25 March 2015

New quality standards to help care homes manage medicines safely and prevent falls in older people

Two new quality standards on managing medicines in care homes and preventing falls will help to improve the quality of care for older people.

More than 350,000 people in England and Wales live in a care home, according to official figures.

However, mistakes in administering medicines are not uncommon. A 2011 study showed that 9 in 10 care home residents were exposed to at least 1 potential medication administration error over a 3-month period.

The new quality standard highlights this as a key issue in need of urgent improvement. It lists actions that should be taken to ensure that all necessary health and social care practitioners are aware of residents’ needs and can administer the right medicines to the right person at the right time. This includes:

  • Health or social care service providers sending a discharge summary, including details of the person’s current medicines, with a person who transfers to or from a care home
  • Prescribers who are responsible for people who live in care homes providing comprehensive instructions for using and monitoring all newly prescribed medicines.
  • A multidisciplinary team undertaking medication reviews for people who live in care homes

The quality standard also says that residents who wish to self-administer their own medicines should be supported to do so as long as it does not put them or others at risk.

Preventing falls

Falls and fall-related injuries are a common and serious problem for older people. Three in 10 people over the age of 75 in England – about 2.5 million - will have at least 1 fall each year. Half of those aged 80 or above will have a fall.

The quality standard for assessing older people after a fall and preventing further falls aims to support hospitals and community services to help improve the quality of life of older people and reduce the number of fall-related injuries occurring in people aged 65 and older.

The standard advises that older people who are living in the community and have a known history of recurrent falls are referred for strength and balance training.

It also says that healthcare professionals should carry out a risk assessment for any older person who visits hospital because of a fall. Those who need to stay in hospital should be offered a ‘home hazard assessment’ and any necessary help to prevent further incidences before they leave.

Professor Gillian Leng, Deputy Chief Executive at NICE, said: “These two new quality standards focus on two specific issues – managing medicines in care homes and falls in older people - where we know inconsistencies exist in the care that people may receive. This can have a detrimental effect on a person’s health and wellbeing, affecting not only their quality of life, but that of their families and carers too.

“The standards contain practical statements to help health and social care providers, practitioners and commissioners assess and improve the quality of care they deliver in key areas. They highlight the need for the health and social care sectors to work together where possible to ensure people receive the best quality care.”

Adam Gordon, Honorary Secretary of the British Geriatrics Society and a consultant geriatrician in Nottingham, said: “Both of these standards are very welcome from the perspective of healthcare professionals looking after older people with multiple medical conditions. 

“We know that prescribing and dispensing errors in care homes are common and these guidelines recognise and seek to mitigate against important contributing causes – namely the failure to effectively communicate medication changes within and between care settings and the failure to have structured prescribing policies in place for care home residents. 

“The falls standard, meanwhile, brings together gold standard practice in how to manage older people following falls and, by giving it the NICE seal of approval, ensures that it will be delivered in hospital and community settings around the country."

Both of these standards are very welcome from the perspective of healthcare professionals looking after older people with multiple medical conditions.

Adam Gordon, British Geriatrics Society

The standards contain practical statements to help health and social care providers, practitioners and commissioners assess and improve the quality of care they deliver in key areas

Prof Gill Leng, NICE