NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST. Medicines Policy: Code of practice Complementary Therapy

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1 NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST Medicines Policy: Code of practice Complementary Therapy Reference CL/MM/07 Approving Body Senior Management Team Date Approved 9 February 208 Implementation Date 9 February 208 Version version 5 Summary of Changes from Previous Version Updated contacts and references section 0 Supersedes CL/MM/07 version 4 Dec 4 Consultation Undertaken Medicines Management Committee Date of Completion of Equality Impact Assessment Date of Completion of We Are Here for You Assessment Date of Environmental Impact Assessment (if applicable) Legal and/or Accreditation Implications Target Audience th Dec 207 th Dec 207 th Dec 207 Nil Review Date st December 2020 Lead Executive Be specific and only list those who need to be aware of the Policy/ Procedure. You should avoid using All staff unless relevant and essential. Medical Director Author/Lead Manager Professor Mojgan Sani Head of Pharmacy and Clinical Director of Medicines Optimisation Ext 699 Further Guidance/Information Sonia Gilmore Secretary to Medicines Management Committee Ext Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208

2 CONTENTS Paragraph Title Page. Introduction 3 2. Executive Summary 3 3. Policy Statement 3 4. Definitions (including Glossary as needed) 3 5. Roles and Responsibilities 4 6. Policy and/or Procedural Requirements 4 7. Training, Implementation and Resources 6 8. Impact Assessments 6 9. Monitoring Matrix 8 0. Relevant Legislation, National Guidance 9 and Associated NUH Documents Appendix Equality Impact Assessment 0 Appendix 2 Environmental Impact Assessment 2 Appendix 3 Here For You Assessment 4 Appendix 4 Certification Of Employee Awareness 6 Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 2

3 .0 Introduction. Patients are often taking complementary therapy which they have bought themselves. This policy outlines the potential hazards of complementary therapy and the responsibilities of health care professionals to identify patients on complementary therapy. 2.0 Executive Summary 2. All staff must be alert to patients wishing to use complementary therapy, particularly in vulnerable groups of people. Prescribers must ask patients about the use of these therapies which are not prescribed by health professionals, and be alert to hazards which may arise from their use such as drug interactions, or adverse drug reactions. 3.0 Policy Statement 3. The Trust acknowledges that patients may wish to use complementary therapy. This policy enables identification of these patients and ensures that use of these therapies are documented. 4.0 Definitions 4. Glossary Complementary and alternative medicine (CAM)-a broad term that includes herbal products, nutritional supplements, homeopathic medicines, aromatherapy oils and many other beliefs, therapies and practices (e.g. yoga, massage) Herbal preparations- contain plant derived material, either as raw or processed ingredients which may be from one or more plants 2 Homeopathy- a holistic complementary and alternative therapy based on the concept of like to treat like, and involves the administration of dilute and ultradilute products prepared according to methods given in homeopathic pharmacoepeias 2 Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 3

4 5.0 Roles and Responsibilities 5. Committees Medicines Management Committee are responsible for ensuring this policy is kept up to date 5.2 Individual Officers Individual practitioners must be alert to patients currently taking complementary and alternative medicines. They must follow the appropriate policies to ensure that use of these therapies by patients is identified an early stage of the admission. 6.0 Policy and/or Procedural Requirements 6. HOMEOPATHIC MEDICINES, HERBAL MEDICINES AND FOOD SUPPLEMENTS Complementary and alternative medicines, such as homeopathic medicines, herbal medicines and food supplements are taken by many people. There is an erroneous perception that because such products are natural they are free from safety issues. In addition some patients are unwilling or do not think it necessary to tell health professionals that they are taking such therapy. Practitioners must actively ask patients if they are taking or wishing to take alternative therapy. This should be done during the medicines reconciliation process at admission, or at other times when a medicines are discussed with the patient (refer to Medicines reconciliation policy CL/MM/03 and Prescribing policy CL/MM/006). Potential hazards include: interactions with conventional prescribed medicines adverse reactions or toxicity to alternative therapy- some herbal therapy can be potent or toxic disease flare up whilst taking alternative therapy patients self-treating an undiagnosed disease self-treatment of a serious medical condition with alternative therapy in preference to conventional medicine Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 4

