The CQC has made five recommendations to improve medicines practice in care homes.
In a new report sharing the learning from risks and good practice in medicines arising from inspections, the regulator for England advises the following:
- Follow best practice guidance, specifically NICE guidance for managing medicines in care homes (SC1) and in the community (NG67)
- Have an attached or named pharmacist to support staff with aspects such as administering medicines covertly, ‘when required’ (PRN) medicines, and those required as part of end of life care. Train staff and assess their competency in handling and administering medicines. It should be clear who is responsible for training staff about medicines and that this training is kept up to date
- There should be clear clinical responsibility for, and oversight of medicines.
- Nursing associates should be deployed safely and effectively, with the appropriate competencies and supervision when their work involves medicines
- Adopt NHS England initiatives such as Enhanced Health in Care Homes and Medicines Optimisation in Care Homes.
In the report the CQC highlights that as well as errors with administration and ‘when required’ medicines, incidents included intentional overdose by individuals, and errors linked to supplies from the pharmacy or doctor.
Incorrect doses are the most commonly-reported error in statutory notifications from adult social care services. This sometimes happened when members of staff did not check the medicines administration record (MAR) chart before administering the medicine, original doses not signed as being administered on the MAR chart, and missed doses, caused by changes in the timing of medicines rounds, incomplete MAR charts, staff forgetting to administer or order medicines in a timely way.
Staffing levels were also found to affect the timing of medicine administration, and distractions for administration errors. Transdermal patches are a particular area of concern, as patches can be doubled-up, missed off or changed at incorrect intervals.
Other issues include:
- Record keeping: Handwritten MAR charts are particularly prone to errors or omissions. PRN medication (see below) record-keeping is particularly problematic
- ‘When required’ (PRN) medicines – such as pain relief, or asthma reliever inhalers. Staff in adult social care services did not always have enough information to administer correctly. ensure they were able to support people with PRN medicines. Records did not always show what actions were taken before using PRN medicines, which should not be used as a first line option.
- Storage and disposal of medicines: Problems include unattended trolleys unattended and medicines being stored in accessible or unsuitable (temperature) locations
- Covert administration and mental capacity: Mental capacity and best interest assessments were not always carried out
- Staff training: lack of competency assessments or regular competency checks
- Policy, procedures and audit: Out of date policies and ineffective systems to monitor quality and drive improvement
- Self-administration of medicines: A considerable number of statutory notifications relate to intentional overdose (especially young adults with a mental health condition)
- Transfer of care: Problems include: Missing or unexpected medicines following discharge, misinterpreted instructions, and missed actions.