Choose well: who should I contact for medical advice? Half a tablet

Issue 10, September 2014
Newsletter for Care Home staff, General Practitioners and Community Pharmacists
Choose well: who should I contact for medical advice?
When a resident is feeling unwell or requires medical intervention it is worthwhile considering all options
before asking for a visit from the GP to see the resident at the care home.
Your local pharmacist:
 Provides advice on medication, interactions and side effects. This can be particularly useful if a
resident has recently started a new medication and you are not sure if the symptoms the resident is
experiencing could be due to the new medication.
 Will advise on minor ailments e.g. coughs and colds.
 Many pharmacies are open late in the evening and at weekends.
NHS 111:
 You can call 111 at any time when you need medical help fast but it’s not a 999 emergency.
 Will provide you with health information or reassurance about what to do next.
 This service is particularly useful out of hours when problems arise and advice is required.
If the resident is able to go to the surgery then book an appointment for them:
 If possible this will always be preferable to a visit as the GP will have access to full patient information.
If you consider that you do need to speak to the resident’s GP practice to ask for a visit:
 Contact the GP surgery as early as possible in the day to request a visit. This
will enable the surgery to arrange their time efficiently and prepare for the
 Ensure all residents who require a visit are named at the time of the request to
enable the GP to access the resident’s notes before the visit.
 Avoid asking the GP to see extra people on arrival at the Care Home as they
will not have access to the resident’s notes.
Half a tablet - Cautionary notes
Splitting tablets in half is not routine practice for many medications as this can affect the way
they are absorbed and also makes the medicine unlicensed. However, there may be occasions
where a dose of a medication is required that can only be provided by splitting a tablet in half,
as the dose is not available as a standard tablet. Splitting tablets in half should only occur where advised by
the resident’s prescriber.
Not all tablets are suitable for splitting in half. Before a tablet is prescribed as half a tablet, it is important the
prescriber checks to ensure it is safe to split the tablet. If safety cannot be confirmed, then the GP should
contact the manufacturer or local medicines information for further advice.
Confusion can arise when half a tablet is prescribed. It is important:
 The GP ensures the dose on the prescription is printed in words (e.g. half a tablet to be taken in the
morning) not in numbers (e.g. ½ a tablet in the morning). Using numbers could potentially lead to a
dispensing error if the pharmacist misread ½ as 1-2 tablets in the morning.
 Care homes should have information in their medication administration policy on how to deal with half
 If care homes have a resident prescribed half a tablet and this is causing a problem they should discuss
this with their supplying pharmacy
 Care home staff must be aware of medications that are to be given as half a tablet. Where tablets have
already been halved (e.g. by the pharmacist) care must be taken to ensure these tablets do not
mistakenly get halved again on administration.
 Where care home staff need to halve a tablet use of a tablet cutter is preferred
 Where tablets are issued from an original pack, consideration should be given to what will happen with the
remaining half. Some tablets need to be kept airtight and once popped from the blister pack should be
taken immediately and the remaining half disposed of via the usual pharmaceutical waste method.
 All parties should document any advice sought in the resident’s medical records, notes or care plan.
Controlled drug (CD) cupboards in care homes
Providers of adult care homes must comply with the Misuse of Drugs Act 1971 and
associated regulations when storing controlled drugs. The Health and Social Care Act 2008
Regulation 13 states that ‘The registered person must (have) appropriate arrangements for…
safe keeping… of medicines’.
If a care home does not have any controlled drugs on the premises and does not have suitable
controlled drug storage, they would not be in breach of the Misuse of Drugs Act. However, to comply with The
Health and Social Care Act, they must evidence that they have a suitable arrangement to store the medicines
should they be needed. This ensures that there is no delay to a resident’s treatment should they be
prescribed a controlled drug and the manager would not be in breach of the Misuse of Drugs legislation
(which could be prosecuted by the police).
Care homes often have cupboards and registers that they are not using. Some care homes have other
arrangements, e.g. groups of homes may have one cupboard available in a head office that can be fitted at
very short notice wherever it is first needed and then another purchased; eventually all the homes will be
Care homes who infrequently use their CD cupboards may have a tendency to store other items in the
cupboard. CD cupboards should only be used for the storage of CDs and no other medication or valuables
should be stored in the cupboard (except for “Just in case boxes” when if space permits the whole box should
be stored in the CD cupboard– see guidance sheet for further details).
