Care homes to get new NICE medicine guidance to help stop medication errors

The National Institute for Health and Care Excellence has published draft good practice guidance for those involved in handling, prescribing, commissioning and decision-making about medicines in care homes.

Administering medicine is integral to the daily routine of a care home and this new draft guidance makes recommendations about the systems and processes needed to ensure the safe and effective use of medicines in care homes.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “Despite existing guidance and standards on managing medicines in care homes, recent studies have found evidence that medication errors are commonplace.

“Sadly, the high profile cases that make it into the news are just the tip of the iceberg. It's therefore very important that there are clear, documented, systems and processes in place for managing medicines in care homes which use the best available evidence.”

However he added that it is vital that “a person-centred approach should be adopted with consideration of the residents' wishes being paramount when devising these processes to ensure safe use of medicines in the care home.”

Administering medicine is a contentious issue as while health professionals say self administration of medicines, where this is possible, can give residents more independence and personal control, evidence suggests that care home staff feel this can cause problems for the home.

Staff believe allowing residents to administer their own medicine can lead to difficulties in medication recording, difficulties where the resident has to take several different drugs, difficulties with storing controlled drugs and difficulties with medication review.

Professor Baker said: “However, evidence of good practice suggests that these difficulties need not be insurmountable. The evidence also suggests that where residents or their advocate are engaged in decisions about their medicines, medicines may be more likely to be taken as prescribed.”

Staff in care homes can spend up to half of their working hours on medicine-related activities, according to the 2009 Care Homes' Use of Medicines Study (CHUMS).

CHUMS identified an ‘unacceptable level’ of medication errors in older residents living in care homes, with seven out of 10 residents experiencing errors with their medicines on any one day.

Most errors had negligible consequences for residents and no cases of harm were observed. However, in some cases, medication errors may have serious, potentially life-threatening consequences.

Draft recommendations in the guidance say health and social care practitioners should ensure residents have the same right to be involved in decisions about their care and treatment as people who do not live in care homes. They also need to make sure residents have access to any support they need to enable them to take part in decision-making.

In addition, health and social care practitioners should ensure that all information about a resident's medicines, including who will be responsible for ongoing prescribing, is accurately recorded and transferred with care homes residents when they move from one care setting to another.

Organisations should also ensure that a robust process is in place for identifying, reporting, reviewing and learning from medication errors involving residents.

Care home staff should presume that a resident is able to self administer their medicines unless indicated otherwise following an individual risk assessment, according to the guidance.

The draft good practice guidance also covers the processes for effective medication review, prescribing and ordering medicines, dispensing and supplying medicines, receiving, storing and disposing of medicines and administration of medicines by care home staff.

It also covers the covert administration of medicines, and the administration of medicines for minor ailments that can be bought without prescription, such as paracetamol for headaches or remedies for indigestion.

The draft good practice guidance on managing medicines in care homes is available on the NICE website.

Registered stakeholders have until 16 December to submit comments on the draft guidance.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system.