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NICE issues guidance on drugs in care homes

Care home residents should have the same involvement in decisions about their treatment as patients living in their own home, according to latest guidance.

The National Institute for Health and Care Excellence has published guidance for those involved in handling, prescribing and other decision-making about medicines for care home residents.

NICE noted that evidence suggested drug errors were commonplace. It cited one study that found over 90% of 345 residents were exposed to at least one potential error over three months.

The institute said the “starting point” for its guideline was that residents should have the same involvement in decisions about their care and treatment – and have the right to access appropriate services and support – as other patients.

“Good communication is a strong theme throughout this guideline”

Alaster Rutherford

Prescribers should assume care home residents are able to make decisions about their own medicines, it said, but should check if they are concerned.

NICE also said care homes should have a written policy on medicines, stating for example how staff should keep records, deal with mistakes, and review and accurately list the drugs residents are taking.

Alaster Rutherford, chair of the NICE guideline development group, said: “Good communication is a strong theme throughout this guideline, whether through the active participation of residents, record-keeping or when care transfers between settings.”

The guideline also covers the processes for storing and disposing of medicines, their administration by care home staff – including covertly – and treating minor ailments with non-prescription drugs, such as paracetamol, for headaches or indigestion.

“The sheer volume of medicines is a big problem to most care homes”

Ian Turner

Ian Turner, chair of the Registered Nursing Home Association and member of the guideline development group, said: “The key is cracking the medicines review process. The sheer volume of medicines is a big problem to most care homes.

“Currently we are still moving towards understanding how often residents should have their medicines reviewed and what that review should involve,” he said. “This guideline will be extremely helpful in providing clarity around this issue, and in ensuring that medicines reviews are meaningful to everybody.”

 

Readers' comments (14)

  • Tiger Girl

    Pity that NICE has to point out the obvious!:

    The institute said the “starting point” for its guideline was that residents should have the same involvement in decisions about their care and treatment – and have the right to access appropriate services and support – as other patients.

    Prescribers should assume care home residents are able to make decisions about their own medicines, it said, but should check if they are concerned.

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  • michael stone

    Re Tiger Girls comment about ‘decision making’ as explained by NICE: see the Mental Capacity Act section 1(2) and section 3 – this isn’t by any means ‘rocket science’ ! Before you administer anything to mentally-capable patients, you are supposed to get their [informed] consent (and that goes for pain relief and sedation, as well).

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  • Far too much and increasing amounts of often unnecessary medications and supplements prescribed by an often self-interested medical profession acting on behalf of a definitely self interested drug industry. The latest nonsense being the "prescribing" of food supplements which the nurse therefore has to "administer". Nurses have become virtual full time "medication practitioners" with any extra time given to pseudo academic office bound care planning whilst constantly back-watching with little time for actual basic nursing any more.

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  • PS
    A good wholesome diet with time spent competently aiding feeding rather than setting up PEG pumps, assistance with a little exercise and moreover time to spend exercising a little of that compassion we read about somewhere during our extended studies that is apparently so important during the final stages of life.

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  • Anonymous | 17-Mar-2014 4:05 pm

    what are you talking about?

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  • tinkerbell

    Agree folk in care homes should be able to make decisions wherever possible. What about someone severely cognitively impaired who lacks capacity to make a decision about an antibiotic, do we continue to allow it to rage whilst we hold a capacity meeting?

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  • tinkerbell

    on 13 March whilst attending a meeting at one of the care homes I saw the Daily Mail headline that people are being put in care homes against their wishes. A high court judge was asked to make a decision on capacity regarding whether the person needed to be in care. He said that whilst trying to make this decision he 'felt as though he had been through a washing machine and the spinner'. How human of him to be so honest, it is a minefield.

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  • Anonymous | 17-Mar-2014 5:25 pm

    No.... what are YOU talking about?!

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  • In my experience (of several care homes over the years) nurses and care staff are so conscious of litigation and investigation that every twinge felt by a resident is thought to be life threatening, people end up being seen by umpteen care professionals and ending up with medication that just isn't necessary. The resident then feels that they must need them because the Dr prescribed them. God forbid that they decide they don't want them! Nurses try to talk people into taking them as if they don't then completion of paperwork explaining why they have not been administered is mandatory! Nurses are made to feel like they have failed in this instance. If the person was at home no one would make them take their medication if they didn't want to. Drug rounds in homes are far too long due to over prescribing of medication. Sorry for rambling.

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  • michael stone

    tinkerbell | 17-Mar-2014 5:44 pm

    ' What about someone severely cognitively impaired who lacks capacity to make a decision about an antibiotic, do we continue to allow it to rage whilst we hold a capacity meeting?'

    This is exactly the type of decision, which should have been thought about in advance if at all possible. If it is something which hadn't been thought about, ideally very rapid discussion of 'best interests' between the people who should be involved (which almost always isn't just the clinicians) would take place, but failing that being possible giving the antibiotics will I feel be the default (because in situations where a new infection would 'not be treated as the best interests decision' the overall situation is such that this should have been discussed earlier).

    Mental Incapacity combined with 'emergencies' is a very trick area.

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  • michael stone

    'very tricky area'.

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  • tinkerbell

    there isn't a team ready to jump out of the woodwork for a best interest meeting in medical emergencies, it is difficult to get a gp, lack of district nurses, to visit most care homes, let alone a social worker, a family member (if they have one) a mental health practitioner, uncle tom cobbly an all for best interests or mental capacity. That's the reality. Most people also of this particular age group do not have advanced directives either. I have yet to meet one and I cover at least 16 care homes in my catchment area which consists of over 90 (and growing) clients on my caseload.

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  • michael stone

    tinkerbell | 18-Mar-2014 5:53 pm

    There are some serious problems with Advance Decisions and with Welfare Attorneys (which most clinicians insist on wrongly describing as 'LPAs') and it seems that many of those issues, would be rapidly resolved if ADRTs and WAs were much more common.

    But the 'antibiotics one' isn't all that tricky - does giving the antibiotics reduce suffering ? If someone 'wants to die if I'm actively dying' (my phrase) and an untreated chest infection would kill him overnight, then not treating him lets him die as he wishes to - by contrast, curing the ches tinfection, might lead to weeks, months or years longer of 'the life the patient has tried to refuse'.

    But if the infection is not life threatening, but if left untreated would cause more disabilty or pain, then why would any normal person object to, as opposed to requesting, the antibiotics ?

    Paramedics have got awful 'conceptual issues' with advance decisions that refuse treatments, for conditions where it isn't immediately obvious if the condition is 'life-threatening' - it all a mess of confusion and misunderstanding !

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  • Elderly people dont want to take medication-not because they want to die but get a bit confused,if only at odd times. Sometimes a little diversion therapy, though time consuming, can mean that the client will take the medication without thinking. I agree a lot of medication is prescribed unnecessarily, just to keep care home STAFF comfortable, in that they wont think they are neglecting or ignoring some minor complaint that would probably have gone the next day anyway. After all, they are not trained nurses but are people who want the best for the people in their care and dont want to miss something that MIGHT turn into something nasty. Experienced carers and those who know the client well, know when the medication is really needed and whether a missed dose will matter too much, if the client gets too aggressive about taking it. There are Carers and carers!

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