Medication Use in Care Homes: Best Practices and Regulations

1. Medication use in care homes Angela Soni Care Home Pharmacist Hounslow CCG

2. Areas to be covered during presentation 1) Documentation 2) Medication Administration Records 3) Storage areas 4) Administration 5) Pharmacies 6) Controlled drugs 7) Homely remedies 8) Covert Administration 9) Transfer of care

3. Documentation • Medicines policy • Up to date • Based on current legislation and best available evidence • Written processes for • transferring setting • Identifying, reporting and reviewing medicines • Ordering, reviewing, receiving, storing and disposing • Self administration • Staff administration + training requirements • Covert administration • Homely remedies

4. Protocol if temperatures go out of range • Up to date BNF available • Incident reporting – any near misses • Record keeping • In medication administration records • Information in emails, telephonesetc • Transfer of care letters and summaries about medicines • Medicines ordered for residents

5. Medication Administration Records (MARs) • All medicines (including when required, external, injectables) must be written on MAR sheet • When required medicines should have a maximum amount stated • Ensure medicines prescribed for a resident are not used by other residents • Signed and annotated correctly

6. Paper based or electronic • Legible • Signed by care home staff • After patient has had the dose • Before moving onto the next resident • Clear and accurate • Factual • Dated and times • Allergies stated • Any special instructions

7. Storage areas • Locked • Storage area room • Fridge • Cupboards • Trolleys (which can be fixed into place) • Temperature 24 hours • Medication storage areas • Fridge • Fridge must be cleaned and defrosted regularly

8. Keys with appropriate person • Internal and external medicines stored separately • Self medicating – need to have a locked cupboard • All medication must be in date

9. Administration • Best practice to administer from original containers • Dosettes • 6 R’s of administration • Right resident • Right medicine • Right route • Right dose • Right time • Residents right to refuse • Maintain patients independence where possible • Limit distractions for staff administering medicines

10. What to do if resident is having meal • What to do is resident is asleep • How to administer certain medicines e.g. patches, eye drops • How to record a refusal of medicine • How to manage ‘when required’ medicines

11. Pharmacies • Atleast 2 people should know how to order medicines (although ordering can take place by one person) • Designated time • Care homes should not delegate this responsibility to pharmacies • Records should be kept of what is ordered. • Once medicines received these should be checked to make sure they have been prescribed and supplied correctly

12. Pharmacies • Ask pharmacist about special precautions or warnings on a newly prescribed drug • Patient information leaflets should be supplied with medicines

13. Controlled drugs • Suitable bolted and locked cupboard • Stock levels agree with written balance • Entries into a suitably bound book • No cancellations allowed • Disposal must have two signatures recorded • Record made for unwanted medicines returned to pharmacy • Identify excess and expired items • Keep records

14. Homely remedies • Homely remedies are medicines that can be obtained without a prescription from a pharmacy or supermarket • Only those ailments in the policy may be treated using the specified medicines at the specified dose. • No advice is needed from a doctor or pharmacist to administer these medicines • Maximum 48 hours before referral to a GP • Must be in date

15. Minor self-limiting conditions that can be treated using homely remedies include: • Mild pain • Cough • Antihistamines • Diarrhoea • Constipation • Indigestion • Minor skin condition (e.g. itchy/dry skin) • Soften ear wax

16. Covert administration • This is NOT the same as crushing! • Covert Administration is the administration of any medical treatment in a disguised form. • Patient is refusing to have their medicines. • Only patients who do NOT have capacity to make a decision about their medicines. • Obtain further advice prior to crushing

17. Transfer of care • Red bag scheme • When patient is sent to hospital • Details of patients current medication are sent to the hospital • When a patient is received into the home • Residents medicines are carefully recorded the day they are transferred into the home

18. Details on a discharge summary • Full name, DOB, weight, NHS number, address, • GP details • Allergies/reactions • Current medication, with route of administration and indication if known • Date and time of last when required medication • Changes to medication

19. Guidance • NICE guidance: Managing Medicines in Care Homes (SC1), March 2014 • NICE guidance: Medicines Management in Care Homes, QS85, March 2015

20. Questions