1. Medication use in care homes
Angela Soni
Care Home Pharmacist
Hounslow CCG
Hello, my name is Angela Soni and I am a care home pharmacist working for the medicines management team at Hounslow CCG. Today, I am going to talk about medication use in care homes and how we make sure our residents are safe and well looked after

2. Areas to be covered during presentation
1) Documentation 2) Medication Administration Records 3) Storage areas 4) Administration 5) Pharmacies 6) Controlled drugs 7) Homely remedies 8) Covert Administration 9) Transfer of care
Here are some of the areas I am going to lok at during this presentation

3. Documentation Medicines policy Up to date
Based on current legislation and best available evidence
Written processes for
transferring setting
Identifying, reporting and reviewing medicines
Ordering, reviewing, receiving, storing and disposing
Self administration
Staff administration + training requirements
Covert administration
Homely remedies
Medicines policy – should be up to date,

4. Protocol if temperatures go out of range Up to date BNF available
Incident reporting – any near misses
Record keeping
In medication administration records
Information in s, telephones etc
Transfer of care letters and summaries about medicines
Medicines ordered for residents

5. Medication Administration Records (MARs)
All medicines (including when required, external, injectables) must be written on MAR sheet
When required medicines should have a maximum amount stated
Ensure medicines prescribed for a resident are not used by other residents
Signed and annotated correctly

6. Paper based or electronic
Legible
Signed by care home staff
After patient has had the dose
Before moving onto the next resident
Clear and accurate
Factual
Dated and times
Allergies stated
Any special instructions

7. Storage areas Locked Temperature 24 hours
Storage area room
Fridge
Cupboards
Trolleys (which can be fixed into place)
Temperature 24 hours
Medication storage areas
Fridge must be cleaned and defrosted regularly

8. Keys with appropriate person
Internal and external medicines stored separately
Self medicating – need to have a locked cupboard
All medication must be in date

9. Administration Best practice to administer from original containers
Dosettes
6 R’s of administration
Right resident
Right medicine
Right route
Right dose
Right time
Residents right to refuse
Maintain patients independence where possible
Limit distractions for staff administering medicines

10. What to do if resident is having meal
What to do is resident is asleep
How to administer certain medicines e.g. patches, eye drops
How to record a refusal of medicine
How to manage ‘when required’ medicines

11. Pharmacies
Atleast 2 people should know how to order medicines (although ordering can take place by one person)
Designated time
Care homes should not delegate this responsibility to pharmacies
Records should be kept of what is ordered.
Once medicines received these should be checked to make sure they have been prescribed and supplied correctly
Staff should have designated time

12. Pharmacies
Ask pharmacist about special precautions or warnings on a newly prescribed drug
Patient information leaflets should be supplied with medicines

13. Controlled drugs Suitable bolted and locked cupboard
Stock levels agree with written balance
Entries into a suitably bound book
No cancellations allowed
Disposal must have two signatures recorded
Record made for unwanted medicines returned to pharmacy
Identify excess and expired items
Keep records
Cd records 2 years
Destruction records 7 years

14. Homely remedies
Homely remedies are medicines that can be obtained without a prescription from a pharmacy or supermarket
Only those ailments in the policy may be treated using the specified medicines at the specified dose.
No advice is needed from a doctor or pharmacist to administer these medicines
Maximum 48 hours before referral to a GP
Must be in date
however guidance may b
. If the resident’s condition does not respond to the homely remedy, or if it worsens, refer to the GP even if this is before the maximum 48 hours period
e sought if deemed appropriate.  

15. Minor self-limiting conditions that can be treated using homely remedies include:
Mild pain
Cough
Antihistamines
Diarrhoea
Constipation
Indigestion
Minor skin condition (e.g. itchy/dry skin)
Soften ear wax

16. Covert administration
This is NOT the same as crushing!
Covert Administration is the administration of any medical treatment in a disguised form.
Patient is refusing to have their medicines.
Only patients who do NOT have capacity to make a decision about their medicines.
Obtain further advice prior to crushing

17. Transfer of care Red bag scheme When patient is sent to hospital
Details of patients current medication are sent to the hospital
When a patient is received into the home
Residents medicines are carefully recorded the day they are transferred into the home
Good communication about a resident's medicines is a key factor in preventing medication errors when care home residents transfer between care settings, and also promotes continuity of care following transfer

18. Details on a discharge summary
Full name, DOB, weight, NHS number, address,
GP details
Allergies/reactions
Current medication, with route of administration and indication if known
Date and time of last when required medication
Changes to medication

19. Guidance
NICE guidance: Managing Medicines in Care Homes (SC1), March 2014
NICE guidance: Medicines Management in Care Homes, QS85, March 2015

20. Questions