Quality statement 4: Prescribing medicines

Quality statement

Prescribers responsible for people who live in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines.

Rationale

If too few instructions are given to a resident (if self‑administering) or the care home staff it can reduce the effectiveness of a medicine or even potentially increase the risk of harm. Clear instructions are therefore important to ensure resident safety. This is particularly the case with variable dose or 'when required' medicines (when a clear indication of the circumstances to administer the medicine is needed). If a resident's capacity changes, care home staff may need to start administering the person's medicine for them, and will need instructions. Requirements for recording clear instructions on how a medicine should be used and monitored should be included as part of a clear written process for prescribing and issuing prescriptions for people who live in care homes (see recommendation 1.9.1 in NICE's guideline on managing medicines in care homes).

Quality measures

Structure

Evidence of local arrangements that prescribers responsible for people who live in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines.

Data source: Local data collection.

Process

The proportion of newly prescribed medicines for people who live in care homes that are provided with comprehensive instructions for use and monitoring.

Numerator – the number in the denominator that are provided with comprehensive instructions for use and monitoring.

Denominator – the number of newly prescribed medicines for people who live in care homes.

Data source: Local data collection.

Outcome

Medicines‑related problems attributable to incomplete information provided with a prescription.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (such as GP practices, pharmacies) ensure that comprehensive instructions for using and monitoring all newly prescribed medicines are provided for people who live in care homes.

Healthcare professionals (such as GPs, pharmacists and nurse prescribers) provide comprehensive instructions for using and monitoring all newly prescribed medicines for people who live in care homes.

Commissioners (such as NHS England and clinical commissioning groups) ensure that any services they commission that prescribe medicines for people who live in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines for people who live in care homes.

What the quality statement means for patients, service users and carers

People who live in care homes have accurate and complete information given to them and to the care home staff about any new medicines they are prescribed. This should include information about how and when their medicines should be used, and any checks that should happen.

Source guidance

Definitions of terms used in this quality statement

Comprehensive instructions for using and monitoring newly prescribed medicines

These include:

  • recording clear instructions on how a medicine should be used, including how long the resident is expected to need the medicine and, if important, how long the medicine will take to work and what it has been prescribed for (use of the term 'as directed' should be avoided)

  • providing any extra details the resident and/or care home staff may need about how the medicine should be taken

  • any tests needed for monitoring.

When prescribing variable dose and 'when required' medicine(s), information should include:

  • dosage instructions on the prescription (including the maximum amount to be taken in a day and how long the medicine should be used, as appropriate) so that this can be included on the medicine's label

  • instructions for:

    • when and how to take or use the medicine (for example, 'when low back pain is troublesome take 1 tablet')

    • monitoring

    • the effect the medicine is expected to have.

[Adapted from Managing medicines in care homes (NICE guideline SC1), recommendations 1.9.1 and 1.9.2]