Background St Catherine's Hospice (StCH) Community team provides clinical advice and practical nursing support for palliative care patients living at home as part of shared care arrangements with the patient's primary care team. Following on from Accountable Officer work undertaken within the hospice Medicines Management Group, a significant gap in the support of community nursing staff from the hospice in the management of controlled drugs (CDs) was identified. Unlike in the inpatient setting, few guidelines incorporating regulations and Care Quality Commission outcomes could be found that explained processes for safely managing CDs in the home. The hospice catchment area spans two counties and Primary Care Trusts. The guidelines available within the community for the teams from the hospice to refer to regarding safe and supportive practice were inconsistent.
Aim Produce clear guidelines for hospice community teams on the safe handling of CDs in the patient's home. Document CD processes on appropriate locality specific paperwork, ideally witnessed by two hospice staff.
Conclusion The process of a second signature for a CD check is best practice and in the community setting this is achieved within a hierarchy of what is practical, safe for the practitioner and in the best interests of the patient, by either:
▶ Another member of the community team
▶ A care worker
▶ A relative/carer (if judged not to cause distress).
A StCH drug incident form is now completed and processed if errors/discrepancies are found. As part of last offices and verification of death in the home all CDs are now checked and signed off and accounted for as the hospice team leave the family. Unused CDs are returned to the pharmacy by the patient's family. If there is any concern about leaving CDs in the home a risk assessment is completed.
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