5 Vulnerable groups of patients include paediatric patients, terminally ill patients, patients with difficult to treat or chronic illnesses (in which long term usage of herbal medicines may occur), older patients, and pregnant or breastfeeding patients. The presentation of such products may include amongst other things: topical medicines, powders, tablets and capsules. The use of patient's own homeopathic medicines, herbal medicines or food supplements must be discussed with a doctor and they must be documented in the medical notes and on the medicines communication section of the in-patient drug chart before they are used in the hospital. Advice regarding the content of a product or specific drug interactions may be obtained from the Pharmacy Medicines Information department. If the patient requests advice on complementary therapy, the health care professional should contact a pharmacist or the Pharmacy medicines information department. If the patient wishes to continue to use their complementary medicines, the patient or their carers must obtain further supplies themselves and should inform staff that they are continuing to take these preparations. They will not be supplied through the NUH pharmacy. 6.2 AROMATHERAPY AND OTHER COMPLEMENTARY THERAPIES NOT COVERED BY SECTION 6. Any member of NUH staff who performs any such therapies must have undertaken specific accredited training. The member of staff must also have the agreement of the appropriate clinical lead to carry out any complementary therapy within the Trust. The patient must consent to any complementary therapy. Supplies of materials and equipment used for such therapies may only be obtained from NUH approved suppliers. Appropriate protocols must be agreed for local use. Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 5

6 7.0 Training and Implementation 7. Training This is an existing procedure and training will take place via the training already in place. 7.2 Implementation This policy will be published on the Trust intranet. Communication to staff will be via the usual routes. 7.3 Resources No additional resources are required. 8.0 Trust Impact Assessments 8. Equality Impact Assessment An equality impact assessment has been undertaken on this draft and has not indicated that any additional considerations are necessary. 8.2 Environmental Impact Assessment An environmental impact assessment has been undertaken on this draft and has not indicated that any additional considerations are necessary. 8.3 Here For You Assessment A Here For You assessment has been undertaken on this document and has not indicated that any additional considerations are necessary. Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 6

7 Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 7

8 9.0 Policy / Procedure Monitoring Matrix Minimum requirement to be monitored Prescribing of CAM Incident data Responsible individual/ group/ committee Individual divisions/ specialties Individual divisions/ specialties Process for monitoring e.g. audit Prescribing audit Monitoring of DATIX data Frequency of monitoring Ongoing Ongoing Responsible individual/ group/ committee for review of results Divisional/ local Governance Forum Divisional/ local Governance Forum Responsible individual/ group/ committee for development of action plan Divisional/ local Governance Forum Divisional/ local Governance Forum Responsible individual/ group/ committee for monitoring of action plan Divisional/ local Governance Forum/ MMC Divisional/ local Governance Forum/ MSG Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 8

9 0.0 Relevant Legislation, National Guidance and Associated NUH Documents 0. List all of the following which are relevant:. Legislation-European Traditional Herbal Medicinal Products Directive National Guidance-MHRA alert Public Health Risk with herbal medicines: an overview Policy Division July Associated NUH Documents CLMM03 medicines reconciliation on admission to hospital References:. UK Medicines Information Service 2. Royal Pharmaceutical society 202 Homeopathic and herbal remedies: A quick reference guide 3. Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 9

10 Insert templates of relevant impact assessments (page break after each) APPENDIX Equality Impact Assessment (EQIA) Form (Please complete all sections) Q. Date of Assessment: th December 207 Q2. For the policy and its implementation answer the questions a c below against each characteristic (if relevant consider breaking the policy or implementation down into areas) Protected Characteristic a) Using data and supporting information, what issues, needs or barriers could the protected characteristic groups experience? i.e. are there any known health inequality or access issues to consider? The area of policy or its implementation being assessed: b) What is already in place in the policy or its implementation to address any inequalities or barriers to access including under representation at clinics, screening Race and no no no Ethnicity Gender No no no Age No no no Religion No no no Disability No no no Sexuality no no no c) Please state any barriers that still need to be addressed and any proposed actions to eliminate inequality Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 0

11 Pregnancy and No no no Maternity Gender no No no Reassignment Marriage and no no no Civil Partnership Socio-Economic no no no Factors (i.e. living in a poorer neighbour hood / social deprivation) Area of service/strategy/function Q3. What consultation with protected characteristic groups inc. patient groups have you carried out? None Q4. What data or information did you use in support of this EQIA? None Q.5 As far as you are aware are there any Human Rights issues be taken into account such as arising from surveys, questionnaires, comments, concerns, complaints or compliments? No Q.6 What future actions needed to be undertaken to meet the needs and overcome barriers of the groups identified or to create confidence that the policy and its implementation is not discriminating against any groups-none What By Whom By When Resources required Q7. Review date st December 2020 Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208

