Get Help Breaking Down the Decision Support Tool: Drug Therapies & Medications: Symptom Control, Part 1

This series takes a detailed look at the domains of the Decision Support Tool. This week we examine the first three descriptors in the Drug Therapies & Medications: Symptom Control domain, to help you assess your or your relative’s “level of need” in this important domain.

Catch up on parts one to Sixteen below!

Get Help Breaking Down The Decision Support Tool: An Overview

Get Help Breaking Down the Decision Support Tool: Breathing Part 1

Get Help Breaking Down the Decision Support Tool: Breathing Part 2

Get Help Breaking Down the Decision Support Tool: Nutrition Part 1

Get Help Breaking Down the Decision Support Tool: Nutrition Part 2

Get Help Breaking Down the Decision Support Tool: Continence

Get Help Breaking Down the Decision Support Tool: Skin (including tissue viability), Part 1

Get Help Breaking Down the Decision Support Tool: Skin (including tissue viability), Part 2

Get Help Breaking Down the Decision Support Tool: Mobility, Part 1

Get Help Breaking Down the Decision Support Tool: Mobility, Part 2

Get Help Breaking Down the Decision Support Tool: Communication

Get Help Breaking Down the Decision Support Tool: Psychological & Emotional Needs

Get Help Breaking Down the Decision Support Tool: Cognition, Part 1

Get Help Breaking Down the Decision Support Tool: Cognition, Part 2

Get Help Breaking Down the Decision Support Tool: Behaviour, Part 1

Get Help Breaking Down the Decision Support Tool: Behaviour, Part 2

Following the 2018 revisions of the DST, Drug Therapies & Medications was one of the only domains that did not move, retaining its original place at domain number ten. While it formerly followed Breathing, it now comes after Behaviour. The assessed levels of need in the Behaviour domain range from ‘No Needs’ to ‘Priority’ needs, one of only four domains that include all six possible levels of need.

In any domain with a possible ‘Priority’ level of need, there is potential for an immediate risk to life, should needs not be met or be met improperly. The ‘Priority’ level of need is sufficient to evidence eligibility for NHS Continuing Healthcare funding (CHC), regardless of any other level of need and without examination of the four Key Characteristics.

Needs in the Drug Therapies & Medications domain are perhaps the most straightforwardly health related; medications being prescribed for the management and treatment of an identified health need. Whether the administration of medication by a suitably trained professional is required, depends on the patient’s capacity and ability to take their medication independently, and in the setting of care. The degree of skill required for such administration will depend on the type of medication prescribed, the nature of the prescription (routine or as required), the effectiveness of the medication in managing symptoms, and the degree of risk and potential side effects.

The following clinical factors are relevant to the assessment of needs in this domain:

• Are medications prescribed?
• Are symptoms well-controlled?
• Are there any side effects of the medications?
• Does the person require supervision and/or prompts to take their medication?
• Is the medication administered by a nurse? If so, is this because of the type of medication or the setting of care?
• Is the person compliant with their medication regime?
• What is the risk to the person if medication is not taken as prescribed?
• What is the route of the medication (oral, sublingual, buccal subcutaneous etc.)?
• Is the medication administered via a feeding tube (PEG – percutaneous endoscopic gastronomy)?
• Does the person administering the medication require particular knowledge or skill (e.g., insulin)?
• Does the person experience pain? To what degree?
• Can the person reliably express pain symptoms?
• Is prescribed analgesia effective in managing pain?
• Does pain impact on care in other domains (e.g., mobility, behaviour)?
• Are any medications prescribed on a “PRN” basis (pro re nata = as required)?

The Decision Support Tool provides the following advice to those assessing needs in the Drug Therapies & Medications: Symptom Control domain:

The individual’s experience of how their symptoms are managed and the intensity of those symptoms is an important factor in determining the level of need in this area. Where this affects other aspects of their life, please refer to the other domains, especially the psychological and emotional domain. The location of care will influence who gives the medication. In determining the level of need, it is the knowledge and skill required to manage the clinical need and the interaction of the medication in relation to the need that is the determining factor. In some situations, an individual or their carer will be managing their own medication and this can require a high level of skill.

