NICE, the health and social care guidance body, has published its guideline for those involved in handling, prescribing, commissioning and other decision-making about medicines in care homes. The guideline makes recommendations about the systems and processes that need to be in place to ensure the safe and effective use of medicines for all children, young people and adults who live in care homes, including those who need nursing care.

Despite existing guidance and standards on managing medicines in care homes,^{i, ii} recent studies have found evidence that medication errors are commonplace. The 2009 Care Homes' Use of Medicines Study (CHUMS)ⁱⁱⁱ found that of the 256 care home residents included in the study, two thirds had been exposed to one or more medication errors. A later study^iv found that over 90% of the 345 residents included in the study were exposed to at least 1 potential medication administration error over a 3-month period. Although most medication errors have negligible consequences for residents, in some cases they may have serious, potentially life-threatening consequences.

The National Care Forum document Safety of medicines in the care home (2013) identified that ‘when a person enters a home, staff often automatically assume responsibility for managing medicines. This can lead to a loss of independence and control for the resident'.

The starting point for the NICE guideline on managing medicines in care homes is that residents should have the same involvement in decisions about their care and treatment, and should have the right to access appropriate services and support equivalent to those who do not live in care homes. It also recommends that residents have access to any support they need to enable them to take part in decision-making. This includes considering any mental health problems, any sight or hearing problems, any difficulties reading or speaking English, or any cultural differences that a person may have that might mean extra help is needed. These should be recorded in the person's care plan and should be checked regularly.

Other recommendations in the NICE guideline on managing medicines in care homes include:

• All care homes should have a written policy that they follow, which gives information about how staff in the care homes should:
  • share information about medicines
  • keep records about medicines
  • deal with any mistakes that might happen when people who are living in a care home are given their medicines
  • review and accurately list the medicines someone is taking
  • order, receive, store and dispose of medicines
  • give medicines to people in their care.
• Health professionals who prescribe medicines should assume that people who live in care homes are able to make decisions about their own medicines. However, if a health professional is concerned about a person's ability to make such decisions, they should check whether the person is able to understand why, for example, a new medicine is needed before offering it.
• Providers of health or social care services should have processes in place for sharing accurate information about a resident's medicines including what is recorded and transferred when a resident moves from one care setting to another (including hospital).
• Commissioners and providers of health or social care services should ensure that a robust process is in place for identifying, reporting, reviewing and learning from medicines errors involving residents.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Care home residents are often vulnerable and often have complex medical needs requiring them to take a number of medicines. This sometimes makes them particularly dependent on care home staff to help them take their medicines. This guideline provides clear advice on medicines management systems and processes that place the resident firmly at the centre of decision-making, ensuring that their needs are paramount and can be addressed safely and effectively.”

Alaster Rutherford,Chair of the Guideline Development Group, said: "Good communication is a strong theme throughout this guideline, whether through the active participation of residents, record-keeping or when care transfers between settings. Through our recommendations for robust care homes medicines policies and processes, all involved with care - residents, health and social care providers and commissioners - can be confident that medicines are being used safely and effectively. Encouraging residents of all ages and abilities - the guideline covers both children's and adults' care homes - to be involved in managing their medicines is strongly supported by this guideline and is an essential part of promoting self-care and independence."

Brian Brown, National Pharmacy Manager at the Care Quality Commission and member of the guideline development group, commented: “We welcome the publication of the NICE guideline on managing medicines in care homes. This guideline emphasises the need for all providers to work together in the best interests of the patient receiving the medicine. Care homes providers have a clear responsibility for ensuring people living in care homes are supported to have their medicines in a safe and effective manner, and that they are involved in the care they receive.”

Dr Susanna Jacks, a GP and member of the Guideline Development Group, said: "It is a challenge getting the right medicine at the right time to care home residents. This guideline has been developed through the collaboration of the wide range of professionals working in this field. It offers a robust framework of policies and processes so that GPs in partnership with care home staff and pharmacists can provide high quality care to this vulnerable group of patients."

“The key is cracking the medicines review process” says Ian Turner, Chairman of the Registered Nursing Home Association and member of the Guideline Development Group. “The sheer volume of medicines is a big problem to most care homes. It's a problem from an accuracy point of view, but it also takes a phenomenal amount of effort to maintain that system.

“Moving towards a situation where we have more commonality around managing medicines in care homes and better standards has got to be a significant step forward. It will mean that any issues with medicines are picked up early and that homes are better supported. The medicines review process needs to entail better communication between the pharmacist, care home and GP. Currently we are still moving towards understanding how often residents should have their medicines reviewed and what that review should involve. This guideline will be extremely helpful in providing clarity around this issue, and in ensuring that medicines reviews are meaningful to everybody. For individual residents, this means they will be on an optimum medicines regime. And, if you can reduce the number of medicines, the problem of volume becomes easier in the care home.”

The guideline also covers the processes for reviewing medicines, prescribing and ordering medicines, dispensing and supplying medicines, receiving, storing and disposing of medicines, administration of medicines by care home staff, the covert administration of medicines^v, and the administration of medicines for minor ailments that can be bought without prescription, such as paracetamol for headaches or remedies for indigestion.

Ends

Notes to Editors

References and explanation of terms

i. Department for Educations National Minimum Standards (DfE, 2011) for children's homes.

ii. Essential standards of quality and safety published by the Care Quality Commission (CQC, 2010)

iii. CHUMS

iv. Szczepura et al (2011)

v. ‘Covert administration of medicines' is the term used when medicines are administered in a disguised form without the knowledge or consent of the resident receiving them (for example, medicines added to food or drinks).

About the guideline

1. The guideline on managing medicines in care homes is available on the NICE website at /proxy/?sourceUrl=http%3a%2f%2fwww.nice.org.uk%2fguidance%2fsc%2fSC1.jsp

2. To support the implementation of the guideline, NICE are holding 2 implementation workshops on 16 May in Leeds and 22 May in London. Registration for the events is now open on the NICE website.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

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