Quality standard
Quality statement 3: Self-administration
Quality statement 3: Self-administration
Quality statement
People who live in care homes are supported to self‑administer their medicines if they wish to and it does not put them or others at risk.
Rationale
It is important for people living in care homes to maintain their independence, and that they have as much involvement in taking their medicines as they wish and are safely able to. However, when a person enters a care home staff will often automatically assume responsibility for managing their medicines. It should be assumed that people who live in a care home can take and look after their medicines themselves, unless a risk assessment has indicated otherwise. It is important to take into account a person's choice over whether or not they wish to self‑administer their medicine and also to consider if self‑administration will be a risk to them or others. Risk assessments are also important to determine what support a person needs to help them to self‑administer different medicines (for example, a resident may be able to manage oral tablets but not eye drops), allowing care homes to ensure that necessary support is provided. Risk assessment should be reviewed periodically, and whenever circumstances change, to address if any adjustment to support is needed.
Quality measures
Structure
a) Evidence of local arrangements that care home staff provide support for residents to self‑administer their medicines unless a risk assessment has indicated otherwise.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that individual risk assessments are carried out that identify and document any support that a care home resident needs to self‑administer their medicines.
Data source: Local data collection.
Process
a) Proportion of people who live in a care home who have an individual risk assessment to identify any support they need to self‑administer their medicines.
Numerator – the number in the denominator who have an individual risk assessment to identify any support they need to self‑administer their medicines.
Denominator – the number of people who live in a care home.
Data source: Local data collection.
b) Proportion of people who live in a care home who wish to self‑administer their medicines, and who have not had a risk assessment that indicates that this would put themselves or others at risk, who self‑administer their medicines.
Numerator – the number in the denominator who self‑administer their medicines.
Denominator – the number of people who live in a care home who wish to self‑administer their medicines, and who have not had a risk assessment that indicates that this would put themselves or others at risk.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (care homes) ensure that staff support people to self‑administer their medicines if they want to, unless an individual risk assessment has indicated that they are not able to do so safely.
Health and social care practitioners support people to self‑administer their medicines if they want to, unless an individual risk assessment has indicated that they are not able to do so safely.
Commissioners (local authorities) ensure that services they commission support people to self‑administer their medicines if they want to, unless an individual risk assessment has indicated that they are not able to do so safely.
People who live in care homes are given support to take and look after their own medicines if they want to, unless they have had an assessment that shows it might not be possible or safe.
Source guidance
Managing medicines in care homes. NICE guideline SC1 (2014), recommendations 1.13.1 and 1.13.2
Definitions of terms used in this quality statement
Risk assessment
Health and social care practitioners should carry out an individual risk assessment to find out how much support a care home resident needs to carry on taking and looking after their medicines themselves (self‑administration). Risk assessment should consider:
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the resident's choice
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if self‑administration will be a risk to the resident or to other residents
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if the resident can take the correct dose of their own medicines at the right time and in the right way (for example, do they have the mental capacity and manual dexterity for self‑administration?)
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how often the assessment will need to be repeated based on individual resident need (during periods of acute illness, a resident's capacity and ability to self‑medicate may fluctuate, needing more frequent assessment)
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how the medicines will be stored
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the responsibilities of the care home staff, which should be written in the resident's care plan.
The care home manager should coordinate the risk assessment and should help to determine who should be involved. This should be done individually for each resident and should involve the resident (and their family members or carers if the resident wishes) and care home staff with the training and skills for assessment. Other health and social care practitioners (such as the GP and pharmacist) should be involved as appropriate to help identify whether the medicines regimen could be adjusted to enable the resident to self‑administer.
[Adapted from NICE's guideline on managing medicines in care homes, recommendations 1.13.2. and 1.13.3]
Support to self-administer medicines
Support may include practical help to self‑administer medicine, such as providing a glass of water with which to take medicine, reminder charts, large‑print labels, hearing labels, easy‑to‑open containers, help measuring liquids, devices to help with the use of inhalers, colour coding of labels (for example, for different times of day) and providing prompts for when medicines should be taken, (for example, with or after food or on an empty stomach).
Support may also involve providing the person with suitable information about the medicine, information on how to take the medicine and advice on any potential side effects.
Individual risk assessments should identify how much support a resident needs to take and look after their medicine.
[Adapted from expert consensus and NICE's guideline on managing medicines in care homes]
Equality and diversity considerations
Consideration should be given to a number of factors that can affect a resident's ability to self‑administer their own medicines, including their mental health, mental capacity, health literacy, vision, hearing, language and culture. Health and social care practitioners need to ensure that these factors are considered for each resident, and any barriers to self‑administration of medicines are identified and taken into account.