Keech Hospice Care

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This assessment was focused on the quality statement of medicines optimisation. We rated medicines optimisation as good during this assessment because we found that the service had robust processes in place for medicines reconciliation and prescription stationary management. A contract was in place to provide a clinical pharmacy service.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were no current inpatients at the time of our visit and we were therefore unable to gather feedback from patients, relatives or carers. We have not received any concerns about people’s experience of medicines optimisation since the time of our last inspection.

A weekly clinical pharmacy service has been provided on site since February 2024 by a visiting pharmacist. Medicine information and advice can be obtained outside of the weekly visit. Supplies were obtained from a local community pharmacy. The visiting pharmacist checked appropriateness of pharmaceutical treatment, prescribing and administration and provided feedback after each visit to the service. The service was advised of actions that needed completing through a bespoke electronic system. These were monitored by the pharmacist to ensure completion. The clinical pharmacist attended the multi-disciplinary team (MDT) meeting. Staff were positive about the impact of the clinical pharmacy service that was now in place. The clinical pharmacist was involved in training staff in medicines management.

Prescription stationery was securely stored within the Controlled Drugs cupboard in the treatment room which only authorised staff could access. We saw two adult patients, who had recently been inpatients, had a medicines reconciliation fully completed by medical staff. Medicine reconciliation is the process where staff check that patients have the correct medicines when they move between services or are admitted from home. Quantities of medicines brought in by patients or their families were recorded by nurses. One child was expected to come in for day care whilst we were there. We saw that a parental drug chart had been sent by the parents ahead of the admission which had been completed with all the details of the child’s current medicines. This was used by the admitting doctor to cross check against other current records to ensure a full medicines reconciliation had been completed and all medicines were accurate.

A medicines policy was in place and was currently undergoing review, both the medicines reconciliation process and prescription stationery governance were covered in policy and reflected current practice. The service had a central database for tracking prescription stationery, this accounted for every prescription within the organisation, whether it had been used or whether it was destroyed. This process was regularly audited. Medicines reconciliation was completed by the medical staff using a proforma within the electronic system. There was no oversight of the medicines reconciliation rate and an audit of the process had not been completed. The Clinical Safety and Assurance Group (CSAG) reviewed medicines incidents monthly and informed the medicines management committee of any emerging themes and trends. Staff told us they benchmarked against other hospices with regards to incident reporting. The medicines management committee met quarterly, and minutes from May 2024 showed a well-attended meeting where learning from incidents, policy and procedure changes, training, feedback from external meetings and correspondence from relevant bodies were discussed. Medicine audits were being completed within the service, the controlled drugs audit had been completed in the Children’s unit in May 2024 and the adult controlled drugs audit was due to be completed once the service resumed admissions.