12 Environmental Impact Assessment APPENDIX 2 The purpose of an environmental impact assessment is to identify the environmental impact of policies, assess the significance of the consequences and, if required, reduce and mitigate the effect by either, a) amend the policy b) implement mitigating actions. Area of impact Waste and materials Soil/Land Water Air Environmental Risk/Impacts to consider Is the policy encouraging using more materials/supplies? Is the policy likely to increase the waste produced? Does the policy fail to utilise opportunities for introduction/replacement of materials that can be recycled? Is the policy likely to promote the use of substances dangerous to the land if released (e.g. lubricants, liquid chemicals) Does the policy fail to consider the need to provide adequate containment for these substances? (e.g. bunded containers, etc.) Is the policy likely to result in an increase of water usage? (estimate quantities) Is the policy likely to result in water being polluted? (e.g. dangerous chemicals being introduced in the water) Does the policy fail to include a mitigating procedure? (e.g. modify procedure to prevent water from being polluted; polluted water containment for adequate disposal) Is the policy likely to result in the introduction of procedures and equipment with resulting emissions to air? (e.g. use of a furnaces; combustion of fuels, emission or particles to the atmosphere, etc.) Action Taken (where necessary) NO NO n/a NO n/a NO NO n/a NO Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 2

13 Energy Nuisances Does the policy fail to include a procedure to mitigate the effects? Does the policy fail to require compliance with the limits of emission imposed by the relevant regulations? Does the policy result in an increase in energy consumption levels in the Trust? (estimate quantities) Would the policy result in the creation of nuisances such as noise or odour (for staff, patients, visitors, neighbours and other relevant stakeholders)? n/a n/a NO NO Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 3

14 We Are Here For You Policy and Trust-wide Procedure Compliance Toolkit APPENDIX 3 The We Are Here For You service standards have been developed together with more than,000 staff and patients. They can help us to be more consistent in what we do and say to help people to feel cared for, safe and confident in their treatment. The standards apply to how we behave not only with patients and visitors, but with all of our colleagues too. They apply to all of us, every day, in everything that we do. Therefore, their inclusion in Policies and Trust-wide Procedures is essential to embed them in our organization. Please rate each value from 3 ( being not at all, 2 being affected and 3 being very affected) Value Score (- 3). Polite and Respectful Whatever our role we are polite, welcoming and positive in the face of adversity, and are always respectful of people s individuality, privacy and dignity. 2. Communicate and Listen We take the time to listen, asking open questions, to hear what people say; and keep people informed of what s happening; providing smooth handovers. 3. Helpful and Kind All of us keep our eyes open for (and don t avoid ) people who need help; we take ownership of delivering the help and can be relied on. 4. Vigilant (patients are safe) Every one of us is vigilant across all aspects of safety, practices hand hygiene & demonstrates attention to detail for a clean and tidy environment everywhere. 5. On Stage (patients feel safe) Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 4

15 We imagine anywhere that patients could see or hear us as a stage. Whenever we are on stage we look and behave professionally, acting as an ambassador for the Trust, so patients, families and carers feel safe, and are never unduly worried. 6. Speak Up (patients stay safe) We are confident to speak up if colleagues don t meet these standards, we are appreciative when they do, and are open to positive challenge by colleagues 7. Informative We involve people as partners in their own care, helping them to be clear about their condition, choices, care plan and how they might feel. We answer their questions without jargon. We do the same when delivering services to colleagues. 8. Timely We appreciate that other people s time is valuable, and offer a responsive service, to keep waiting to a minimum, with convenient appointments, helping patients get better quicker and spend only appropriate time in hospital. 9. Compassionate We understand the important role that patients and family s feelings play in helping them feel better. We are considerate of patients pain, and compassionate, gentle and reassuring with patients and colleagues. 0. Accountable Take responsibility for our own actions and results. Best Use of Time and Resources Simplify processes and eliminate waste, while improving quality 2. Improve Our best gets better. Working in teams to innovate and to solve patient frustrations TOTAL 2 Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 5

16 APPENDIX 4 CERTIFICATION OF EMPLOYEE AWARENESS Document Title Medicines Policy: Code of practice Complementary therapy Version (number) 5 Version (date) 9 February 208 I hereby certify that I have: Identified (by reference to the document control sheet of the above policy/ procedure) the staff groups within my area of responsibility to whom this policy / procedure applies. Made arrangements to ensure that such members of staff have the opportunity to be aware of the existence of this document and have the means to access, read and understand it. Signature Print name Date Division/ Directorate The manager completing this certification should retain it for audit and/or other purposes for a period of six years (even if subsequent versions of the document are implemented). The suggested level of certification is; Clinical Divisions - Divisional General Manager or nominated deputies Corporate Directorates - deputy director or equivalent. The manager may, at their discretion, also require that subordinate levels of their directorate / department utilize this form in a similar way, but this would always be an additional (not replacement) action. Medicines Policy: Code of practice Complementary therapy CL/MM/07 version 5 February 208 6