Domain One: The Patient Experience
Domain 1 focus on the patient experience and communication between the patient and clinical team
**** Content on this page is referenced from the RPS Homecare Handbook and Professional Standards document****
Standard 1: Patient Engagement1 2
1.1 Informed choice
This standard recognises the integral role that patients and carers play in the delivery of a successful homecare delivery experience. Trust should provide clear and consistent information about their medicine pathways and the role of homecare medicine service. Homecare services should comply with the NHS Homecare Patient Charter which was created by the Patient Charter Workgroup of the Homecare Strategy board.
Useful example from RPS Homecare handbook appendices
1.2 Information about Homecare Services
It is important that patients are supported in their decision making process when trust are counselling them about the homecare medicine service. Trust should endeavour to provide comprehensive information in clear language. General information should include:
- Information about their medicines in a form they can understand
- Access to an appropriate healthcare professional to discuss medicines
- Details on contacting the homecare team (NHS and service provider) within normal working hours and out of hours
- Information about homecare services in a form they understand
- Information about complaints process for homecare services
- Information about how their personal data will be used to provide the homecare service
- Options available should the patient wish to switch to an alternative route of care
It is recommended by RPS that further information is included about the homecare medicine service:
Patients’ rights and responsibilities and/or copy of the relevant patient charter
Summary of the benefits and risks of homecare services
The treatment and expected outcomes
Information regarding the medication and potential side effects – the patient will receive a PIL with the medication, however the trust should consider if the patient would benefit from additional or summary information aimed specifically to the homecare service.
What patients’ are to expect from a homecare service. Provide an overview on the delivery, administration, storage of medicines and the removal of waste (if applicable)
How the patients’ GP will be informed about the homecare service provided
Useful example from RPS Homecare Handbook appendices
1.3 Adherence to medicines pathway
The RPS recommends that trusts use the NHMC combined registration and consent form for the registration of patients in homecare services. Trusts can use a form of their own design, however it is strongly recommended that all the components of the template are retained as a minimum to ensure consistency of approach to patient homecare registration
The patient information record form provides clinician’s and the patient with a standard script which is used during the referral process. This records provides assurance that up-to-date, relevant information regarding the homecare medicine service has been discussed during the counselling process. The form is signed by the patient (or carer) at the end of the referral process and the document stored in the patient notes. The patient information record form is intended for NHS internal use only.
Patient adherence to their medicine pathway and their compliance with the provisions of homecare services should be regularly reviewed. Patient/carers competency to self-administer their medication should be reviewed. Where a patient is experiencing difficulties, there must be adequate support or help to comply with the homecare medicine pathway
1.4 Patient needs and responsibilities
The trust should establish system to ensure patients are appropriately counselled about the homecare medicine service and understand their responsibilities for adhering to the medicine pathway and provisions of the homecare service.
Standard 2: Episode of Care 1 2
2.1 On referral to homecare services
The trust should establish systems to identify patients who may need support adhering to their medicine pathway or to request additional support. The patient should be routinely assessed by a healthcare professional to provide assurance that the patient is competent to self-administer medicines and to provide support when needed. RPS provides a template which can be amended/branded by NHS trusts.
The assessment of whether homecare is suitable for an individual patient should also take into account the home environment and the assessment should include the following (but not limited to):
Patients’ willingness and ability to receive treatment at home as well as understanding their responsibilities with regard to the treatment
Patients’ competence to self-administer medicines
Suitability of home
Safe storage of medicines, risk of cross contamination
Infection prevention, appropriate ancillaries and competent use of equipment
Access for delivery/nursing staff
Workplace health and safety – slips and trips, smoking, pets etc.
Potential risks to patients caused by the introduction of homecare equipment
2.2 Ongoing care of homecare patients
Patients who are receiving homecare services must be reviewed on a regular basis in accordance with their medicine pathways or care plan. The service must have procedures in place to manage changes to dosages, changes to medication and services to ensure continuity of care and safeguard patient safety. Clinical records must be updated and shared in a timely manner with relevant homecare professionals.
The following procedures will help to establish a robust system:
Patient medicine dose changes – a clear communication strategy is required from clinician to pharmacy and homecare supplier
Process for dealing with patients who have stopped or halted treatment to avoid wastage of medicines or the patient continuing unnecessary treatment
Process for managing patients who fail to attend review appointments and blood tests
2.3 Monitoring patients’ outcomes
Patient reviews should monitor the following:
Patients’ response to their medicines
Compliance with the medicines pathway
Side effects of medicines
Complaints regarding the medicine/service
There must be a robust procedure for managing and resolving patient identified homecare issues. Patients should be surveyed to monitor and guide improvements in homecare services.
Standard 3: Integrated Care 1 2
3.1 Effective communication and continuity of professional duty of care
The Chief Pharmacist (or equivalent) for NHS trusts are responsible for ensuring the trust homecare team have the skills and experience necessary to make suitability assessments and provide an escalation mechanism for resolution of issues. All homecare team members should have access to necessary information to be able to discharge their duty of care. Clinic and service notes must be completed, accurate and up-to-date.
3.2 Working with other professions
The Medical Director and Nursing Director are involved with the Chief Pharmacist in setting homecare strategy and risk assessment of services. There must be a robust complaint and incident reporting system and at that earliest opportunity complaints should be investigated and a root cause analysis completed.
Homecare services should be regularly reviewed to provide assurance that services are effective and safe for patients. Trusts can complete the RPS Homecare Standards Audit to assess current service provisions against best practice principles.
3.3 Working with multiple regulatory frameworks
The Chief Pharmacist or equivalent must maintain a working knowledge of all current regulations and standards applicable to homecare services.
1 Professional standards for Homecare Services in England – Royal Pharmaceutical Society (2013)
2 Handbook for Homecare Services in England – Royal Pharmaceutical Society (2014)
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