SC - subcutaneously S/L - sublingually IM - intramuscularly IO - intra-ocular Inh - inhalation Neb - nebulisation Peg - enteral feeding NG - naso-gastric tube Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 31 Humber Administration of treatment abbreviations Nursing staff will sign the drug chart each time they administer a drug to the patient. If the drug is not administered then they need to document why by putting a number instead of their signature. This number should be written red ink and the reason why should be written in more detail on the back of the drug chart. The numbers represent the following reasons; 1. 2. 3. 4. 5. 6. 7. 8. Patient away from ward Patient could not take dose Patient refused Dose not available Omitted at nurse’s discretion Dr requested omission Self administered Nil by mouth Important Medicines Management Pharmacy Technicians need to take note of any 4. Dose not available. The Pharmacy Technician must investigate why the dose was not available. If the item is on the ward then they must notify the nurse and pharmacist. If the item was not available on the ward, the Pharmacy Technician must question why and action. (Is the item a to-follow? Was the item ordered?) Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 32 Humber Below is a list of abbreviations, which are commonly used, that may be useful when working at ward level. AF ARF Atrial Fibrillation Acute Renal Failure HT IDDM AML AXR Bx BP Ca CABG Acute Myeloid Leukaemia Abdominal X-ray Biopsy Blood Pressure Carcinoma Coronary Artery Bypass Graft IBD IHD LFT LVF JVP MI Hypertension Insulin Dependent Diabetes Mellitus Inflammatory Bowel Disease Ischaemic Heart Disease Liver Function Test Left Ventricular Failure Jugular Venous Pressure Myocardial Infarction CCU CCF Coronary Care Unit Congestive Cardiac Failure MSU NAD Mid-Stream urine Nothing Abnormal Detected CK Creatinine Kinase NIDDM CNS CVA Central Nervous System Cerebro-Vascular Accident OA PC Non-Insulin Dependent Diabetes Mellitus Osteoarthritis Presenting Complaint CXR COA(P)D PE PEFR Pulmonary Embolism Peak Expiratory Flow Rate CRF CHD DH DU DVT ECG EEG ESRD Chest X-ray Chronic Obstructive Airways (pulmonary) Disease Chronic Renal Failure Coronary Heart Disease Drug History Duodenal Ulcer Deep Vein Thrombosis Electrocardiograph Electroencephalogram End Stage Renal Disease PMH RA SE SOB SOBOE OA THR T4 Previous Medical History Rheumatoid Arthritis Side Effect Short of Breath Shortness of Breath on Exertion Osteoarthritis Total Hip Replacement Thyroxine (Levothyroxine) etOH Ethanol TFT Thyroid Function Test(s) FBC Full Blood Count TSH Thyroid Stimulating Hormone Fe FeSO4 GORD Iron Ferrous Sulphate Gastro-Oesphageal Reflux Disease Gastric Ulcer Heart Rate U&E US URTI Urea and Electrolytes Ultrasound Upper Respiratory Tract Infection Urinary Tract Infection GU HR UTI Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 33 Humber Appendix 2 – Yorkshire and Humber Medicines Management Training Scheme The Scheme enables pharmacy technicians to ensure the effective use of patient’s own medication. It also aims to develop a professional interaction between patients, pharmacy staff and health care professionals in the provision of medicines management. The pharmacy technician must complete the introductory pre-course workbooks prior to attending the study days. Following the Introduction to Medicines Management study day pharmacy technicians will need to complete a portfolio of evidence. An Introduction to Medicines Management Study Day, is held each October/November. Stage 1 Introductory Skills/Induction Introductory 1 - Introduction to ward/clinical environments Introductory 2 – Communication Skills Introductory 3 - Medicines Calculations Stage 2 Core Skills Level 1 National Accreditation Assessment of patient's own drugs, PODS Managing Supply of Medicines Medicines History Taking Optional Skills Level 1 Regional Certification Patient counselling & consultation skills Inhaled Therapy Transcribing Anticoagulation Substance Users – Supervised Administration Needle Exchange (plus interactive program) Assessment for self-medication, SAM Stage 3 Advanced - Mentoring Y&H Mentors - Mentoring trainees (included within Mentor Study Day) Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 34 Humber Appendix 4 - Competency Levels Organisations may use competency levels to indicate which areas of work could be covered by appropriately trained medicines management staff. As the medicines management role is developed in-line with service improvement and national standards, different skills and expertise are needed to cover these developments. Full training and competency assessment is given to staff for each area of medicines management they are responsible for. See appendix 2 for full details of the Yorkshire and Humber Medicines Management Framework. The table below shows how 4 competency levels might be used to provide a medicines management service but it is important to remember that each organisation will have its own policies and procedures for training and utilising staff in medicines management roles. Competency Levels-an example Task/responsibility Assess Patients Own Medication for re-use Level 1 * Annotate drug chart with supply information * Create a Pharmacy profile card * Maintain sufficient supplies on ward * Follow-up transfer of medication and pharmacy profile card Obtain Medication History * Level 2 * Inhaler Counselling * Anticoagulation Counselling * Transcribe-Accurately transcribe items for discharge onto a discharge prescription Limitations of Medicines Management staff role Level 4 * Medication History –Document in medical notes Transcribing-Accurately transcribe items onto a profile card Transcribing-Liaise with prescriber Level 3 * * * It is extremely important that the member of staff is aware of their own limitations and must always refer issues outside of their training and abilities to the ward pharmacist/senior staff member. Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the 35 Humber Appendix 5 - Self Reflective Log Self Reflective Log Yorkshire and Humber Medicines Management Training Scheme Candidates Name:..............................................Organisation:...............................................Module Title:....................................................................... Log Number 1. 2. 3. Date Reflective log title Area of practice covered Page/section/title/activity reference Mistake made whilst completing PODs Communication with patient NPSA Report RRR009 error Self improvement New learning e.g. task 4 Candidate Initials Mentor Initials e.g. Preparation Work A – Reading 4. 5. 6. You must complete at least three reflective logs for this module. Please give your reflective log a suitable title and state what area of practice it covers. (Think about how you would fill in your CPD entries) Area of practice could be a situation or an event involving: errors made, good practice, new learning, peer discussion, new situation, something you could have done better, something you could improve, a new idea to improve a service, etc. Please reference the page number, and the section, or the activity the self reflective log refers to. (Examples in blue type above) Extract taken from GPhC Plan and Record Guidance for CPD (Version ii) The GPhC describes reflection as thinking about things: your practice as a pharmacy technician, identifying change, or developing yourself professionally. It also includes thinking about when things go wrong or not the way you thought they should have: analysing what happened and thinking about how to prevent it happening again. Reflection can also be thinking about conversations you had with colleagues or something you have read. Evaluation of your learning from a situation is also reflection. It means reflecting on (thinking about) what you have learnt and if it has helped you and benefited what you do in your job and how you work. Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber 36 Candidate Name......................................................Organisation....................................................................... Reflective Log Title............................................................. Module Title................................................ Date: The details: Describe what happened. (thinking about the action) Writing down the details helps you look back on the situation and clearly identify what happened. This way you can think about your understanding of the situation, what you did and what you are learning as you record it here. How did it make you feel? (thinking about emotions) Thinking about your emotions means learning from how you felt at the time. Did you feel stressed? Or were you anxious? Were you confident in the situation? Calm? Did you feel happy or relieved that everything went well? It’s important to reflect on your emotions because they tell you a lot about how well you cope in various situations. This often depends on your knowledge, skills and abilities. Why was it important to you? (thinking about your development) Here you might ask yourself how well you did, what you could have done better, and how you can improve. You might realise you need to know more and set in place some more learning. What have you learnt? (Evaluation) Ask yourself what you have actually learnt from what happened that you can now use in your day to day work? What can you do better because of this learning? Have you put in place anything new (either for yourself, your colleagues or pharmacy services) due to your learning. Mentors Comments: Signature of Candidate...................................................................Date................................................... Mentors Signature..........................................................................Date.................................................. 37 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber Appendix 6 - Continuing Professional Development Evaluation (Reflection on Learning) Having completed this module you may wish to use this page to reflect on your learning experience and add it to your GPhC CPD record. CPD No.: _____________________________ Entry No.: Name of Entry: _____________ ___________________________________________________ Date learning undertaken: _____/_____/_____ Time taken: _____________ Action: U1 Please describe the activity you have undertaken (Describe the activity you carried out, being specific about the details) U2 To which areas of competence does this learning relate? (If you cannot find any competences that match, write your own.) U3 What have you learnt as a result? (Briefly describe what you learnt from doing the activities.) Evaluation (Reflection on learning) U4 Please describe an example of how you have applied this learning. (Give an example of how you have used what you have learnt.) U5 Describe any feedback you have had. (This might include users of your services/products, staff and colleagues. The learning may have had an impact on you, for example by affecting your confidence or motivation, and you should record this. Feedback may come in many forms, for example, verbally, through surveys, or through statistics on performance.) U6 Have you identified any learning needs as a result of undertaking this activity? (Tick box) (If so, start a new CPD record that starts with Reflection) Yes No 38 Introduction to Ward/Clinical Environments - Copyright © 2015 Health Education Yorkshire and the Humber