Medicines Management in Care Homes

Medicines management in care homes, especially nursing homes, is becoming increasingly complex with many patients who would previously have been treated in hospitals being discharged into the community. These homes are effectively becoming mini hospitals in the community.

NICE guidance

NICE guidance was launched in March 2014 and aims to provide “recommendations for good practice on the systems and processes for managing medicines in care homes”.

It covers all aspects of medicines management including prescribing, handling and administering medicines to care home residents and also the provisions of care or services relating to medicines in care homes.

Pharmacists are categorised within the guidance as “health and social care practitioners” who provide services to care homes, including primary care pharmacists, supplying community pharmacists and specialist care home pharmacists.

NICE guidance details aspects of medicines management including medicines management policies in care homes, providing residents with information about their medicines and health related conditions so that they can be as involved in medicines related decisions as patients who do not live in care homes, both of which could require a pharmacist input.

Pharmacists could be directly involved in medication reviews and reconciliation of medicines for residents moving from one care setting to another, including residents new to a care home.

NICE requires improved communication between care providers to ensure that everyone who is involved in a residents care knows when medicines are started, stopped or changed which means that pharmacists will be included in the” loop of information” about medication for care home residents.

Pharmacists may find that care homes are requesting increasing amount of:

• medicines related information.
• medicine support including reviewing and reconciling medicines.
• advice on reducing or identifying side effects.
• methods of covertly administering medicines after an appropriate multi-disciplinary review.
• assessment of a resident’s ability to self-medicate or advising on treatment options to allow residents to self-administer their medication.

Pharmacists are also encouraged to act to:

• reduce the incidence of medication errors in care homes by advising on the time of day that medicines are administered.
• where possible reducing the number of daily doses of medicines administered during the busier morning and night medication rounds and increasing the administration of these medicines during the quieter lunchtime medication rounds where appropriate.

What this means for you

There is an increasing role for pharmacists in managing medicines in care homes with provision of medicines and training of care home staff being the starting point.

NICE guidance advises that all residents should have their medicines reconciled when they are admitted to a care home and this process should involve a pharmacist. The draft guidance also advises that care homes should ensure that residents receive medication reviews and that this could be carried out by a community pharmacist assuming that they are clinically competent to undertake the review.

The Royal Pharmaceutical Society has supported the involvement of pharmacists in improving medicines management in care homes through a free resource pack including National Care Forum resources .

Numark training support

The modules have been developed to help you effectively and confidently deliver the training to your homes and covers:

• Supply of medicines.
• Administration of medicines.
• Legal requirements and responsibilities associated with administering medication.

The training consists of three modules and PowerPoint presentation.

The care homes staff can also be given a trainee manual as part of the programme which is designed to consolidate their learning and can be used as a reference guide as they adopt/embed new processes where necessary.

Pharmacists or registered technicians wishing to deliver the training require good background knowledge of care home legislation and processes and are recommended to have completed the CPPE 'Supporting people in Care Homes' training pack .

• Numark Care Homes Training incorporates the latest NICE guidelines.
• Our assessment process includes workplace competencies.

Care homes assessment process

On completion of the training there is a two-step assessment process. The first step involves assessing the trainee’s knowledge and understanding of the content of the training session whilst the second step focuses on workplace competency.

Step 1: Knowledge and understanding will be assessed by:

• thirty multiple-choice questions.
• 45 minute time limit.
• pass mark of 70%.

Step 2: Workplace competency will be assessed by activities within the care home that are evaluated by the care home manager or nominated deputy where the trainee will be required to demonstrate their ability to:

• safely receive medication into the home.
• administer medication to a resident.
• dispose of obsolete medication.
• show an understanding of care homes medicines policies.

Certificates are issued to confirm competence at each stage of the process and allow trainees to demonstrate both a knowledge of medicines management in care homes and a practical ability to apply this knowledge.

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