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Earlier this year NICE launched a guideline on managing medicines in care homes that should be a 'must read' for pharmacists. Asha Fowells reports

RECENT GUIDANCE ON medicines management in care homes published by the National Institute for Health and Care Excellence (NICE) is relevant to any pharmacy that has any form of involvement with care homes, no matter how small. The guidance will form a significant part of a NICE quality standard that is likely to be published in the first half of 2015.

It is worth noting that the guideline does not cover specific conditions or medicines, but considers the prescribing, handling and administration of medicines to residents living in care homes and the provision of care or services relating to medicines €“ including related products such as continence supplies and other appliances €“ in such an environment.

Although the document encompasses both residential and nursing homes in its definition of €care homes€, it does not deal with domiciliary care settings.

Recommendations

'Managing medicines in care homes' makes 17 recommendations for good practice:

€¢ Develop and review policies for safe and effective medicines use

As a provider of healthcare services, pharmacies need to ensure it is clear who is accountable and responsible for using medicines safely in the care home. Pharmacies can also help care homes develop and review their medicines policies to ensure they are up-to-date and useful, and include written processes covering most of the other recommendations.

€¢ Support residents to make informed decisions

It is now widely accepted that patients should be involved in decisions about their treatment and care, but this is sometimes overlooked for care home residents who may be perceived as less capable and/or interested.

This recommendation includes the advice that care home staff should inform pharmacies if a resident refuses to take a certain product, in order that further supplies and wastage can be prevented, although patient consent for this information to be passed on should be obtained.

€¢ Share information about a resident's medicines

Pharmacies can assist in this by providing a summary sheet if a resident is transferring to another care setting (including hospital) and advise on the best way for staff members to convey medicines' information to one another (e.g. at shift handovers).

€¢ Ensure that records are accurate and up-to-date

This should include the resident's care plan, medicines administration record (MAR) and recording information from prescriptions and correspondence about medicines (e.g. emails, letters, phone messages).

€¢ Identify, report and review medicines-related problems

The pharmacist is likely to be the first port of call regarding any adverse effects that arise as a result of medication, whether correctly or incorrectly given, but the prescriber should also be informed, and the details recorded in the resident's care plan and on the patient medication record at the pharmacy (assuming patient consent has been given).

€¢ Keeping residents safe

Safeguarding is not normally thought of in relation to medicines, but is hugely important. All suspected and confirmed medicines-related safety incidents, including near misses and incidents that do not result in any harm, should be recorded and reported according to local arrangements, and an investigation conducted. The care home medicines policy should clearly state when the appropriate regulatory authority (usually the Care Quality Commission) must be notified.

The guidance is relevant to any pharmacy with an involvement in care homes

€¢ Accurately listing a resident's medicines (medicines reconciliation)

This should involve a pharmacist, the resident, and/or their family members or carers, plus any other relevant health and social care practitioners, and form part of a full needs assessment and care plan. When transferring into or out of a care home, the following information should be available:

€¢ Full name, date of birth, NHS number, address and weight of resident

€¢ Details of GP and any other relevant contacts defined by the resident and/or their family members or carers (e.g. consultant, regular pharmacist, specialist nurse)

€¢ Known allergies and reactions to medicines or ingredients

€¢ Medicines the resident is currently taking, including name, strength, form, dose, timing and frequency, route of administration and indication

€¢ Changes to medicines, including medicines started, stopped or dosage changed, and reason

€¢ Date and time the last dose of any 'when required' medicine was taken or any medicine given less often than once a day (weekly or monthly medicines)

€¢ Other information, including when the medicine should be reviewed or monitored, and any support the resident needs to carry on taking the medicine

€¢What information has been given to the resident and/or family members or carers.

€¢ Regular medication reviews

These should involve the resident (plus family or carers if needed), a pharmacist, the GP, a community matron or specialist nurse, care home staff member, practice nurse and social care practitioner.

€¢ Prescribing medicines

There should be a clear written process for GP practices to prescribe and issue prescriptions to care home patients, with remote prescribing used in exceptional circumstances only. Any new or changed medicines should not be given until care home staff have received confirmation in writing, and the MAR and care plan updated within 24 hours.

€¢ Medicines' ordering

At least two members of the care home staff should be trained to order medicines and be allocated protected time to do so. The task should not be delegated to the supplying pharmacy.

€¢ Dispensing and supplying medicines

Pharmacies should have SOPs in place for dispensing medicines for care home residents, particularly those in monitored dosage systems, and provide a MAR chart where possible.

€¢ Receiving, storing and disposing medicines

Care homes should store medicines securely and appropriately and keep records of medicines that have been disposed of (by the local pharmacy).

€¢ Helping residents to look after and take their medicines themselves

Self-administration should be assumed to be standard unless a risk assessment suggests otherwise.

€¢ Care home staff administering medicines to residents

Pharmacies can help care homes develop and review their administration process, being mindful of issues such as what to do if a resident is asleep, recording requirements and how to manage 'when required' products. Records should be easy to understand, clear, accurate, legible and completed in a timely fashion.

€¢ Care home staff giving medicines to residents without their knowledge

Covert administration should only take place if the resident is unable to make decisions about his/her treatment and care. Administration of medicines in this way must be thoroughly assessed and recorded and regularly reviewed.

€¢ Care home staff giving non-prescription and over-the-counter products to residents

This should ideally be covered by a €homely remedies€ process, which should detail the name of the product, indication, dose, frequency, maximum dose, recording requirements and when it is and isn't appropriate (for example: paracetamol for patients on other paracetamol-containing medicines).

€¢ Competency of care home staff

Only staff who have undergone the necessary training and have the required skills should be allowed to administer medicines to residents, and this should be reviewed annually.