Care homes’ safe access and use of medicines: guidance, templates and flowcharts

In May 2020, NHS England and NHS Improvement set out four key areas outlining the urgent clinical pharmacy and medicines optimisation support needed in care homes: 1

- Clinical review of priority residents- Timely supply of medication- Medication information and queries from care home staff- Structured Medication Reviews

This pack was developed by cross-sector Pharmacy Leaders and other health and social care disciplines in the Northwest Region of England. It focusses on facilitating care home residents’ timely receipt of medicines. As other guidance is ratified, the pack is likely to expand. However, as of 16 May 2020, it contains guidance, templates and flowcharts for:

1. Medication acquisition for Covid19 symptom control – including end of life – in care homes with nursing and hospices

2. Medication acquisition for Covid19 symptom control – including end of life – in care homes without nursing

3. Bulk Prescribing for Care Homes 4. Homely Remedy guidance for care homes during C19 Pandemic 5. Reuse of medicines in northwest region care homes during C19 Pandemic

Documents can be accessed by either clicking on the icons for word versions, or the hyperlinked titles for pdfs.

Organisations are welcome to use and adapt the materials, and references to acknowledge authors and sources are included below.

1 https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/COVID-19-response-primary-care-and-community-health-support-care-home-residents.pdfV1.1 Care homes’ safe access and use of medicines: guidance, templates and flowcharts

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1. Medication acquisition for Covid19 symptom control in care homes with nursing and hospices: guidance and templates

- Audience: commissioners, providers, medicines management teams, hospice and care home staff to adapt for their settings

- Aim: to support safe and timely treatment for those presenting with common COVID-19 related symptoms including those at end of life.

- Contents include:

- Priority methods of obtaining medicines

- Standard Operating Procedures for obtaining medicines rapidly in-hours and out of hours

- Requisitioning Prescription Only Medicines (POMs) and Controlled Drugs (CDs)

- Risk Assessment for the Management of Controlled Drugs (CDs)

- Palliative Care Drugs – Quantities to be ordered by care homes and hospices when first case of COVID-19 presents

- Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. Medication acquisition for Covid19 symptom control in care homes with nursing and hospices: guidance and templates; Northwest Region, England. May 2020.

2. Medication acquisition for Covid19 symptom control in care homes without nursing: guidance and templates

- Audience: commissioners, providers, medicines management teams, care home staff to adapt for their settings

- Aim: to support safe and timely treatment for those presenting with common COVID-19 related symptoms including those at end of life.

- Contents include:

- Priority methods of obtaining medicines

- Flowcharts for

- Ordering Prescription only Medicines (POMs) via Prescription: In Hours and Out of hours

- Ordering medication for resident demonstrating COVID-19 symptoms and deteriorating: Out of Hours

- Repurposing of medication for service user demonstrating COVID-19 symptoms and rapidly deteriorating: In Hours

- Reference: Midland and Lancashire Commissioning Support Unit, Medicines Optimisation Team. Medication acquisition for Covid19 symptom control in care homes without nursing: guidance and templates; Northwest Region, England. May 2020.

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3. Bulk Prescribing for Care Homes: A Guide for Care Home Teams - Audience: care home teams, prescribers, medicines management

teams

- Aim: to support safe and timely treatment for those needing repeat medicines used on a “when needed” (PRN) basis; and to reduce the need for care homes to store many boxes/bottles of the same “prn” medicines.

- Contents include:

- Medicines and products suitable and unsuitable for bulk prescribing

- Sample prescription (green FP10) for bulk prescribing in a care home

- Flowcharts on ordering, receiving, storing, record-keeping and auditing

- Roles and responsibilities for care homes, prescribers and pharmacies

- Template letters

- Reference: Midland and Lancashire Commissioning Support Unit Medicines Optimisation Team. Bulk Prescribing for Care Homes: A Guide for Care Home Teams; Northwest Region, England. May 2020.

4. Homely remedies in care homes during Covid19 pandemic: guidance

- Audience: commissioners, providers, medicines management teams, hospice and care home staff to adapt for their settings

- Aim: to support the acquisition and administration of homely remedies in residents with COVID-19 symptoms, such as:

o Fever

o Cough

o Constipation (a common side-effect of some of the medications that may be used in service users with COVID-19 e.g. cough suppressants)

- A homely remedy is a medicine that is normally available at home for the short-term management of a minor condition (e.g. paracetamol). These can be purchased from a community pharmacy or local shop. A prescription is not required for these medicines, however, given the potential seriousness of Covid19, clinical advice should be sought and documented.

- Contents include:

- Care home Homely Remedy Guidance for use during COVID-19

- Example Homely Remedies Authorisation Sheet

- Example Homely Remedies Staff Signature Sheet

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- Example Homely Remedies Record Sheet

- Supporting Information for Homely Remedies

- Standard operating procedures for obtaining Homely Remedy medicines

- Reference: Midland and Lancashire Commissioning Support Unit, Medicines Optimisation Team. Homely remedies in care homes during Covid19 pandemic; Northwest Region, England. May 2020.

5. Reuse of Medicines in Care Homes During the COVID-19 Pandemic - Audience: carers, care home nurses, GP practice staff, community

pharmacy staff, community service nursing teams and medicines management teams (i.e. all staff involved in the medicine reuse process)

- Aim: to provide health and social care professionals working in, or supporting, care homes across the North West with practical guidance on the reuse of medicines in crisis situation where no medicine is available for a resident within the timeframe required.

- Reuse of medicines is the term used to describe a situation where medicine that was originally bought or prescribed for one resident is used by a different resident.

- Contents include:

- Definitions and criteria for reuse

- Seeking permission, information leaflets and templates for documentation

- Risk assessments and documentation

- Storage, administration and documentation logs

- Standard operating procedures and flowcharts

- Roles and responsibilities

- Sample patient specific direction

- Reference: Swift A, Trumper Z. Safe Reuse of Medicines in Care Homes During the COVID-19 Pandemic; Wigan, England. May 2020.

Author – Devina Halsall V1.0 – 17 May 2020

Agreed by NW Region Medicines and Pharmacy Cell – 18 May 2020

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