Care homes should ensure residents are enabled to administer their own medication if at all possible, according to draft guidance from the National Institute for Health and Care Excellence (Nice).
The good practice body is currently consulting on a new quality standard, which aims to improve the quality of life for care home residents who require medication.
The standard will be applicable to children, young people and adults living in residential care settings and builds on the social care guidance, Managing medicines in care homes, which was published by Nice earlier this year.
The guidelines have been drafted in response to concerns around the loss of independence faced by residents when the responsibility for administering medication is automatically assumed by staff, as well as the number of medication errors people have been subject to.
Medication management was also identified as the biggest area of non-compliance among social care providers in 2012, following a market report by the Care Quality Commission.
The institute has developed seven draft statements that highlight areas where improvements are most needed in relation to medication management in residential care. Here’s a quick guide to what they mean for providers:
1. Care homes have a medicine policy that is regularly reviewed
Have a medicines policy in place that is based on current legislation and sets out clear processes for staff to follow on all aspects of medication management. The policy should be regularly reviewed and updated and should address local requirements and the needs of the individual care home.
2. People who live in care homes are supported to self-administer their medicines unless a risk assessment has indicated that they are unable to do so
Ensure staff are carrying out risk assessments to determine the amount of support a person needs to administer their medication and support people to self-administer if required.
3. People who live in care homes have an accurate listing of their medicines made on the day that they transfer into a care home
Have a system in place to ensure accurate record-keeping of medications. There should also be the resources available for staff to make a list of a residents’ required medications before or immediately after their admission to the care home.
4. People who live in care homes have details of their medicines shared with their new care provider when they move from one care setting to another
A process should be put in place to enable the sharing of information on medication, particularly for when a resident is moving to a new care setting.
5. GP practices have a clear written process for prescribing medicines for their patients who live in care homes
GPs should have clear processes in place for prescribing and issuing prescriptions to patients living in care homes and should provide all the necessary details about how a medicine is to be used. In particular, GPs should give clear instructions about how ‘when required’ medicines should be given to provide clarity for care home staff.
6. People who live in care homes have at least 1 multidisciplinary medication review per year
GP surgeries should make arrangements for all patients living in care homes to have an annual multidisciplinary medication review. Practitioners should ensure that the review involves the resident and their family members or carers and a local team of health and social care professionals.
7. Care homes have a documented process for the covert administration of medicines for adult residents
Providers should have a process in place for covert administration of medicine for adults in care homes and ensure practitioners are aware of, and follow, this system.
The guidance is due to be published in March 2015 and will be the institute’s fourth quality standard for social care providers.
Professor Gillian Leng, deputy chief executive and director of health and social care at Nice, said: “Children, young people and adults living in care homes often have complex health issues and can be more vulnerable than other people. Because of this, care homes may decide that decisions about medication are best made by staff. However, this may not necessarily be true.
“Evidence shows that involving people in decisions about their own care and supporting them to take an active role in managing their medicines can help them feel valued and improve their quality of life.”
The public consultation on the draft quality standard will run until 5pm on Friday 7 November 2014. To respond, download a comments form and email to QSconsultations@nice.org.uk.
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NICE guidance, do not address the fundamental flaw in drug use, ie that there is no central check, or even audit, of the amount,, or type of drugs, used in residential care homes, and it is unclear, even if, these regulations, apply to the many independent living units, that have been set up for all those 18 year olds with learning disabilities and autism removed from their families.
It would appear, the prescriptions for all the drugs used, are left to the individual GP practices, and CAMHS teams, and even, it appears sometimes, the managers of care for profit homes.
With government policies to encage, via the MCA 05,particularly altzeimers, and autistics, in care homes, and independent living units, it is of great concern, that there is no central check on the amount, or type of medication used, in these commercially run places
With families, often deliberately excluded from these vulnerable peoples lives, and the fact that a recent report has revealed that 3 a day learning disabled die needlessly, this is very worrying.
As we have seen with the many scandals disclosed in the media, care in homes can be abusive, as the model is to put profit before all.
As drugs make care more efficient, and make money for very powerful drug cartels,, and GP’s prescriptions also lead to profit for GPs, this is a very dangerous situation for our most vulnerable, and should have been addressed by NICE.