What is this guideline about and who is it for?

Purpose of this guideline

The purpose of this guideline is to provide recommendations for good practice on the systems and processes for managing medicines in care homes.

Audience for this guideline

This guideline is for people and organisations involved with managing medicines in care homes. It is anticipated that health and social care providers will need to work together to ensure that care home residents benefit from the good practice recommendations in this guideline.

Scope of this guideline

The guideline is for all people who have a collective responsibility for residents' care, ensuring safe and effective use of medicines in care homes. This includes:

  • residents living in care homes and their family members or carers (as appropriate)

  • people who provide care in care homes (for example, care home staff [including nurses employed by the home], GPs, community nursing teams and specialist nurses)

  • people who provide services to care homes (for example, supplying pharmacies, GPs, dispensing doctors and appliance contractors)

  • people who commission or monitor how care is provided in care homes (for example, local authorities, the Care Quality Commission (CQC) and the Office for Standards in Education, Children's Services and Skills (Ofsted)).

This guideline considers prescribing, handling and administering medicines to residents living in care homes and the provision of care or services relating to medicines in care homes. In this guideline, the term 'medicine' includes all healthcare treatments that may be considered in care homes. Examples include continence products, appliances and enteral feeds.

This guideline does not provide recommendations for named medicines or for specific conditions or types of illness. The guideline also does not include recommendations for managing medicines in the domiciliary care setting.

The guideline and recommendations are written in the context of health and social care in England. The guideline is aimed at:

  • NHS organisations

  • local authorities (in England)

  • independent organisations, for example, all types of independent care homes, voluntary and charitable agencies

  • independent contractors, for example, community pharmacies, GPs, appliance contractors, providers of care home staff.

All NICE guidelines are developed in accordance with the NICE equality scheme.

Definitions used in this guideline

For the purposes of this guideline the term 'care home' covers the provision of 24‑hour accommodation together with either non‑nursing care (for example, a residential home) or nursing care (for example, a care home with nursing).

The term 'care home provider' is used for the registered provider of care. If regulation or practice differs between different types of care homes (for example, a children's care home, an adult's care home, a non‑nursing care home or a nursing care home), then the type of care home is specified in the text.

When the term 'organisations' is used, this includes all commissioners and providers (including care home providers), unless specified otherwise in the text. Commissioners are those individuals who undertake commissioning which is 'the process used by health services and local authorities to: identify the need for local services; assess this need against the services and resources available from public, private and voluntary organisations; decide priorities; and set up contracts and service agreements to buy services. As part of the commissioning process, services are regularly evaluated'.

Providers are organisations that directly provide health or social care services (such as a care home).

Individual people who live in care homes are referred to as 'residents' or 'care home residents' in this guideline.

A 'care home' can be of any size (number of residents) or have any type of resident (children, older people, people with cognitive impairment, young disabled people, people with a learning disability), but should be a registered provider of care (for example, in England with either the CQC or Ofsted).

For the purposes of this guideline, the term 'care home staff' includes registered nurses and social care practitioners working in a care home.

The term 'carer' is used for an informal or unpaid carer.

The term 'health and social care practitioners' is used to define the wider care team, including care home staff (registered nurses and social care practitioners working in care homes), social workers, case managers, GPs, pharmacists and community nurses. When specific recommendations are made for a particular professional group, this is specified in the recommendation, for example, 'GPs'.

The term 'pharmacist' is used for all pharmacists, including primary care pharmacists, care home pharmacists and supplying pharmacists. Primary care pharmacists work in the primary care setting and may have a role working with care homes. Care home pharmacists have a dedicated role working in care homes. Supplying pharmacists work in a community pharmacy or chemist shop.

When a care home resident is able to look after and take their own medicines, this is referred to as 'self-administration'.

When the guideline refers to the administration of medicines, this is when care home staff check and give, or help to give, a resident their medicine(s).