Treatment Escalation Plan - New Version of TEP to be released September 2014
A new version of the TEP form (Version 10) will be released for use in the Devon wide community in early
September 2014. This new version incorporates a new section to document mental capacity / best interest
decisions and is more user friendly than the existing version (Version 9). The new version will be
accompanied by a guide regarding completing TEP forms and an information sheet on frequently asked
questions around TEP.
Any existing stocks of TEPs can be continued to be used. Any existing TEP forms in place do not need to be
replaced unless there is a clinical reason to do so.
Information regarding TEP can be found on the following website:
Supplies of TEP forms for:
 NEW Devon CCG can be continued to be obtained by telephone on: 01752 246501
emailing: [email protected]/ or [email protected]
Torbay & South Devon Health Care Trust can be obtained by contacting Narnia Kestell, Service
Coordinator on 01803 547113 [email protected]
Useful websites to visit
We are pleased to announce Northern, Eastern and Western Devon Clinical
Commissioning Group has created a dedicated webpage to share our Caring for Care
Homes newsletters and guidance sheets. See the below link:
You will also find the link to the NICE guideline ‘Managing medicines in care homes’.
Please remember, you can still continue to access care home guidance sheets, newsletters and other
information through the following links:
Another important website that we feel you would find useful is the breathe better website. This
website has been designed to help patients, residents, carers and healthcare professionals
improve inhaler technique. You will find some excellent resources and helpful videos to watch
on this website. For more detail please visit:
To contact us please email: [email protected]
Keeping well and protecting our residents
Seasonal flu vaccination
It’s the start of flu season again and vaccines will be available from September onwards.
Flu is a serious illness
There are around 75,000 GP consultations, 27,000 hospitalisations and 900 intensive care admissions for
flu in England each year. In 2012-13 there were estimated to be 11,000 deaths attributable to influenza.
Flu is especially serious for those with underlying health conditions, including those in long term care.
Vaccination is the best way of protecting people, including the over-65s, those with underlying health
conditions, and frontline care staff.
Duty of care to our residents
The National Influenza Plan 2014/15 sets out our responsibilities as employers:
‘Frontline health and social care workers have a duty of care to protect their patients and service
users from infection. This includes getting vaccinated against flu.’
‘It is important that health and social care workers protect themselves by having the flu vaccine, and,
in doing so… reduce the risk of spreading flu to their service users, colleagues and family members’.
Influenza vaccination is also an important tool helping us to build organisational resilience during the
Winter months, reducing sickness absence and disruption to essential services.
Key actions for care home managers
 Promote awareness of vaccination among all eligible staff;
Strongly encourage all frontline staff to take up vaccination;
Make it easy for staff to get their vaccination (e.g. in work time if feasible) and to obtain
Encourage all staff to be champions and advocates of vaccination with colleagues and their clients;
Monitor and report uptake of vaccination among staff teams.
The earlier people are vaccinated, the better the protection against influenza for both staff and clients.
Vaccines will be available from September 2014.
How to obtain vaccination
Vaccination is free to all 65 years and over, carers, pregnant women, people with a clinical risk condition,
and children 2, 3 and 4 years old. More information on eligibility can be found at:
vaccinations/pages/who-should-have-flu-vaccine.aspx . Frontline care workers should be able to obtain
free vaccination, either arranged or reimbursed through their employer. Further information can also be
found on the NHS Employers Flu Fighter campaign website:
Vaccination is the best protection
Some of the barriers to vaccination are fear of side-effects. Vaccination has been shown to be the safest
and most effective protection against flu. Key messages are:
Influenza can be a serious illness, especially for those with existing health conditions;
Vaccination is the most effective protection against influenza;
The vaccination cannot cause influenza as it does not contain the active virus;
Vaccination can help keep you, and those you are in contact with, healthy this Winter, and prevent
you taking time off work with flu.
More information please visit:
NHS Choices -
10 myths about the flu and the flu vaccine -
Useful Contacts:
Plymouth / South Hams: Tracy Fabiano, Public Health England Screening & Immunisation Coordinator
([email protected])
Ruth Harrell, Consultant in Public Health, Plymouth City Council ([email protected],gov,uk)
Torbay and North Devon: Lisa Adams, Public Health England Screening & Immunisation Coordinator
([email protected])
Linda Churm, Acting Consultant in Public Health, Torbay Council ([email protected] )
Exeter, Mid & East Devon: Matt Harris, Public Health England Screening & Immunisation Coordinator
([email protected])
Julia Chisnell, Specialty Registrar in Public Health ([email protected]) or Sarah Bird,
Advanced Public Health Practitioner, Devon County Council, ([email protected])
Information supplied from Public Health, Devon County Council
To contact us please email: [email protected]