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How to achieve the NICE guidelines on

Managing Medicines in Care Homes

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Objectives

Understand roles and accountabilities for improving quality of care

Understand the importance of the NICE Quality Standards for

managing medicines

How you can make use of NICE Quality Standards to improve

standards of care

Understand resources available to support your care homes

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Improving the quality of care – who does what?

Quality

Care Managers

Commissioners

NICE

CQC

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What are NICE Guidelines and Quality

Standards

NICE guidelines – evidence based recommendations on ‘what

works’

Quality standards – a concise set of statements designed to drive

and measure improvement in quality

90 Recommendations 7 Statements

NICE GUIDANCE NICE QUALITY STANDARDS

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How you can use NICE quality standards to

improve your care home

Demonstrate commitment to quality improvement

Prepare for CQC inspection and evidence that your service is well

led

Guide workforce recruitment and development

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Managing Medicines in Care Homes Quality

Standards – commencing March 2015

1) Care homes have a medicines policy that is regularly reviewed.

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.

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.

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.

5) GP practices have a clear written process for prescribing medicines for their

patients who live in care homes.

6) People who live in care homes have at least 1 multidisciplinary medication

review per year.

7) Care homes have a documented process for the covert administration of

medicines for adult residents.

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Statement 1. Care homes have a medicines policy that is

regularly reviewed

How is this measured?

Written evidence of a care home medicine policy that is relevant to the individual care

home

Evidence that the policy has been reviewed and is up to date with local arrangements

and current legislation

How is it achieved?

Undertake a base line assessment against NICE policy check list and local guidelines

Appoint a person to be accountable for maintaining, updating and reviewing policies.

What trigger points initiate a review?

Cascade briefing to all staff – including night and agency staff – role of eLearning

systems

How is compliance to policies and procedures measured and monitored?

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Statement 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

How is it measured?

Number of residents where risk assessment has been undertaken

Number of residents who self-administer (based on risk assessment)

Resident feedback on how they feel supported to self-administer

How is it achieved?

Include a self-administration assessment as part of initial resident assessment

(include existing residents)

Seek involvement of wider stakeholders e.g. resident, family, GP and Pharmacist

Define ongoing review process and success criteria

Review use of Monitored Dosage Systems

Review medication formulations with Pharmacist and GP

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Statement 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

How is it measured?

Protocol exists to ensure accurate listing of residents medication

Time between a person entering a care home and completion of their medicines

reconciliation

How is it achieved?

Medicines reconciliation forms part of initial assessment and is a prioritised activity

Agree protocols with main agencies e.g. social services, hospital, GP

Where should this information be recorded and who should be informed?

Support and escalation process where discrepancies exist

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Statement 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

How is it measured?

Proportion of transfers to and from a care home where the resident is accompanied

with an accurate record of their medicines

How is it achieved?

Production of a master MAR - containing regular medication and other sourced drugs

– use of eMAR solutions

Agreement with hospital and local care providers on standardised templates

Process to share data between health professionals – GP, Pharmacist

Escalation and support process where discrepancies exist

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Statement 5. GP practices have a clear written process for

prescribing medicines for their patients who live in care homes

How is it measured?

Number of prescriptions that include clear instructions of when and how (including

dosage instructions) the prescribed medicine is to be used

Medication errors attributable to incomplete information provided with a prescription

How is it achieved?

Agree a policy with the GP practices/ hospital for the prescribing to residents in the

care home

Agree verbal change to instructions protocol with key prescribers

Utilise pharmacy to conduct an initial review of all prescriptions, to check for missing,

inaccurate or incomplete instructions e.g. as directed, PRNs without protocol

Define process to ensure that changes made at point of care are reflected in both GP

and pharmacy software systems.

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Statement 6. People who live in care homes have at least 1

multidisciplinary medication review per year

How is it measured?

Proportion of people who live in care homes and are receiving medication whose last

multidisciplinary medication review occurred no more than 1 year ago

Feedback from care home residents that they feel involved in their medication

reviews.

How is it achieved?

Define process for prompting a medication review

Agreement from GPs as to when and where medication reviews will be conducted –

GP clinic in the home?

Liaise with CCG regarding single GP Model for care home

Prioritisation of residents for review e.g. multiple meds, chronic conditions, risk of fall

Multidisciplinary approach using other health professionals, families and residents

Utilise administration and clinical data to understand holistic view of resident

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Statement 7. Care homes have a documented process for the covert

administration of medicines for adult residents

How it measured?

Evidence of a written process for the covert administration of medicines to adult

residents in care homes

How is it achieved?

Agree criteria that trigger an assessment

Adopt a multidisciplinary approach including family/ advocate

How is success measured and what is the review period?

Liaison from pharmacy and local drug Information service to assess medication

formulation suitability

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Summary Recommendations

Have an accountable person for maintaining, updating and reviewing policies and procedures that cover each Quality Standard

Have a process for checking staff competency – new starters and ongoing

Have a process for evidencing actions and assessing outcomes of Quality Standards

Review role of software solutions for medication data capture, management information, training and competency assessments, auditing and task management

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NICE Resources

www.nice.org.uk/guidance/sc1/resources

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NICE Pathways

http://pathways.nice.org.uk/pathways/managing-medicines-in-care-homes

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What next?

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Inspected Care Home Ratings and % Achieving NICE Standards

CQC % Achieving NICE Standards