In previous blogs I looked at safe handling and administration of medicines in Care Homes, and the role of NICE Medicines and Prescribing Centre Associates.
Here I reflect on the NICE Quality Standard for Managing Medicines in Care Homes.
Like the Guidelines the Quality Standard are wide ranging, with huge implications for Care Homes. To help make practical sense of the NICE Quality Standard here are tips for delivering three of its overarching quality statements. The focus is on safety of residents and is based on what I have learned from my role as a NICE Medicines and Prescribing Associate.
Meeting Quality Standards represents a challenge for care home providers and staff, not least because many of them rely on other services and providers to help deliver a joined up approach to medicines management.
‘Care Homes have a medicines policy that is regularly reviewed’.
It’s worth considering how your policy links to staff training and how user friendly it is. Are procedures outlined clearly in the policy and do you use checklists? We recently helped a care home produce a checklist on the key information needed when calling doctor. It is based on the SBAR (situation-background- assessment-recommendation) principle to help focus on the key information. This is proving popular as it saves time on the ‘phone, and the structured approach is popular with GPs.
‘People have an accurate listing of their medicines on the day they transfer to the care home’.
This is an area where care home staff are dependent on others. Hours can be spent trying to sort out problems. My advice here is for managers to ensure that discrepancies are reported back to the source, and ask for feedback on how they are followed up. Additionally it’s helpful to record your satisfaction with good quality and complete discharge information, and our experience is that electronic systems can greatly improve quality of this information.
Several NHS patient safety alerts relate to discharge medicines.
‘People who live in care homes have at least 1 multidisciplinary medication review per year’.
There is considerable variation in practice around medicines reviews, with help available from Clinical Commissioning Group Medicines Management Teams and Specialist Clinicians in some areas. Although this is an area largely outside the control of care homes there are 3 things which can help.
- Firstly, consistently referring back any prescriptions which don’t have complete and unambiguous directions.
- Secondly, ensure that there is an easily accessible record of what each medicine is being prescribed for, (regular medicines, one-off prescriptions and as required medicines). I am still amazed that this isn’t always the case.
- And thirdly, whilst staff residents / relatives are not expected to be experts on medicines, access to basic information the each medicine, including on side-effects and interactions should be readily available (see below for a link to trusted medicines information).
Author: Steve Turner, Managing Director Care Right Now (CIC)