References below to medication being required to be administered by a registered nurse do not include where such administration is purely a registration or practice requirement of the care setting (such as a care home requiring all medication to be administered by a registered nurse).

Now we’ve outlined the type of things the Multi-Disciplinary Team (MDT) will be considering in this domain, let’s take a look at the descriptors for the first three levels of need. For each level of need, we provide a case study to give you a better understanding of how the descriptors might be applied at your or your relative’s assessment.

NO NEEDS

CASE STUDY – NO NEEDS

Mr. X takes his medication independently, as prescribed by the GP.

His medication regime is non-complex and routinely prescribed. He does not complain of any side effects or unmanaged symptoms.

Mr. X does experience pain in the mornings and takes paracetamol as required with good effect.

Current medication:

Simvastatin 10mg tablets take one each day

Paracetamol 500mg tablets one or two to be taken up to four times a day when required

Citalopram 20mg tablets take one each day

Mr. X presents with ‘NO NEEDS ‘ as his symptoms are managed effectively and without any problems, and medication is not resulting in any unmanageable side-effects.

LOW

CASE STUDY – LOW

Medication Administration Record (MAR)

Aripiprazole 5mg tablets take half a tablet each day (antipsychotic)

Baclofen 5mg/5ml oral solution take two 5ml spoonful three times a day (antispasmodic)

Clopidogrel 75mg tablets take each day (antiplatelet medicine)

Donepezil 5mg tablets take one tablet at night (Memory enhancer)

Fenbid 5% gel apply to right shoulder up to three times a day

Paracetamol 500mg tablets one or two to be taken up to four times a day when required

Senna 7.5mg tablets take 2 tablets at night for constipation, may be omitted if bowels loose

Sertraline 50mg tablets take one each day

Mrs X is reliant on trained staff for the administration and monitoring of her medication due to cognitive impairment and being a resident in a care home. Mrs X will take her medication from a spoon with either water or juice. Care records indicate she is compliant with her medication.

Mrs X does experience some arthritic pain in the mornings, for which she is prescribed paracetamol and analgesic gel with good effect. She is able to let carers know if she is in pain and pain is not impacting on her mobility or other care domains.

Mrs X presents with a ‘LOW’ level of need as she requires supervision/administration of and/or prompting with medication but shows compliance with medication regime, and she experiences mild pain that is predictable and/or is associated with certain activities of daily living. Pain and other symptoms do not have an impact on the provision of care.

MODERATE

CASE STUDY – MODERATE

Mr. X is nil-by-mouth, and all his medications are administered to him via his PEG-tube by a registered nurse.

Mr. X is prescribed a non-complex medication regime which is reviewed routinely by the GP every 6 months. There have been no recent changes or titrations.

All Mr. X’s medications are routinely prescribed, and no PRN medication is documented to be used at this time.

The GP undertakes six-monthly blood tests to check phenytoin levels as Mr. X is prescribed this drug long term.

Mr. X is unable to express symptoms of pain and staff use the Abbey Pain Scale to monitor his condition. Paracetamol is administered four times a day with good effect.

Current medication:

Hyoscine butyl bromide 20mg QDS

Jevity Promote liquid feed 1 litre

Paracetamol 1g QDS

Phenytoin 40mls OD

Mr. X presents with a ‘MODERATE’ level of need as she requires the administration of medication (by a registered nurse, carer or care worker) due to: route of medication (for example PEG).

We hope this has helped you to understand the first three descriptors in the Drug Therapies & Medications: Symptom Control domain.  Don’t miss Part 2, coming very soon!

If you need help assessing your relative’s level of need in any domain on the DST, don’t hesitate to contact us or  speak to one of our specialist Advice Lines to discuss your case today.

Telephone: 0161 979 0430 or email: enquiries@caretobedifferent.co.uk

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