Quality statement 5: Medication reviews

Quality statement

People who live in care homes have medication reviews undertaken by a multidisciplinary team.

Rationale

Many care home residents have multiple and complex conditions. These conditions can change, and the medicines that residents receive to treat these conditions need to be reviewed regularly to ensure that they remain safe and effective. The frequency of multidisciplinary medication reviews should be based on the health and care needs of the resident, with their safety being the most important factor when deciding how often to do the review. The interval between medication reviews should be no more than 1 year, and many residents will need more frequent medication reviews. There can be uncertainty over who should undertake medication reviews. While a number of different health professionals can conduct medication reviews for care home residents, the review should involve a multidisciplinary group of key people who agree and document the roles and responsibilities of each member of the team and how they work together.

Quality measures

Structure

Evidence of local arrangements that medication reviews for people who live in care homes involve a multidisciplinary team who agree and document the roles and responsibilities of each member of the team and how they work together.

Data source: Local data collection.

Process

Proportion of medication reviews carried out for people who live in care homes that involve a multidisciplinary team.

Numerator – the number in the denominator that involve a multidisciplinary team.

Denominator – the number of medication reviews carried out for people who live in care homes.

Data source: Local data collection.

What the quality statement means for health and social care practitioners and commissioners

Health and social care practitioners (such as GPs and care home managers) ensure that medication reviews involve a local team of health and social care practitioners (multidisciplinary team) who agree and document the roles and responsibilities of each member of the team and how they work together.

Commissioners (such as NHS England area teams and local authorities) stipulate that medication reviews in care homes involve a local team of health and social care practitioners (multidisciplinary team) who agree and document the roles and responsibilities of each member of the team and how they work together.

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

People who live in care homes have their medicines reviewed by a team of people who look after their health and social care to check for any problems.

Source guidance

Definitions of terms used in this quality statement

Medication review

Health and social care practitioners should discuss and review the following during a medication review:

  • the purpose of the medication review

  • what the resident (and/or their family members or carers, as appropriate, and in line with the resident's wishes) thinks about the medicines and how much they understand

  • the resident's (and/or their family member or carer's, as appropriate, and in line with the resident's wishes) concerns, questions or problems with the medicines

  • all prescribed, over‑the‑counter and complementary medicines that the resident is taking or using, and what these are for

  • how safe the medicines are, how well they work, how appropriate they are, and whether their use is in line with national guidance

  • any monitoring tests that are needed

  • any problems the resident has with the medicines, such as side effects or reactions, taking the medicines themselves (for example, using an inhaler) and difficulty swallowing

  • helping the resident to take or use their medicines as prescribed (medicines adherence)

  • any more information or support that the resident (and/or their family members or carers) may need.

[Managing medicines in care homes (NICE guideline SC1), recommendation 1.8.5]

Multidisciplinary team

Health and social care practitioners ensure that medication reviews involve the resident and/or their family members or carers (if appropriate) and a local team of health and social care practitioners (multidisciplinary team). This may include a:

  • pharmacist

  • community matron or specialist nurse, such as a community psychiatric nurse

  • GP

  • member of the care home staff

  • practice nurse

  • social care practitioner.

The roles and responsibilities of each member of the team and how they work together should be carefully considered and agreed locally. GPs should work with other health professionals to identify a named health professional who is responsible for medication reviews for each resident. This should take into account the clinical experience and skills of the health professional, how much they know about the resident and the resident's condition, and whether they can access the relevant information.

[Managing medicines in care homes (NICE guideline SC1), recommendations 1.8.2 and 1.8.3]

Equality and diversity considerations

Consideration should be given to potential barriers to care home residents taking an active role in their medication review. These include mental health problems, lack of (mental) capacity to make decisions, health problems (such as problems with vision and hearing) and difficulties with reading or speaking. Some illnesses can restrict the capacity of residents to be involved in a medication review and a resident's capacity to be involved in decisions about their medicine may vary over time. Consideration should be given to adjusting the timing of a review to occur when a resident has the capacity to be involved, and potentially allowing time for a resident to recover from any acute illness before conducting the review. If appropriate, family members and carers could be 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.