Introduction

This quality standard covers the prescribing, handling and administering of medicines for all people (including adults, children and young people) living in care homes, and the provision of care or services relating to medicines to those people.

The term 'care home' is used to cover the provision of 24‑hour accommodation together with either non‑nursing care or nursing care. A care home can be of any size (number of residents) or have any type of resident (for example, children, older people, people with cognitive impairment, young disabled people or people with a learning disability), but should be a registered provider of care (for example, registered with either the Care Quality Commission or Ofsted [the Office for Standards in Education, Children's Services and Skills in England]).

For more information see the managing medicines in care homes topic overview. This quality standard should be read alongside the Mental Capacity Act 2005 and the accompanying code of practice.

Why this quality standard is needed

The National Care Forum's report, 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'. This quality standard focuses on ensuring that a person‑centred approach to medicines in care homes is taken – with care home residents supported to take an active role in decisions about their treatment and, wherever possible, to self‑administer their medicines.

The 2009 Care home use of medicines study (CHUMS) found that of the 256 care home residents included in the study, two‑thirds had been exposed to 1 or more medication errors. A 3‑month study published in 2011, Medication administration errors for older people in long-term residential care, reported that more than 90% of the residents included in this study were exposed to at least 1 potential medicine administration error. To improve the safe and effective use of medicines by people of all ages who live in care homes, clear systems and processes are needed across the medicines management pathway.

The quality standard is expected to contribute to improvements in the following outcomes:

  • adverse medicine‑related events

  • care home residents' quality of life

  • family and carer confidence in care provision

  • individual care

  • medication errors.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care related quality of life* (NHSOF 2)

Outcome measure

People manage their own support as much as they wish, so that they are in control of what, how and when support is delivered to match their needs

1B Proportion of people who use services who have control over their daily life

3 Ensuring that people have a positive experience of care and support

Overarching measure

People who use social care and their carers are satisfied with their experience of care and support services

3A Overall satisfaction of people who use services with their care and support

3B Overall satisfaction of carers with social services

Placeholder 3E The effectiveness of integrated care* (NHSOF 4.9)

Outcome measures

Carers feel that they are respected as equal partners throughout the care process

3C The proportion of carers who report that they have been included or consulted in discussions about the person they care for

People know what choices are available to them locally, what they are entitled to, and who to contact when they need help

3D The proportion of people who use services and carers who find it easy to find information about support

People, including those involved in making decisions on social care, respect the dignity of the individual and ensure support is sensitive to the circumstances of each individual

4 Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm

Overarching measure

4A The proportion of people who use services who feel safe* (PHOF 1.19)

Outcome measures

People are protected as far as possible from avoidable harm, disease and injuries

People are supported to plan ahead and have the freedom to manage risks the way that they wish

4B The proportion of people who use services who say that those services have made them feel safe and secure

Aligning across the health and care system

* Indicator complementary

Abbreviations: NHSOF, NHS Outcomes Framework; PHOF, Public health outcomes framework.

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions* (ASCOF 1A)

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Enhancing quality of life for people with dementia

2.6ii A measure of the effectiveness of post‑diagnosis care in sustaining independence and improving quality of life* (ASCOF 2F)

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

4b Patient experience of hospital care

Improvement areas

Improving the experience of care for people at the end of their lives

4.6 Bereaved carers' views on the quality of care in the last 3 months of life

Improving people's experience of integrated care

4.9 People's experience of integrated care* (ASCOF 3E)

Alignment across the health and social care system

* Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Table 3 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicator

4.13 Health‑related quality of life for older people

Service user experience and safety issues

Ensuring that care is safe, effective and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to managing medicines in care homes.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services and service user experience in adult mental health services (see the NICE pathways on patient experience in adult NHS services and service user experience in adult mental health services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and are supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that impact on service user experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for managing medicines in care homes specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole managing medicines in care homes pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people in care homes.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality managing medicines in care homes service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care practitioners involved in assessing, caring for and treating people in care homes should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people in care homes. If appropriate, health and social care practitioners should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care. The views of residents in care homes about who should and should not be involved in their care are important and should be respected. If the resident lacks the capacity to decide who should and should not be involved, health and social care practitioners must act in the resident's best interests, taking account of the provisions in the Mental Capacity Act 2005.